https://www.journalmechanicalventilation.com/the-pressure-volume-curve-how-to-set-peep/

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Andro Youakim ◽  
ehab daoud
Keyword(s):  
Tidal Volume ◽  
Airway Pressure ◽  
Inflection Point ◽  
Vertical Axis ◽  
Horizontal Axis ◽  
Lower Inflection Point ◽  
Maximum Curvature ◽  
Volume Curve ◽  
Pressure Volume Curve

Figure 1: Pressure-Volume curve. Horizontal axis is airway pressure in cmH2O, vertical axis is resultant tidal volume in ml. LIP: Lower inflection point, HIP: high or upper inflection point, PMC: point of maximum curvature or expiratory inflection point.

Set Positive End-expiratory Pressure during Protective Ventilation Affects Lung Injury

2002 ◽  
Vol 97 (3) ◽  
pp. 682-692 ◽  
Author(s):  
Muneyuki Takeuchi ◽  
Sven Goddon ◽  
Marisa Dolhnikoff ◽  
Motomu Shimaoka ◽  
Dean Hess ◽  
...  
Keyword(s):  
Inflection Point ◽  
Peep Level ◽  
Arterial Oxygen ◽  
Positive End Expiratory Pressure ◽  
Lower Inflection Point ◽  
Arterial Oxygen Partial Pressure ◽  
Volume Curve ◽  
Pressure Volume Curve ◽  
Fraction Of Inspired Oxygen ◽  
Inspired Oxygen

Background The most appropriate method of determining positive end-expiratory pressure (PEEP) level during a lung protective ventilatory strategy has not been established. Methods In a lavage-injured sheep acute respiratory distress syndrome model, the authors compared the effects of three approaches to determining PEEP level after a recruitment maneuver: (1) 2 cm H(2)O above the lower inflection point on the inflation pressure-volume curve, (2) at the point of maximum curvature on the deflation pressure-volume curve, and (3) at the PEEP level that maintained target arterial oxygen partial pressure at a fraction of inspired oxygen of 0.5. Results Positive end-expiratory pressure set 2 cm H(2)O above the lower inflection point resulted in the least injury over the course of the study. PEEP based on adequate arterial oxygen partial pressure/fraction of inspired oxygen ratios had to be increased over time and resulted in higher mRNA levels for interleukin-8 and interleukin-1beta and greater tissue inflammation when compared with the other approaches. PEEP at the point of maximum curvature could not maintain eucapneia even at an increased ventilatory rate. Conclusion Although generating higher plateau pressures, PEEP levels based on pressure-volume curve analysis were more effective in maintaining gas exchange and minimizing injury than PEEP based on adequate oxygenation. PEEP at 2 cm H(2)O above the lower inflection point was most effective.

Alveolar Recruitment in Pulmonary and Extrapulmonary Acute Respiratory Distress Syndrome

2007 ◽  
Vol 106 (2) ◽  
pp. 212-217 ◽  
Author(s):  
Arnaud W. Thille ◽  
Jean-Christophe M. Richard ◽  
Salvatore M. Maggiore ◽  
V Marco Ranieri ◽  
Laurent Brochard
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Tidal Volume ◽  
Distress Syndrome ◽  
Alveolar Recruitment ◽  
High Peep ◽  
Static Compliance ◽  
Volume Curve ◽  
Pressure Volume Curve

Background Alveolar recruitment in response to positive end-expiratory pressure (PEEP) may differ between pulmonary and extrapulmonary acute respiratory distress syndrome (ARDS), and alveolar recruitment values may differ when measured by pressure-volume curve compared with static compliance. Methods The authors compared PEEP-induced alveolar recruitment in 71 consecutive patients identified in a database. Patients were classified as having pulmonary, extrapulmonary, or mixed/uncertain ARDS. Pressure-volume curves with and without PEEP were available for all patients, and pressure-volume curves with two PEEP levels were available for 44 patients. Static compliance was calculated as tidal volume divided by pressure change for tidal volumes of 400 and 700 ml. Recruited volume was measured at an elastic pressure of 15 cm H2O. Results Volume recruited by PEEP (10 +/- 3 cm H2O) was 223 +/- 111 ml in the pulmonary ARDS group (29 patients), 206 +/- 164 ml in the extrapulmonary group (16 patients), and 242 +/- 176 ml in the mixed/uncertain group (26 patients) (P = 0.75). At high PEEP (14 +/- 2 cmH2O, 44 patients), recruited volumes were also similar (P = 0.60). With static compliance, recruitment was markedly underestimated and was dependent on tidal volume (226 +/- 148 ml using pressure-volume curve, 95 +/- 185 ml for a tidal volume of 400 ml, and 23 +/- 169 ml for 700 ml; P < 0.001). Conclusion In a large sample of patients, classification of ARDS was uncertain in more than one third of patients, and alveolar recruitment was similar in pulmonary and extrapulmonary ARDS. PEEP levels should not be determined based on cause of ARDS.

