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  • Meeting abstract
  • Open Access

Effects of PEEP above the L-Pflexon gas exchange, hemodynamic and gastric tonometer in ARDSpatients

  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care20015 (Suppl 3) :P43

https://doi.org/10.1186/cc1376

  • Published:

Keywords

  • Public Health
  • Catheter
  • Cardiac Output
  • Respiratory Rate
  • Emergency Medicine

Introduction and method

In order to study the acute effects of optimal PEEP on oxygenation, CO2 exchange, hemodynamic parameters and gastric mucosal PCO2 we analyzed 10 ARDS patients (<5 days of installation) after 30 min on PEEP 5 cmH2O (T0), then 30 min on PEEP 2 cmH2O above the L-Pflex (T1) and than 30 min after PEEP of 5 cmH2O (T2). They were all sedated-paralyzed. A Swan-Ganz catheter with a semicontinuous cardiac output and continuous gastric tonometer was inserted in each patient. The tidal volume and respiratory rate were kept constant (8 ml/kg and 20/min; VCV). L-Pflex was titrated by PxV curve (random volumes). The mean APACHEII was 21.3.

Results

See Table

Table

 

T0-30 min

T1-30 min

T2-30 min

Patients

after

after

after

 

PEEP=

PEEP 2 cmH2O

PEEP=

n = 10

5 cmH2O

>L-Pflex

5 cmH2O

PEEP (cmH2O)

5.0 ± 0.0

11.6 ± 3.0*

5.0 ± 0.0

Minute ventilation (l/min)

11.4 ± 1.8

11.4 ± 1.8

11.4 ± 1.8

PaO2/FIO2

77.6 ± 23.5

136 ± 41.4

97.7 ± 41.1

PaCO2 (mmHg)

38.6 ± 12.2

36.8 ± 12.0

39.1 ± 13.2

PCO2 gap (mmHg)

8.6 ± 4.8

9.4 ± 3.6

7.8 ± 3.0

SVO2%

67.4 ± 13.6

76.6 ± 9.0

73.6 ± 5.1

Arterial lactate (mg/dl)

20.2 ± 6.1

20.5 ± 5.0

21.6 ± 4.8

PCW (mmHg)

11.4 ± 4.5

13.3 ± 2.9

12.3 ± 2.4

Cardiac index

4.6 ± 1.0

3.9 ± 1.0*

4.3 ± 1.2

Conclusion

Although cardiac index had decreased, PEEP titrated by L-Pflex of PxV curve of the respiratory system improved oxygenation without impairing regional hemodynamics in ARDS patients.

Authors’ Affiliations

(1)
Intensive Care Unit of Hospital Israelita Albert Einstein, São Paulo, Brazil

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