Detection of optimal PEEP for equal distribution of tidal volume by volumetric capnography and electrical impedance tomography during decreasing levels.

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Date of download: 5/30/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Mechanical Breath Profile of Airway Pressure Release.

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Detection of optimal PEEP for equal distribution of tidal volume by volumetric capnography and electrical impedance tomography during decreasing levels of PEEP in post cardiac-surgery patients P Blankman, A Shono, B.J.M. Hermans, T Wesselius, D Hasan, D Gommers British Journal of Anaesthesia Volume 116, Issue 6, Pages 862-869 (June 2016) DOI: 10.1093/bja/aew116 Copyright © 2016 The Author(s) Terms and Conditions

Fig 1 Schematic model of three phases of the expiration. The Vcap curve is divided in three phases. Phase I represents exhaled CO2 from the airways, whereas phase III represents exhaled CO2 from the alveoli. Phase II is a mixed phase with CO2 from both the airways and alveoli. Point A is the inflection point of phase II, which is the theoretical point where the airway compartment is separated from the alveolar compartment. VDaw, airway dead space, Vtalv, alveolar tidal volume, Vt, tidal volume. British Journal of Anaesthesia 2016 116, 862-869DOI: (10.1093/bja/aew116) Copyright © 2016 The Author(s) Terms and Conditions

Fig 2 Tidal Impedance Variation at different PEEP levels. Data are shown as mean (sd). In the dependent lung region the ventilation distribution was decreased when PEEP was lowered, whereas the non-dependent region received more ventilation as compared with PEEP 14 cm H2O. * Indicates a significant reduction in TIV of the non-dependent region according to 6 cm H2O. † Indicates a significant reduction in TIV of the dependent region as compared with 12 cm H2O. Dashed lines represents the interpolation lines; open circles+non-dependent region; solid circles+dependent region. P<0.05 was considered significant. British Journal of Anaesthesia 2016 116, 862-869DOI: (10.1093/bja/aew116) Copyright © 2016 The Author(s) Terms and Conditions

Fig 3 Mean intratidal gas distribution (ITV) curve of all the patients at each PEEP step. Data are shown as mean (sd). ITV curve represents the mean percentile contribution (%) of ventilation distribution in non-dependent and dependent lung regions during the entire inspiration. At PEEP 12 and 10 cm H2O, intratidal gas distribution curves stayed close to each other, showing equal distribution to both regions. Dashed lines represents the interpolation lines; open circles+non-dependent region; solid circles+dependent region. British Journal of Anaesthesia 2016 116, 862-869DOI: (10.1093/bja/aew116) Copyright © 2016 The Author(s) Terms and Conditions

Fig 4 Effect of increased PEEP on the Vcap curve. Figure 4 demonstrates the effect of two PEEP levels on the Vcap curve. As a result of the PEEP application the Vcap curve shifts to the right, indicating an increase in airway dead space. PeCO2 + Expiratory carbondioxide pressure; Vcap + volumetric capnography. British Journal of Anaesthesia 2016 116, 862-869DOI: (10.1093/bja/aew116) Copyright © 2016 The Author(s) Terms and Conditions