Positive airway pressure and vertical transpulmonary pressure gradient in man

1975 ◽  
Vol 38 (5) ◽  
pp. 896-899 ◽  
Author(s):  
K. Rehder ◽  
N. Abboud ◽  
J. R. Rodarte ◽  
R. E. Hyatt
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Pressure Gradient ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Transpulmonary Pressure ◽  
Vertical Gradient ◽  
Normal Subjects ◽  
Volume Curve ◽  
Pressure Volume Curve ◽  
Consistent Change

Static transpulmonary pressure (Pao-Pes) and the vertical gradient of transpulmonary pressure were determined in five sitting conscious normal subjects at mean airway pressures of 0 (ambient), 11, and 21 cmH2O. All subjects exhibited a nonuniform transpulmonary pressure gradient down the esophagus. The vertical pressure gradient was consistently larger in the lower (8–20cm below esophageal artifact) than in the middle region (0–8cm) of the esophagus. The gradient was not significantly altered by continuous positive airway pressure (11 and 21 cmH2O) or by changes in lung volume (60, 70, and 80% of total lung capacity (TLC)). Continuous positive airway pressure also did not result in a consistent change of the overall static pressure-volume curve of the lung. There was a small but statistically significant increase in TLC with each increase in airway pressure.

scholarly journals Airway pressure-volume curve estimated by flow interruption during forced expiration.

1988 ◽  
Vol 155 (1) ◽  
pp. 105-106
Author(s):  
NOBUO OHYA ◽  
JYONGSU HUANG ◽  
TOSHIHARU FUKUNAGA ◽  
HIROHISA TOGA
Keyword(s):  
Airway Pressure ◽  
Forced Expiration ◽  
Flow Interruption ◽  
Volume Curve ◽  
Pressure Volume Curve

The upper inflection point of the pressure-volume curve

2002 ◽  
Vol 28 (7) ◽  
pp. 842-849 ◽  
Author(s):  
Giuseppe Servillo ◽  
Edoardo De Robertis ◽  
Salvatore Maggiore ◽  
François Lemaire ◽  
Laurent Brochard ◽  
...  
Keyword(s):  
Inflection Point ◽  
Volume Curve ◽  
Pressure Volume Curve

scholarly journals A Comparison of the Effects of Suxamethonium, Atracurium and Vecuronium on Intracranial Haemodynamics in Swine

1989 ◽  
Vol 17 (4) ◽  
pp. 448-455 ◽  
Author(s):  
J. P. Ducey ◽  
S. A. Deppe ◽  
K. T. Foley
Keyword(s):  
Baseline Level ◽  
Cerebral Perfusion ◽  
Inflection Point ◽  
Perfusion Pressure ◽  
Rapid Rise ◽  
Arterial Blood ◽  
Volume Curve ◽  
Pressure Volume Curve ◽  
Early Fall ◽  
To Receive

Sixteen Yorkshire swine weighing 15–20 kg were studied to compare the effects of suxamethonium, atracurim and vecuronium on intracranial pressure (ICP), heart rate (HR), arterial blood pressure (BP), and cerebral perfusion pressure (CPP) in swine with normal or elevated ICP. In each animal an intacranial pressure-volume curve was produced by the inflation of an epidural balloon. The baseline ICP (Po), the ICP at the inflection point (Pi) and on the steep portion (Pmax) of the pressure-volume curve were identified and the balloon volumes recorded. The animals were assigned to receive either suxamethonium 1.0 mg/kg, atracurium 0.6 mg/kg, vecuronium 0.2 mg/kg, or saline placebo intravenously at three conditions: First, with the epidural balloon deflated Po, next at Pi, then at Pmax. Neither atracurium, vecuronium, nor placebo produced any statisticially significant effect on HR, BP, ICP, or CPP at any baseline level of ICP. Suxamethonium produced an early fall in ICP (0.8±0.3, 2.6±1.0 and 3.5±1.3 mmHg at Po, Pi and Pmax respectively: P = .0005) followed by a rapid rise above the pre-infusion level (1.8 ± 0.6, 2.8 ±0.6 mmHg, and 2.2 ±0.5 mmHg at P0, Pi and Pmax respectively: P =.0005). A fall in BP coupled with the rise in ICP resulted in a fall in CPP (5.8 ± 2.3, 6.1 ±1.2, and 6.3 ± 1.8 mmHg at P0, Pi and Pmax respectively: P = .0005). Although the fall in CPP was not large, in the presence of elevated ICP, where CPP already is marginal, such a decrease may compromise cerebral blood flow. Atracurium and vecuronium had no effect on ICP or haemodynamics, even in the presence of an elevated ICP. These agents may be preferred in settings of suboptimal CPP or in the presence of pre-existing intracranial hypertension.

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