Effect of positive end-expiratory pressure on additional passive ventilation generated by CPR compressions in a porcine model

Intensive Care Medicine Experimental

James P. Keith¹  Katlyn Burr¹  Yosef Levenbrown²  Anne Hesek³  Md Jobayer Hossain⁴  Thomas H. Shaffer⁵ 

[1] Department of Respiratory Care, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA;Division of Pediatric Critical Care, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, 19803, Wilmington, DE, USA;Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA;Nemours Biomedical Research, Wilmington, DE, USA;Nemours Biomedical Research, Wilmington, DE, USA;Department of Applied Economics and Statistics, University of Delaware, Newark, DE, USA;Nemours Biomedical Research/Center for Pediatric Lung Research, Wilmington, DE, USA;Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA;Departments of Pediatrics and Physiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA;

关键词: Cardiac arrest;    Resuscitation;    Ventilation;    Compressions;    Tidal volume;   

DOI  :  10.1186/s40635-021-00401-y

来源: Springer

【 摘 要 】

BackgroundCompressions given during cardiopulmonary resuscitation generate small, ineffective passive ventilations through oscillating waves. Positive end-expiratory pressure increases the volume of these passive ventilations; however, its effect on passive ventilation is unknown. Our objective was to determine if increasing positive end-expiratory pressure during cardiopulmonary resuscitation increases passive ventilation generated by compressions to a clinically significant point. This study was conducted on 13 Landrace-Yorkshire pigs. After inducing cardiac arrest with bupivacaine, cardiopulmonary resuscitation was performed with a LUCAS 3.1. During cardiopulmonary resuscitation, pigs were ventilated at a positive end-expiratory pressure of 0, 5, 10, 15, 20 cmH2O (randomly determined) for 9 min. Using the NM3 respiratory monitoring device, expired minute ventilation and volumetric capnography were measured. Arterial blood gas was obtained for each positive end-expiratory pressure level to compare the effects of positive end-expiratory pressure on carbon dioxide.ResultsIncreasing positive end-expiratory pressure from 0 to 20 cmH2O increased the mean (SEM) expired minute ventilation from 6.33 (0.04) to 7.33 (0.04) mL/min. With the 5-cmH2O incremental increases in positive end-expiratory pressure from 0 to 20 cmH2O, volumetric capnography increased from a mean (SEM) of 94.19 (0.78) to 115.18 (0.8) mL/min, except for 15 cmH2O, which showed greater carbon dioxide exhalation with volumetric capnography compared with 20 cmH2O. PCO2 declined significantly as positive end-expiratory pressure was increased from 0 to 20 cmH2O.ConclusionsWhen increasing positive end-expiratory pressure from 0 to 20, the contribution to overall ventilation from gas oscillations generated by the compressions became more significant, and may even lead to hypocapnia, especially when using positive end-expiratory pressures between 15 and 20.

【 授权许可】

CC BY