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Open Access

CO2 dynamics in ARDS patients: effects of PEEP above the Pflex

  • CSV Barbas1,
  • E Silva1,
  • A Garrido1,
  • M Assunção1,
  • C Hoelz1,
  • EC Meyer1 and
  • E Knobel1
Critical Care20015(Suppl 3):P45

https://doi.org/10.1186/cc1378

Published: 26 June 2001

Keywords

Public HealthCatheterEmergency MedicineCardiac IndexConventional Ventilation

Introduction and method

Titrating PEEP above the Pflex can improve oxygenation and survival when compared to the conventional ventilation in ARDS patients. In order to study the dynamics of CO2 in ARDS patients as well as the effects of setting PEEP above the Pflex on the CO2 dynamics we studied seven patients with ARDS criteria (less than 5 days of installation), with mean age of 63 ± 0.11 years and mean APACHE score of 21.4. After performing the PxV curve (random volumes) we ventilated the patients with 8 ml/kg TV and RR of 15 and PEEP of 5 cmH2O. Then we kept the same MV and set PEEP 2 cmH2O above Pflex for 30 min. Then we decreased PEEP to 5 for more 30 min. All the patients have a Swan-Ganz catheter and a continuous tonometer.

Results

See Table.

Table

 

30 min PEEP=5

30 min PEEP >Pflex

30 min PEEP of 5

PaO2/FiO2

81 ± 24

128 ± 42*

101 ± 47

PvO2

42.7 ± 5.8

47.2 ± 7*

42 ± 3

PaCO2

40.6 ± 12

37.5 ± 12

35 ± 12

PvCO2/v-a (CO2)

43 ± 13/4.3 ± 1.5

42 ± 12/4.5 ± 0.3

40 ± 10/4.7 ± 2.

ETCO2/a-ET(CO2)

23.7 ± 8/16.6 ± 3.4

24 ± 7/13.5 ± 4.3*

23 ± 6/12.2 ± 6.5

PgCO2/g-v (CO2)

47 ± 13/3.6 ± 1.2

46 ± 13/4.5 ± 0.3

45 ± 13/5.3 ± 3

CI (l/min/m2)

4.6 ± 1

4.05 ± 0.9*

4.5 ± 1.4

Conclusion

PEEP above the Pflex decreased the cardiac index and the arterial-expired CO2 gradient while increased the oxygenation and the PvO2.

Authors’ Affiliations

(1)
ICU, Hospital Israelita Albert Einstein, São Paulo, Brazil

Copyright

© The Author(s) 2010

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