Application of dead space fraction to titrate optimal positive end-expiratory pressure in an ARDS swine model

Bian,Weishuai; Chen,Wei; Chao,Yangong; Wang,Lan; Li,Liming; Guan,Jian; Zang,Xuefeng; Zhen,Jie; Sheng,Bo; Zhu,Xi

doi:10.3892/etm.2017.4117

Application of dead space fraction to titrate optimal positive end-expiratory pressure in an ARDS swine model

Authors:
- Weishuai Bian
- Wei Chen
- Yangong Chao
- Lan Wang
- Liming Li
- Jian Guan
- Xuefeng Zang
- Jie Zhen
- Bo Sheng
- Xi Zhu
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Affiliations: Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China, Department of Critical Care Medicine, The First Affiliated Hospital, Tsing Hua University, Beijing 100016, P.R. China, Department of Critical Care Medicine, Dongzhimen Chinese Medical Hospital, Beijing Chinese‑Medical University, Beijing 100700, P.R. China, Department of Critical Care Medicine, Third Hospital, Peking University, Beijing 100083, P.R. China
Published online on: February 10, 2017 https://doi.org/10.3892/etm.2017.4117
Pages: 1572-1577

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Abstract

This study aimed to apply the dead space fraction [ratio of dead space to tidal volume (VD/VT)] to titrate the optimal positive end-expiratory pressure (PEEP) in a swine model of acute respiratory distress syndrome (ARDS). Twelve swine models of ARDS were constructed. A lung recruitment maneuver was then conducted and the PEEP was set at 20 cm H2O. The PEEP was reduced by 2 cm H2O every 10 min until 0 cm H2O was reached, and VD/VT was measured after each decrement step. VD/VT was measured using single‑breath analysis of CO2, and calculated from arterial CO2 partial pressure (PaCO2) and mixed expired CO2 (PeCO2) using the following formula: VD/VT = (PaCO2 ‑ PeCO2)/PaCO2. The optimal PEEP was identified by the lowest VD/VT method. Respiration and hemodynamic parameters were recorded during the periods of pre‑injury and injury, and at 4 and 2 cm H2O below and above the optimal PEEP (Po). The optimal PEEP in this study was found to be 13.25±1.36 cm H2O. During the Po period, VD/VT decreased to a lower value (0.44±0.08) compared with that during the injury period (0.68±0.10) (P<0.05), while the intrapulmonary shunt fraction reached its lowest value. In addition, a significant change of dynamic tidal respiratory compliance and oxygenation index was induced by PEEP titration. These results indicate that minimal VD/VT can be used for PEEP titration in ARDS.

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