Anesthesiology
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To determine the effects of a step change in end-expiratory pressure on functional residual capacity (FRC) and lung-thorax compliance (CLT), 10 cm H2O positive end-expiratory pressure (PEEP) was applied in eight patients who needed mechanical ventilation for acute pulmonary failure. Of the total change in FRC, 66 +/- 5.3 per cent (mean +/- SEM) was complete within the next breath, and 90 per cent change was achieved in 4.6 +/- 1.4 breaths (24 +/- 6.4 sec). There was no statistically significant difference between times to 90 per cent FRC change with application and with removal of PEEP. ⋯ These data define a time-dependent increase in lung volume that resembles pressure-volume hysteresis in normal man. Possible mechanisms include surface tension changes, recruitment of nonventilated lung, and stress relaxation of lung and chest wall. This study may explain the greater efficiency of PEEP compared with large tidal-volume ventilation in increasing PaO2 in patients with acute pulmonary failure.