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  • Title: [The significance of point-inflection at static pressure-volume curve in optimal PEEP at early stage of ARDS in sheep].
    Author: Zhang H, Ma S, Chao Y.
    Journal: Zhonghua Yi Xue Za Zhi; 1998 Jun; 78(6):409-12. PubMed ID: 10923499.
    Abstract:
    OBJECTIVE: To study the optimal level of PEEP at early stage of ARDS. METHOD: The parameters of hemodynamics, lung mechanics, and gas exchange were compared at different levels of PEEP, including maximal static compliance PEEP, point-inflection PEEP, 3 cmH2O higher or lower than point-inflection PEEP, and zero end-expiratory pressure. RESULTS: Point-inflection PEEP (6.8 +/- 1.4 cmH2O) was significantly lower than maximal static compliance PEEP (9.3 +/- 1.4 cmH2O), P < 0.01. The hemodynamic parameters were not significantly different in point-inflection PEEP compared with 0cmH2O-PEEP (P > 0.05), but oxygenation index (PaO2/FiO2) and lung mechanics (static compliance and airway resistance) were improved significantly at point-inflection PEEP (P < 0.01). At maximal static compliance PEEP or 3 cmH2O higher than point-inflection PEEP, the hemodynamic parameters and PaO2/FiO2 were not different from those at point-inflection PEEP (P > 0.05). The pulmonary vascular resistance index (PVRI) was significantly higher (P < 0.05) and the mean airway pressure and peak inspiratory pressure increased significantly (P < 0.01). CONCLUSION: In the treatment of early ARDS, the PEEP needed may be lower than the "optimal PEEP" determined by obtaining the maximal static compliance. The application of point-inflection PEEP determined at inspiratory static pressure-volume curve was appropriate as the best PEEP.
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