![]() ![]() ![]() Thirty-three percent of the patients were "complete PEEP-absorbers." Multiple logistic regression was used to predict the behavior of "complete PEEP-absorber." The best model included a respiratory rate lower than 20 breaths/min and the presence of flow limitation. The mean total PEEP was 7 ± 2 cmH2O at ZEEP and 9 ± 2 cmH2O after the application of PEEP (p < 0.001). All measurements were repeated three times, and the average value was used for analysis.įorty-seven percent of the patients suffered from chronic pulmonary disease and 52 % from acute pulmonary disease 61 % showed flow limitation at ZEEP, assessed by manual compression of the abdomen. Total PEEP (i.e., end-expiratory plateau pressure) was measured both at ZEEP and after applied PEEP equal to 80 % of auto-PEEP measured at ZEEP. One hundred patients with auto-PEEP of at least 5 cmH2O at zero end-expiratory pressure (ZEEP) during controlled mechanical ventilation were enrolled. This study aimed to empirically assess the extent to which flow limitation alone explains a "complete PEEP-absorber" behavior (i.e., absence of further hyperinflation with PEEP), and to identify other factors associated with it. From a pathophysiological perspective, all subjects with flow limitation are expected to be "complete PEEP-absorbers," whereas PEEP should increase total PEEP in all other patients. We refer to these patients as "complete PEEP-absorbers." Conversely, adverse effects of PEEP application could occur in patients with auto-PEEP when the total PEEP rises as a consequence. In some patients with auto-positive end-expiratory pressure (auto-PEEP), application of PEEP lower than auto-PEEP maintains a constant total PEEP, therefore reducing the inspiratory threshold load without detrimental cardiovascular or respiratory effects. 13 Respiratory Epidemiology, Occupational Medicine and Public Health, Imperial College, London, UK.12 Department of Anesthesia and Intensive Care, Cardarelli Hospital, Naples, Italy.11 Department of Anesthesia, Critical Care Medicine and Emergency, University of Brescia at Spedali Civili, Brescia, Italy.10 Department of Anesthesia and Intensive Care, Mellino Mellini Hospital, Chiari, Italy.9 Department of Anesthesia and Intensive Care, Cattinara Hospital, Trieste, Italy.8 Department of Anesthesia and Intensive Care, Santa Maria degli Angeli Hospital, Pordenone, Italy.7 Department of Anesthesia and Intensive Care, Agnelli Hospital, Pinerolo, Italy.6 Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Naples, Italy.5 Department of Anesthesia and Intensive Care, Misericordia Hospital, Grosseto, Italy.4 Department of Anesthesia and Intensive Care, SS.3 Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, Brescia, Italy.2 Department of Anesthesia and Intensive Care, Spedali Civili Hospital, Brescia, Italy. 1 Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, Brescia, Italy. ![]()
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