• Respiratory care · Jan 2020

    Effect of PEEP on Dead Space in an Experimental Model of ARDS.

    • Gerardo Tusman, Emiliano Gogniat, Matías Madorno, Pablo Otero, José Dianti, Ignacio Fernandez Ceballos, Martín Ceballos, Natalí Verdier, Stephan H Böhm, Pablo O Rodriguez, and San Roman Eduardo E Department of Intensive Care Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina..
    • Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina. gtusman@hotmail.com.
    • Respir Care. 2020 Jan 1; 65 (1): 11-20.

    BackgroundThe difference between Bohr and Enghoff dead space are not well described in ARDS patients. We aimed to analyze the effect of PEEP on the Bohr and Enghoff dead spaces in a model of ARDS.Methods10 pigs submitted to randomized PEEP steps of 0, 5, 10, 15, 20, 25 and 30 cm H2O were evaluated with the use of lung ultrasound images, alveolar-arterial oxygen difference (P(A-a)O2 ), transpulmonary mechanics, and volumetric capnography at each PEEP step.ResultsAt PEEP ≥ 15 cm H2O, atelectasis and P(A-a)O2 progressively decreased while end-inspiratory transpulmonary pressure (PL), end-expiratory PL, and driving PL increased (all P < .001). Bohr dead space (VDBohr /VT), airway dead space (VDaw /VT), and alveolar dead space (VDalv /VTalv ) reached their highest values at PEEP 30 cm H2O (0.69 ± 0.10, 0.53 ± 0.13 and 0.35 ± 0.06, respectively). At PEEP <15 cm H2O, the increases in atelectasis and P(A-a)O2 were associated with negative end-expiratory PL and highest driving PL. VDBohr /VT and VDaw /VT showed the lowest values at PEEP 0 cm H2O (0.51 ± 0.08 and 0.32 ± 0.08, respectively), whereas VDalv /VTalv increased to 0.27 ± 0.05. Enghoff dead space and its derived VDalv /VTalv showed high values at low PEEPs (0.86 ± 0.02 and 0.79 ± 0.04, respectively) and at high PEEPs (0.84 ± 0.04 and 0.65 ± 0.12), with the lowest values at 15 cm H2O (0.77 ± 0.05 and 0.61 ± 0.11, respectively; all P < .001).ConclusionsBohr dead space was associated with lung stress, whereas Enghoff dead space was partially affected by the shunt effect.Copyright © 2020 by Daedalus Enterprises.

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