Positive pressure ventilation: what is the real cost?

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Positive pressure ventilation: what is the real cost? N. Soni, P. Williams British Journal of Anaesthesia Volume 101, Issue 4, Pages 446-457 (October 2008) DOI: 10.1093/bja/aen240 Copyright © 2008 British Journal of Anaesthesia Terms and Conditions

Fig 1 Monitoring oxygenation. Based on arterial values which correlate poorly with adequacy of tissue oxygenation. British Journal of Anaesthesia 2008 101, 446-457DOI: (10.1093/bja/aen240) Copyright © 2008 British Journal of Anaesthesia Terms and Conditions

Fig 2 Alveolar inflation. (a) Represents the beginning of inspiration. Pressure P acts on a consolidated alveolus, a normal alveolus and a distended alveolus. (b) End inspiration. Pressure P produces a broad spectrum of effects. British Journal of Anaesthesia 2008 101, 446-457DOI: (10.1093/bja/aen240) Copyright © 2008 British Journal of Anaesthesia Terms and Conditions

Fig 3 Pressure–volume curve and the effects on alveoli. British Journal of Anaesthesia 2008 101, 446-457DOI: (10.1093/bja/aen240) Copyright © 2008 British Journal of Anaesthesia Terms and Conditions

Fig 4 Airway pressure and the lymphatics. Peak flow at a pressure of 4 mm Hg. Airway pressure of 15 mm Hg or higher compresses thin-walled collapsible lymphatics. The lymphatics drain into the central veins characterized by the superior vena cava (SVC). If the SVC pressure is high, 12 mm Hg in this example, drainage will be impeded. Hence both airway pressures and venous pressures will potentially impede drainage. British Journal of Anaesthesia 2008 101, 446-457DOI: (10.1093/bja/aen240) Copyright © 2008 British Journal of Anaesthesia Terms and Conditions

Fig 5 Flow diagram illustrating the physiological interactions of positive pressure ventilation. (a) leads to (b) leads to (c) British Journal of Anaesthesia 2008 101, 446-457DOI: (10.1093/bja/aen240) Copyright © 2008 British Journal of Anaesthesia Terms and Conditions