uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Maximal hysteresis: a new method to set positive end-expiratory pressure in acute lung injury?
Show others and affiliations
2008 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 5, 641-649 p.Article in journal (Refereed) Published
Abstract [en]

Background: No methods are superior when setting positive end-expiratory pressure (PEEP) in acute lung injury (ALI). In ALI, the vertical distance (hysteresis) between the inspiratory and expiratory limbs of a static pressure–volume (PV) loop mainly indicates lung recruitment. We hypothesized that PEEP set at the pressure where hysteresis is 90% of its maximum (90%MH) would give similar oxygenation, but less cardiovascular depression than PEEP set at the pressure at lower inflection point (LIP) on the inspiratory limb or at the point of maximal curvature (PMC) on the expiratory limb in ALI.

Methods: In 12 mechanically ventilated pigs, ALI was induced in a randomized fashion by lung lavage, lung lavage plus injurious ventilation, or by oleic acid. From a static PV loop obtained by an interrupted low-flow method, the pressures at LIP [25 (25, 25) cmH2O, mean and 25, 75 percentiles], at PMC [24 (20, 24) cmH2O], and at 90% MH [19 (18, 19) cmH2O] were determined and used for the PEEP-settings. We measured lung inflation (by computed tomography), end-expiratory lung volume (EELV), airway pressures, compliance of the respiratory system (Crs), blood gases, cardiac output and arterial blood pressure.

Results: There were no differences between the PEEP settings in EELV or oxygenation, but the 90%MH setting gave lower end-inspiratory pause pressure (P<0.025), higher Crs (P<0.025), less hyper-aeration (P<0.025) and better maintained hemodynamics.

Conclusion: In this porcine lung injury model, PEEP set at 90% MH gave better lung mechanics and hemodynamics, than PEEP set at PMC or LIP.

Place, publisher, year, edition, pages
2008. Vol. 52, no 5, 641-649 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-148234DOI: 10.1111/j.1399-6576.2008.01600.xPubMedID: 18419718OAI: oai:DiVA.org:uu-148234DiVA: diva2:401593
Available from: 2011-03-03 Created: 2011-03-03 Last updated: 2011-11-25Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed
By organisation
Anaesthesiology and Intensive Care
In the same journal
Acta Anaesthesiologica Scandinavica
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 175 hits
ReferencesLink to record
Permanent link

Direct link