Chest ACCP Education Calendar
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Murray, I. P.
Right arrow Articles by Banner, M. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Murray, I. P.
Right arrow Articles by Banner, M. J.

Chest, Vol 85, 100-104, Copyright © 1984 by American College of Chest Physicians

ARTICLES

Titration of PEEP by the arterial minus end-tidal carbon dioxide gradient

IP Murray, JH Modell, TJ Gallagher and MJ Banner

It was shown in dogs that intrapulmonary physiologic shunt (Qsp/Qt), arterial oxygen tension (PaO2), total static respiratory compliance (CT), oxygen delivery (O2AV), cardiac output (Qt), and arterial minus end-tidal carbon dioxide gradient (PaCO2-PetCO2) undergo statistically significant deterioration when oleic acid is injected into the pulmonary artery. Positive end-expiratory pressure (PEEP) therapy reduced Qsp/Qt and PaCO2-PetCO2 gradient and increased PaO2. The CT did not show any consistent pattern of improvement with the application of PEEP. The Qt and the O2AV progressively decreased as PEEP was increased. The application of additional PEEP beyond that which minimized the PaCO2-PetCO2 gradient produced a statistically significant increase in the PaCO2-PetCO2 gradient, but this was not reflected by concomitant changes in Qsp/Qt or PaO2 in spite of a further decrease in Qt. Thus, the PaCO2-PetCO2 gradient may be a more sensitive indicator of excessive PEEP than is Qst/Qt or PaO2, since it should be smallest when there is maximal recruitment of perfused or functional gas units without overdistention of alveolar areas contributing to dead space. Also, the use of the PaCO2-PetCO2 gradient permits the rapid titration of PEEP without the need for a pulmonary artery catheter.


This article has been cited by other articles:


Home page
 Br J AnaesthHome page
O. Stenqvist
Practical assessment of respiratory mechanics
Br. J. Anaesth., July 1, 2003; 91(1): 92 - 105.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1984 by the American College of Chest Physicians.