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Functional residual capacity as a noninvasive indicator of optimal positive end-expiratory pressure. 1988

T D East, and J C in't Veen, and N L Pace, and S McJames
Department of Anesthesiology, University of Utah Medical Center, Salt Lake City 84132.

We hypothesized that functional residual capacity (FRC) could be used as a noninvasive indicator of "optimal" positive end-expiratory pressure (PEEP), the level of PEEP that results in venous admixture below 15% with an inspired oxygen fraction less than 0.5. We compared several variables for PEEP optimization--oxygen transport, total respiratory system compliance, FRC-based compliance, mixed venous oxygen saturation, end-tidal to arterial carbon dioxide tension difference, and arterial oxygen saturation--by producing four different PEEP levels, 0, 5, 10 and 15 cm H2O, in 24 mongrel dogs in which pulmonary injury was produced. The data were regressed versus PEEP by using analysis of variance for regression. Venous admixture (F1,23 = 149.3; P less than 0.0001), end-tidal to arterial carbon dioxide tension difference (F1,23 = 64.9; P less than 0.0001), and oxygen transport (F1,23 = 95.1; P less than 0.0001) decreased linearly with PEEP. FRC (F1,23 = 248.1; P less than 0.0001) and arterial oxygen saturation (F1,23 = 66.9; P less than 0.0001) increased linearly with PEEP. Total respiratory system compliance (F1,23 = 66.6; P less than 0.0001) and mixed venous oxygen saturation (F1,23 = 12.2; P less than 0.002) had a quadratic relationship with respect to PEEP with a peak at 5 cm H2O. FRC-based compliance did not have a significant relationship to PEEP. The maximum values of total respiratory system compliance, FRC-based compliance, mixed venous oxygen saturation, and oxygen transport did not occur at PEEP levels that corresponded to a venous admixture below 15% ("optimal" PEEP).(ABSTRACT TRUNCATED AT 250 WORDS)

UI MeSH Term Description Entries
D008170 Lung Compliance The capability of the LUNGS to distend under pressure as measured by pulmonary volume change per unit pressure change. While not a complete description of the pressure-volume properties of the lung, it is nevertheless useful in practice as a measure of the comparative stiffness of the lung. (From Best & Taylor's Physiological Basis of Medical Practice, 12th ed, p562) Compliance, Lung,Compliances, Lung,Lung Compliances
D008176 Lung Volume Measurements Measurement of the amount of air that the lungs may contain at various points in the respiratory cycle. Lung Capacities,Lung Volumes,Capacity, Lung,Lung Capacity,Lung Volume,Lung Volume Measurement,Measurement, Lung Volume,Volume, Lung
D009829 Oleic Acids A group of fatty acids that contain 18 carbon atoms and a double bond at the omega 9 carbon. Octadecenoic Acids,Acids, Octadecenoic,Acids, Oleic
D010100 Oxygen An element with atomic symbol O, atomic number 8, and atomic weight [15.99903; 15.99977]. It is the most abundant element on earth and essential for respiration. Dioxygen,Oxygen-16,Oxygen 16
D011175 Positive-Pressure Respiration A method of mechanical ventilation in which pressure is maintained to increase the volume of gas remaining in the lungs at the end of expiration, thus reducing the shunting of blood through the lungs and improving gas exchange. Positive End-Expiratory Pressure,Positive-Pressure Ventilation,End-Expiratory Pressure, Positive,End-Expiratory Pressures, Positive,Positive End Expiratory Pressure,Positive End-Expiratory Pressures,Positive Pressure Respiration,Positive Pressure Ventilation,Positive-Pressure Respirations,Positive-Pressure Ventilations,Pressure, Positive End-Expiratory,Pressures, Positive End-Expiratory,Respiration, Positive-Pressure,Respirations, Positive-Pressure,Ventilation, Positive-Pressure,Ventilations, Positive-Pressure
D012044 Regression Analysis Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see LINEAR MODELS) the relationship is constrained to be a straight line and LEAST-SQUARES ANALYSIS is used to determine the best fit. In logistic regression (see LOGISTIC MODELS) the dependent variable is qualitative rather than continuously variable and LIKELIHOOD FUNCTIONS are used to find the best relationship. In multiple regression, the dependent variable is considered to depend on more than a single independent variable. Regression Diagnostics,Statistical Regression,Analysis, Regression,Analyses, Regression,Diagnostics, Regression,Regression Analyses,Regression, Statistical,Regressions, Statistical,Statistical Regressions
D012128 Respiratory Distress Syndrome A syndrome characterized by progressive life-threatening RESPIRATORY INSUFFICIENCY in the absence of known LUNG DISEASES, usually following a systemic insult such as surgery or major TRAUMA. ARDS, Human,Acute Respiratory Distress Syndrome,Adult Respiratory Distress Syndrome,Pediatric Respiratory Distress Syndrome,Respiratory Distress Syndrome, Acute,Respiratory Distress Syndrome, Adult,Respiratory Distress Syndrome, Pediatric,Shock Lung,Distress Syndrome, Respiratory,Distress Syndromes, Respiratory,Human ARDS,Lung, Shock,Respiratory Distress Syndromes,Syndrome, Respiratory Distress
D002245 Carbon Dioxide A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. Carbonic Anhydride,Anhydride, Carbonic,Dioxide, Carbon
D004285 Dogs The domestic dog, Canis familiaris, comprising about 400 breeds, of the carnivore family CANIDAE. They are worldwide in distribution and live in association with people. (Walker's Mammals of the World, 5th ed, p1065) Canis familiaris,Dog
D005652 Functional Residual Capacity The volume of air remaining in the LUNGS at the end of a normal, quiet expiration. It is the sum of the RESIDUAL VOLUME and the EXPIRATORY RESERVE VOLUME. Common abbreviation is FRC. Capacities, Functional Residual,Capacity, Functional Residual,Functional Residual Capacities,Residual Capacities, Functional,Residual Capacity, Functional

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