Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 18 , ISSUE 8 ( August, 2014 ) > List of Articles


Compliance versus dead space for optimum positive end expiratory pressure determination in acute respiratory distress syndrome

Nagat S. El-Shmaa, Ghada Fouad El-Baradey

Keywords : Acute respiratory distress syndrome, dead space fraction, positive end expiratory pressure, static compliance

Citation Information : El-Shmaa NS, El-Baradey GF. Compliance versus dead space for optimum positive end expiratory pressure determination in acute respiratory distress syndrome. Indian J Crit Care Med 2014; 18 (8):508-512.

DOI: 10.4103/0972-5229.138150

License: CC BY-ND 3.0

Published Online: 01-04-2007

Copyright Statement:  Copyright © 2014; The Author(s).


Objective: To Compare compliance versus dead space (Vd) targeted positive end-expiratory pressure (PEEP) as regard its effect on lung mechanics and oxygenation. Materials and Methods: This study was carried out on 30 adult acute respiratory distress syndrome patients. The ventilator was initially set on volume controlled with tidal volume (Vt) 7 mL/kg predicted body weight (PBW), inspiratory plateau pressure (Ppl) <30 cm H 2 O. If the Ppl was >30 cm H 2 O with a TV of 6 mL/kg PBW, a step-wise Vt reduction of 1 mL/kg PBW to as low as 4 mL/kg/PBW was allowed. Respiratory rate adjusted to maintain pH 7.30-7.45. FiO 2 start at 100%. Best PEEP determined at 2 points, one by titrating PEEP until reaching the highest static compliance (Cst) (PEEP Cst) and the other one is at the lowest Vd/Vt (PEEP Vd/Vt). The following data measured before and 30 min after setting PEEP Cst and PEEP Vd/Vt. Cst, PaCO 2 - PetCO 2, Vd/Vt, PaO 2 /FiO 2, Ppl, heart rate, mean arterial pressure and oxygen saturation. Results: optimum PEEP determined by Vd/Vt was significantly (P < 0.05) lower than the optimum PEEP determined by Cst. Best PEEP Vd/Vt showed a significant decrease (P < 0.05) in Cst, PaCO 2 - PetCO 2, Vd/Vt and Ppl in comparison with best PEEP Cst. The PaO 2 /FiO 2 showed a significant increase (P < 0.05) with best PEEP Vd/Vt in comparison with best PEEP Cst. Conclusion: Vd guided PEEP improved compliance and oxygenation with less Ppl. Hence, its use as a guide for best PEEP determination may be useful.

PDF Share
  1. Zhao Z, Steinmann D, Frerichs I, Guttmann J, Möller K. PEEP titration guided by ventilation homogeneity: A feasibility study using electrical impedance tomography. Crit Care 2010;14:R8.
  2. Pintado MC, de Pablo R, Trascasa M, Milicua JM, Rogero S, Daguerre M, et al. Individualized PEEP setting in subjects with ARDS: A randomized controlled pilot study. Respir Care 2013;58:1416-23.
  3. Fengmei G, Jin C, Songqiao L, Congshan Y, Yi Y. Dead space fraction changes during PEEP titration following lung recruitment in patients with ARDS. Respir Care 2012;57:1578-85.
  4. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: The Berlin Definition. JAMA 2012;307:2526-33.
  5. Guerin C, Debord S, Leray V, Delannoy B, Bayle F, Bourdin G, et al. Efficacy and safety of recruitment maneuvers in acute respiratory distress syndrome. Ann Intensive Care 2011;1:9.
  6. Badet M, Bayle F, Richard JC, Guérin C. Comparison of optimal positive end-expiratory pressure and recruitment maneuvers during lung-protective mechanical ventilation in patients with acute lung injury/acute respiratory distress syndrome. Respir Care 2009;54:847-54.
  7. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998;338:347-54.
  8. Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL, et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: A randomized controlled trial. JAMA 2008;299:646-55.
  9. Suarez-Sipmann F, Böhm SH, Tusman G, Pesch T, Thamm O, Reissmann H, et al. Use of dynamic compliance for open lung positive end-expiratory pressure titration in an experimental study. Crit Care Med 2007;35:214-21.
  10. Murat S, Engin Ok, Ayßegl RT, Muhammed GŸ, Erdogan S. Can arterial minus end-tidal carbon dioxide gradient be used for peep titration? Turk Respir J 2002;3:94-7.
  11. Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 2006;354:1775-86.
  12. Lucangelo U, Bernabè F, Vatua S, Degrassi G, Villagrà A, Fernandez R, et al. Prognostic value of different dead space indices in mechanically ventilated patients with acute lung injury and ARDS. Chest 2008;133:62-71.
  13. Smith RP, Fletcher R. Positive end-expiratory pressure has little effect on carbon dioxide elimination after cardiac surgery. Anesth Analg 2000;90:85-8.
  14. Murate S, Muhammed G. Lung carbon dioxide elimination corralates with physiologic dead space volume during mechanical ventilatory support. Turk J Med Sci 2001;31:529-32.
  15. Maisch S, Reissmann H, Fuellekrug B, Weismann D, Rutkowski T, Tusman G, et al. Compliance and dead space fraction indicate an optimal level of positive end-expiratory pressure after recruitment in anesthetized patients. Anesth Analg 2008;106:175-81.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.