Positive end expiratory pressure titration guided by plateau pressure in chronic obstructive pulmonary disease patients.

BACKGROUND: PEEP decreases intrinsic PEEP (PEEPi) in COPD patients. However, the best PEEP for someone with COPD is unclear.

METHODS: Ten COPD patients who received invasive mechanical ventilation were enrolled. Before PEEP titration, subjects were sedated and received mandatory ventilation. PEEP increased from 0 to 15 cmH2 O. At each PEEP, peak pressure (Ppeak), plateau pressure (Pplat), PEEPi, and other variables were recorded. Increment of Pplat (ΔPplat) and PEEPi were plotted against PEEP applied. The best PEEP was recorded at the cross of the two curves.

RESULTS: From PEEP = 0 cmH2 O to best PEEP, Ppeak (37.4 ± 5.1 vs. 38.4 ± 4.9 cmH2 O) and Pplat (18.7 ± 3.3 vs. 20.4 ± 3.2 cmH2 O) increased slightly, resistance (28.1 ± 5.6 vs. 26.6 ± 5.0 cmH2 O/l/s) decreased slightly, and PEEPi (7.9 ± 2.3 vs. 1.5 ± 0.4 cmH2 O) decreased sharply. Compliance, heart rate, blood pressure, and SpO2 did not change. However, from best PEEP to PEEP = 15 cmH2 O, Ppeak (38.4 ± 4.9 vs. 44.9 ± 4.3 cmH2 O) and Pplat (20.4 ± 3.2 vs. 27.6 ± 3.3 cmH2 O) increased sharply, and systolic blood pressure (116 ± 13 vs. 99 ± 14 mmHg) and compliance (46.1 ± 18.1 vs. 37.7 ± 10.6 mL/cmH2 O) decreased sharply. At the same time, PEEPi (1.5 ± 0.4 vs. 0.7 ± 0.8 cmH2 O) decreased only slightly, and resistance, heart rate, and SpO2 did not change.

CONCLUSIONS: It is feasible to use Pplat as a simple way of determining the best PEEP in COPD patients.