Effect of PEEP on Dead Space in an Experimental Model of ARDS.

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  • Additional Information
    • Affiliation:
      Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina
      Department of Intensive Care Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
      Instituto Tecnológico Buenos Aires (ITBA), Buenos Aires, Argentina
      Anesthesia Department, Veterinary School, Universidad de Buenos Aires, Buenos Aires, Argentina
      Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
      Pulmonary and Critical Care Medicine, Instituto universitario CEMIC (Centro de Educación Médica e Investigaciones Clínicas), Buenos Aires, Argentina
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      BACKGROUND: The difference between Bohr and Enghoff dead space are not well described in ARDS patients. We aimed to analyze the effect of PEEP on the Bohr and Enghoff dead spaces in a model of ARDS. METHODS: 10 pigs submitted to randomized PEEP steps of 0, 5, 10, 15, 20, 25 and 30 cm H2O were evaluated with the use of lung ultrasound images, alveolar-arterial oxygen difference (P...), transpulmonary mechanics, and volumetric capnography at each PEEP step. RESULTS: At PEEP ≥ 15 cm H2O, atelectasis and P... progressively decreased while end-inspiratory transpulmonary pressure (PL), end-expiratory PL, and driving PL increased (all P < .001). Bohr dead space (V.../VT), airway dead space (V.../VT), and alveolar dead space (V.../V...) reached their highest values at PEEP 30 cm H2O (0.69 ± 0.10, 0.53 ± 0.13 and 0.35 ± 0.06, respectively). At PEEP <15 cm H2O, the increases in atelectasis and P... were associated with negative end-expiratory PL and highest driving PL. V.../VT and VDaw /VT showed the lowest values at PEEP 0 cm H2O (0.51 ± 0.08 and 0.32 ± 0.08, respectively), whereas V.../V... increased to 0.27 ± 0.05. Enghoff dead space and its derived V.../V... showed high values at low PEEPs (0.86 ± 0.02 and 0.79 ± 0.04, respectively) and at high PEEPs (0.84 ± 0.04 and 0.65 ± 0.12), with the lowest values at 15 cm H2O (0.77 ± 0.05 and 0.61 ± 0.11, respectively; all P < .001). CONCLUSIONS: Bohr dead space was associated with lung stress, whereas Enghoff dead space was partially affected by the shunt effect.
    • Journal Subset:
      Allied Health; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA
    • ISSN:
      0020-1324
    • MEDLINE Info:
      NLM UID: 7510357
    • Notes:
      For CE Supplement pages visit: www.rcjournal.com
    • Publication Date:
      20200109
    • Publication Date:
      20200116
    • DOI:
      10.4187/respcare.06843
    • Accession Number:
      141064437
  • Citations
    • ABNT:
      TUSMAN, G. et al. Effect of PEEP on Dead Space in an Experimental Model of ARDS. Respiratory Care, [s. l.], v. 65, n. 1, p. 11–20, 2020. DOI 10.4187/respcare.06843. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=141064437. Acesso em: 26 nov. 2020.
    • AMA:
      Tusman G, Gogniat E, Madorno M, et al. Effect of PEEP on Dead Space in an Experimental Model of ARDS. Respiratory Care. 2020;65(1):11-20. doi:10.4187/respcare.06843
    • APA:
      Tusman, G., Gogniat, E., Madorno, M., Otero, P., Dianti, J., Ceballos, I. F., Ceballos, M., Verdier, N., Böhm, S. H., Rodriguez, P. O., & San Roman, E. (2020). Effect of PEEP on Dead Space in an Experimental Model of ARDS. Respiratory Care, 65(1), 11–20. https://doi.org/10.4187/respcare.06843
    • Chicago/Turabian: Author-Date:
      Tusman, Gerardo, Emiliano Gogniat, Matías Madorno, Pablo Otero, José Dianti, Ignacio Fernandez Ceballos, Martín Ceballos, et al. 2020. “Effect of PEEP on Dead Space in an Experimental Model of ARDS.” Respiratory Care 65 (1): 11–20. doi:10.4187/respcare.06843.
    • Harvard:
      Tusman, G. et al. (2020) ‘Effect of PEEP on Dead Space in an Experimental Model of ARDS’, Respiratory Care, 65(1), pp. 11–20. doi: 10.4187/respcare.06843.
    • Harvard: Australian:
      Tusman, G, Gogniat, E, Madorno, M, Otero, P, Dianti, J, Ceballos, IF, Ceballos, M, Verdier, N, Böhm, SH, Rodriguez, PO & San Roman, E 2020, ‘Effect of PEEP on Dead Space in an Experimental Model of ARDS’, Respiratory Care, vol. 65, no. 1, pp. 11–20, viewed 26 November 2020, .
    • MLA:
      Tusman, Gerardo, et al. “Effect of PEEP on Dead Space in an Experimental Model of ARDS.” Respiratory Care, vol. 65, no. 1, Jan. 2020, pp. 11–20. EBSCOhost, doi:10.4187/respcare.06843.
    • Chicago/Turabian: Humanities:
      Tusman, Gerardo, Emiliano Gogniat, Matías Madorno, Pablo Otero, José Dianti, Ignacio Fernandez Ceballos, Martín Ceballos, et al. “Effect of PEEP on Dead Space in an Experimental Model of ARDS.” Respiratory Care 65, no. 1 (January 2020): 11–20. doi:10.4187/respcare.06843.
    • Vancouver/ICMJE:
      Tusman G, Gogniat E, Madorno M, Otero P, Dianti J, Ceballos IF, et al. Effect of PEEP on Dead Space in an Experimental Model of ARDS. Respiratory Care [Internet]. 2020 Jan [cited 2020 Nov 26];65(1):11–20. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=141064437