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. 2008;12(6):R145.
doi: 10.1186/cc7125. Epub 2008 Nov 20.

End-expiratory lung volume during mechanical ventilation: a comparison with reference values and the effect of positive end-expiratory pressure in intensive care unit patients with different lung conditions

Ido G Bikker  1 , Jasper van Bommel, Dinis Reis Miranda, Jan Bakker, Diederik Gommers
Affiliations

End-expiratory lung volume during mechanical ventilation: a comparison with reference values and the effect of positive end-expiratory pressure in intensive care unit patients with different lung conditions

Ido G Bikker et al. Crit Care. 2008.

Erratum in

  • Crit Care. 2009;13(6):430

Abstract

Introduction: Functional residual capacity (FRC) reference values are obtained from spontaneous breathing patients, and are measured in the sitting or standing position. During mechanical ventilation FRC is determined by the level of positive end-expiratory pressure (PEEP), and it is therefore better to speak of end-expiratory lung volume. Application of higher levels of PEEP leads to increased end-expiratory lung volume as a result of recruitment or further distention of already ventilated alveoli. The aim of this study was to measure end-expiratory lung volume in mechanically ventilated intensive care unit (ICU) patients with different types of lung pathology at different PEEP levels, and to compare them with predicted sitting FRC values, arterial oxygenation, and compliance values.

Methods: End-expiratory lung volume measurements were performed at PEEP levels reduced sequentially (15, 10 and then 5 cmH2O) in 45 mechanically ventilated patients divided into three groups according to pulmonary condition: normal lungs (group N), primary lung disorder (group P), and secondary lung disorder (group S).

Results: In all three groups, end-expiratory lung volume decreased significantly (P < 0.001) while PEEP decreased from 15 to 5 cmH2O, whereas the ratio of arterial oxygen tension to inspired oxygen fraction did not change. At 5 cmH2O PEEP, end-expiratory lung volume was 31, 20, and 17 ml/kg predicted body weight in groups N, P, and S, respectively. These measured values were only 66%, 42%, and 34% of the predicted sitting FRC. A correlation between change in end-expiratory lung volume and change in dynamic compliance was found in group S (P < 0.001; R2 = 0.52), but not in the other groups.

Conclusions: End-expiratory lung volume measured at 5 cmH2O PEEP was markedly lower than predicted sitting FRC values in all groups. Only in patients with secondary lung disorders were PEEP-induced changes in end-expiratory lung volume the result of derecruitment. In combination with compliance, end-expiratory lung volume can provide additional information to optimize the ventilator settings.

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Figures

Figure 1
Figure 1
Progression of EELV in individual patients over three stepwise reductions in PEEP. Mean EELV values at each PEEP level are presented as black dots. Patients are divided according to the type of lung condition. Patients in group N had normal lungs, those in group P had a primary lung disorder, and those in group S had a secondary lung disorder. EELV, end-expiratory lung volume; PBW, predicted body weight; PEEP, positive end-expiratory pressure.
Figure 2
Figure 2
Measured EELV as percentage of predicted sitting FRC at three PEEP levels. The black dotted line represent predicted sitting FRC (100%). Patients in group N had normal lungs, those in group P had a primary lung disorder, and those in group S had a secondary lung disorder. Values are expressed as mean ± standard deviation. EELV, end-expiratory lung volume; FiO2, inspired oxygen fraction; FRC, functional residual capacity; Pao2, arterial oxygen tension; PEEP, positive end-expiratory pressure.
Figure 3
Figure 3
Pao2/Fio2 ratio in different types of lung conditions at three PEEP levels. Patients in group N had normal lungs, those in group P had a primary lung disorder, and those in group S had a secondary lung disorder. Values are expressed as mean ± standard deviation. EELV, end-expiratory lung volume; FiO2, inspired oxygen fraction; Pao2, arterial oxygen tension; PBW, predicted body weight; PEEP, positive end-expiratory pressure.
Figure 4
Figure 4
Correlation between change in EELV and change in dynamic compliance. Data are presented as the difference between the lowest PEEP level (5 cmH2O) and 10 or 15 cmH2O PEEP. Patients in group N had normal lungs, those in group P had a primary lung disorder, and those in group S had a secondary lung disorder. EELV, end-expiratory lung volume; PEEP, positive end-expiratory pressure.
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