Positive end-expiratory pressure ventilation increases extravascular lung water due to a decrease in lung lymph flow

Dirk M. Maybauer, P. O. Talkes, M. Westphal, M. O. Maybauer, L. D. Traber, Perenlei Enkhbaatar, N. Morita, D. L. Traber

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Positive end-expiratory pressure (PEEP) is used to improve gas exchange, increase functional residual capacity, recruit air spaces, and decrease pulmonary shunt in patients suffering from respiratory failure. The effect of PEEP on extravascular lung water (EVLW), however, is still not fully understood. This study was designed as a prospective laboratory experiment to evaluate the effects of PEEP on EVLW and pulmonary lymph flow (QL) under physiologic conditions. Twelve adult sheep were operat ively prepared to measure haemodynamics of the systemic and pulmonary circulation, and to assess EVLW. In addition, the lung lymphatic duct was cannulated and a tracheostomy performed. The animals were then mechanically ventilated in the awake-state without end-expiratory pressure (PEEP 0). After a two-hour baseline period, PEEP was increased to 10 cmH2O for the duration of two hours, and then reduced back to 0 cmH2O. Cardiopulmonary variables, QL, and arterial blood gases were recorded intermittently; EVLW was determined two hours after each change in PEEP. The increase in PEEP re sulted in a decrease in QL (7±1 vs 5±1 ml/h) and an increase in EVLW (498±40 vs 630±58 ml; P<0.05 each) without affecting cardiac output. As PEEP was decreased back to baseline, QL increased significantly (5±1 vs 10±2 ml/h), whereas EVLW returned back to baseline. This study suggests that institution of PEEP produces a re versible increase in EVLW that is linked to a decrease in QL.

Original languageEnglish (US)
Pages (from-to)329-333
Number of pages5
JournalAnaesthesia and Intensive Care
Volume34
Issue number3
StatePublished - Jun 2006
Externally publishedYes

Fingerprint

Extravascular Lung Water
Positive-Pressure Respiration
Lymph
Lung
Gases
Functional Residual Capacity
Pulmonary Circulation
Tracheostomy
Respiratory Insufficiency
Cardiac Output
Sheep
Hemodynamics
Air

Keywords

  • Cardiac output
  • Extravascular lung water
  • Lymph flow
  • Positive end-expiratory pressure
  • Sheep

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Maybauer, D. M., Talkes, P. O., Westphal, M., Maybauer, M. O., Traber, L. D., Enkhbaatar, P., ... Traber, D. L. (2006). Positive end-expiratory pressure ventilation increases extravascular lung water due to a decrease in lung lymph flow. Anaesthesia and Intensive Care, 34(3), 329-333.

Positive end-expiratory pressure ventilation increases extravascular lung water due to a decrease in lung lymph flow. / Maybauer, Dirk M.; Talkes, P. O.; Westphal, M.; Maybauer, M. O.; Traber, L. D.; Enkhbaatar, Perenlei; Morita, N.; Traber, D. L.

In: Anaesthesia and Intensive Care, Vol. 34, No. 3, 06.2006, p. 329-333.

Research output: Contribution to journalArticle

Maybauer, DM, Talkes, PO, Westphal, M, Maybauer, MO, Traber, LD, Enkhbaatar, P, Morita, N & Traber, DL 2006, 'Positive end-expiratory pressure ventilation increases extravascular lung water due to a decrease in lung lymph flow', Anaesthesia and Intensive Care, vol. 34, no. 3, pp. 329-333.
Maybauer, Dirk M. ; Talkes, P. O. ; Westphal, M. ; Maybauer, M. O. ; Traber, L. D. ; Enkhbaatar, Perenlei ; Morita, N. ; Traber, D. L. / Positive end-expiratory pressure ventilation increases extravascular lung water due to a decrease in lung lymph flow. In: Anaesthesia and Intensive Care. 2006 ; Vol. 34, No. 3. pp. 329-333.
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