Acute and Critical Care

Original Article

Comparison of Auto-PEEP Levels Measured by End-expiratory Port Occlusion Method and Trapped Lung Volume: Jang Won Sohn, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2005;20(2):131-135.

Abstract PDF: BACKGROUND
There are several METHODS: for auto-PEEP measurement during mechanical ventilation. The end-expiratory port occlusion (EEPO) method is simple and easy. Theoretically, auto- PEEP level can be also calculated by using trapped lung volume and static compliance. However, the relationship between measured auto-PEEP by EEPO method and the calculated auto-PEEP has not been studied. The purpose of this study is to observe the relationship between the measured and the calculated auto-PEEP. METHODS: 15 patients with auto-PEEP during mechanical ventilation were included. Auto-PEEP was measured by EEPO method, and calculated by using a formula; trapped lung volume/static compliance. All of the patients were paralyzed during the study. If the measured auto-PEEP is higher than calculated auto-PEEP, this patient was included in `high group'; in the opposite case, `low group'. We compared respiratory mechanics between these two groups. RESULTS: Measured auto-PEEP was 9.60+/-2.82 cmH2O, and calculated auto-PEEP was 9.78+/-2.90 cmH2O. There was statistically significant relationship between measured and calculated auto-PEEP (r=0.81, p<0.01). There was no difference on respiratory mechanics between `high group' and `low group'. CONCLUSIONS: The auto-PEEP obtained by calculation with trapped lung volume and static compliance showed a good correlation with that of using EEPO method in the paralyzed patients.

Review

Mechanical Ventilation in Patients with Chronic Obstructive Pulmonary Disease: Tae Hun An; Korean J Crit Care Med. 2003;18(2):67-73.

Abstract PDF: Patients with severe chronic obstructive pulmonary disease (COPD) may require mechanical ventilation following cardiac or general surgery, in connection with thoracic surgery such as lobectomy, wedge resection, lung reduction or bullectomy, during an episode of acute respiratory failure (ARF) secondary to a disease other than COPD such as sepsis, drug overdose, or trauma or for acute-on-chronic respiratory failure (the COPD exacerbation) where acute illness, usually presumed to be infectious in nature, destabilizes the characteristically compensated state. Ventilatory intervention is often life-saving when patients with asthma or COPD experience acute respiratory compromise. Although both noninvasive and invasive ventilation methods may be viable initial choice, which is better depends upon the severity of illness, the rapidity of response, coexisting disease, and capacity of the medical environment. In addition, noninvasive ventilation often relieves dyspnea and hypoxemia in patients with stable severe COPD. This review will only briefly cover noninvasive ventilation and focus primarily on the management of the intubated, mechanically ventilated patient with COPD, with particular emphasis on factors unique to this patient population such as the propensity for dynamic hyperinflation and auto-PEEP, barotrauma, difficult weaning and the prognosis following mechanical ventilation.

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