医学
心脏病学
内科学
慢性阻塞性肺病
心力衰竭
肺病
肺动脉高压
血压
作者
Shailesh Bihari,Andrew D. Bersten
出处
期刊:American Thoracic Society International Conference
日期:2012-05-01
标识
DOI:10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a1696
摘要
Abstract Introduction Potentially beneficial effects of positive end-expiratory pressure (PEEP) in patients with chronic obstructive pulmonary disease (COPD) must be balanced against further overinflation and increased alveolar dead space. Concurrent chronic heart failure (CHF) is common and can lead to changes in lung that can reduce the detrimental effects of PEEP. Objective The aim of this study was to compare the effect of PEEP on volumetric capnography, blood gases, pulmonary mechanics, and vital signs in subjects with either COPD (n = 13) or COPD + CHF (n = 7) during pressure support ventilation. Methods Positive end-expiratory pressure was administered at 0, 5, 10, 15, and 0 cm H 2 O for 15 minutes with pressure support maintained at 10 cm H 2 O. Data are expressed as mean ± SD, and the effect of PEEP and differences between COPD alone and COPD + CHF were tested with repeated-measures analysis of variance. Results Subjects were elderly (72.5 ± 13.3 years) with severe COPD (force expired volume in 1 second, 1.3 ± 0.6L; force expired volume in 1 second/force vital capacity, 40% ± 15%). With increasing PEEP in COPD subjects, dead space ratio increased ( P P = .001), and Paco 2 increased ( P = .013), with no change in COPD + CHF subjects. Subjects with COPD + CHF had improvement in Pao 2 and lower mean arterial pressure, whereas both were unchanged in subjects with COPD alone. Conclusion In subjects with severe COPD alone, caution must be used when administering PEEP 10 cm H 2 O or greater. Subjects with COPD + CHF may benefit from higher levels of PEEP.
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