Biomaterial Database

Titration of PEEP by the arterial minus end-tidal carbon dioxide gradient. 1984

I P Murray, and J H Modell, and T J Gallagher, and M J Banner

It was shown in dogs that intrapulmonary physiologic shunt (Qsp/Qt), arterial oxygen tension (PaO2), total static respiratory compliance (CT), oxygen delivery (O2AV), cardiac output (Qt), and arterial minus end-tidal carbon dioxide gradient (PaCO2-PetCO2) undergo statistically significant deterioration when oleic acid is injected into the pulmonary artery. Positive end-expiratory pressure (PEEP) therapy reduced Qsp/Qt and PaCO2-PetCO2 gradient and increased PaO2. The CT did not show any consistent pattern of improvement with the application of PEEP. The Qt and the O2AV progressively decreased as PEEP was increased. The application of additional PEEP beyond that which minimized the PaCO2-PetCO2 gradient produced a statistically significant increase in the PaCO2-PetCO2 gradient, but this was not reflected by concomitant changes in Qsp/Qt or PaO2 in spite of a further decrease in Qt. Thus, the PaCO2-PetCO2 gradient may be a more sensitive indicator of excessive PEEP than is Qst/Qt or PaO2, since it should be smallest when there is maximal recruitment of perfused or functional gas units without overdistention of alveolar areas contributing to dead space. Also, the use of the PaCO2-PetCO2 gradient permits the rapid titration of PEEP without the need for a pulmonary artery catheter.

UI	MeSH Term	Description	Entries
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
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
D011659	Pulmonary Gas Exchange	The exchange of OXYGEN and CARBON DIOXIDE between alveolar air and pulmonary capillary blood that occurs across the BLOOD-AIR BARRIER.	Exchange, Pulmonary Gas,Gas Exchange, Pulmonary
D012126	Respiratory Dead Space	That part of the RESPIRATORY TRACT or the air within the respiratory tract that does not exchange OXYGEN and CARBON DIOXIDE with pulmonary capillary blood.	Dead Space, Respiratory,Dead Spaces, Respiratory,Respiratory Dead Spaces,Space, Respiratory Dead,Spaces, Respiratory Dead
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
D002302	Cardiac Output	The volume of BLOOD passing through the HEART per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with STROKE VOLUME (volume per beat).	Cardiac Outputs,Output, Cardiac,Outputs, Cardiac
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
D000818	Animals	Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA.	Animal,Metazoa,Animalia
D019301	Oleic Acid	An unsaturated fatty acid that is the most widely distributed and abundant fatty acid in nature. It is used commercially in the preparation of oleates and lotions, and as a pharmaceutical solvent. (Stedman, 26th ed)	9-Octadecenoic Acid,Oleate,cis-9-Octadecenoic Acid,9 Octadecenoic Acid,cis 9 Octadecenoic Acid