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The Relationship Between Gas Delivery Patterns and the Lower Inflection Point of the Pressure-Volume Curve During Partial Liquid Ventilation^*

^* From the Department of Anaesthesia/Respiratory Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Correspondence to: Robert M. Kacmarek, PhD, FCCP, Respiratory Care, Ellison 401, Massachusetts General Hospital, Boston, MA 02114

Study question: To determine whether a positive end-expiratory pressure (PEEP) level equivalent to the lower inflection point (LIP) could be identified by evaluation of the airway pressure, flow (), and volume vs time waveforms during partial liquid ventilation (PLV).

Design: Prospective application of PEEP during PLV in a healthy animal model.

Setting: University hospital animal laboratory.

Participants: Five healthy sheep weighing 30 kg each.

Interventions: The sequential application of 0 to 20 cm H₂O PEEP in 2.5-cm H₂O steps during PLV with both pressure and volume ventilation.

Measurements: Analysis of the pressure, volume, and waveforms as PEEP is sequentially increased.

Results: At 0 cm H₂O PEEP, VT was markedly reduced compared with PEEP VT at 7.5 cm H₂O (p < 0.05) in pressure control ventilation (PCV), and peak inspiratory pressure minus PEEP was markedly increased compared with PEEP at 5.0 cm H₂O (p < 0.05) in volume control ventilation. At 10 cm H₂O PEEP, all waveforms began to stabilize, and no significant differences in any variable assessed were measured at > 12.5 cm H₂O PEEP.

Conclusions: The application of PEEP during PLV markedly alters airway waveforms. Low PEEP decreases VT in PCV and increases airway pressure in VCV. The PEEP level equal to the LIP during PLV can be grossly estimated from airway waveforms. PEEP at 10 cm H₂O is needed to normalize gas delivery to functional residual capacity in the uninjured lung that is partially filled with perfluorocarbon.

Key Words: compliance • gas delivery pattern • lower inflection point • partial liquid ventilation • resistance

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