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

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

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.