Abstract
The effect of positive end expiratory pressure (PEEP) and mean airway pressure (MAP) on respiratory compliance and gas exchange was assessed in children with liver disease. In the first study of 12 patients, PEEP was decreased either by 3 cmH2O below the baseline level (the child's original level) or to 0 cmH2O and then increased to 3 cmH2O above the baseline. Decreasing PEEP impaired compliance (P<0.01), and oxygenation (P<0.05), whereas increasing PEEP improved compliance (P<0.05) and oxygenation (P<0.05). Neither increasing nor decreasing PEEP caused significant changes in the carbon dioxide levels. In the second study, 24 children were studied at their baseline settings and then after increasing the PEEP by 3 cmH2O while simultaneously lowering the peak inspiratory pressure (PIP) to maintain MAP constant (12 children had lung function measurements). In the group overall increasing PEEP while decreasing PIP resulted in an insignificant change inp aO2, but a significant increasep aCO2 (P<0.01) and reduction in tidal volume (P<0.01), the change in compliance was not significant. After a second period at the baseline settings, in 12 children inspiratory time (TI) was increased while keeping MAP constant by reducing PIP. No significant change inp aO2 or compliance was experienced, butp aCO2 increased (P<0.05) and tidal volume decreased (P<0.01). In the other 12 children MAP was increased by prolonging TI. Increasing MAP had a variable effect and the changes inp aO2 andp aCO2 were not significant. No critical MAP level with regard to oxygenation was demonstrated. We conclude that in children with liver disease, increasing PEEP can improve oxygenation and compliance, but the MAP level alone does not determine oxygenation.
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Abbreviations
- FRC :
-
functional residual capacity
- MAP :
-
mean airway pressure
- p a O 2 :
-
arterial oxygen tension
- p a CO 2 :
-
arterial carbon dioxide tension
- PEEP :
-
positive end expiratory pressure
- PIP :
-
peak inflating pressure
- T I :
-
inspiratory time
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Giffin, F., Greenough, A. Effect of positive end expiratory pressure and mean airway pressure on respiratory compliance and gas exchange in children with liver disease. Eur J Pediatr 153, 28–33 (1994). https://doi.org/10.1007/BF02000783
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DOI: https://doi.org/10.1007/BF02000783