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Anesth Analg 2005;100:1112-1116
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000147505.98565.AC

CRITICAL CARE AND TRAUMA

The Effect of Positive End-Expiratory Pressure Level on Peak Expiratory Flow During Manual Hyperinflation

Camila Savian, BPHty*, Pamela Chan, BPHty, MPHtyStud{dagger}{ddagger}, and Jennifer Paratz, MPHty, PhD, FACP*{ddagger}

*Alfred Hospital/La Trobe University, Melbourne, {dagger}Prince of Wales Hospital, Hong Kong, {ddagger}University of Queensland, Australia

Address correspondence and reprint requests to C. Savian, Cardiopulmonary Research Unit, 4th Floor, Philip Block, Alfred Hospital, Commercial Rd, Prahran 3181, Victoria, Australia. Address e-mail to Camila_Savian{at}hotmail.com.

Including positive end-expiratory pressure (PEEP) in the manual resuscitation bag (MRB) may render manual hyperinflation (MHI) ineffective as a secretion maneuver technique in mechanically ventilated patients. In this study we aimed to determine the effect of increased PEEP or decreased compliance on peak expiratory flow rate (PEF) during MHI. A blinded, randomized study was performed on a lung simulator by 10 physiotherapists experienced in MHI and intensive care practice. PEEP levels of 0–15 cm H2O, compliance levels of 0.05 and 0.02 L/cm H2O, and MRB type were randomized. The Mapleson-C MRB generated significantly higher PEF (P < 0.01, d = 2.72) when compared with the Laerdal MRB for all levels of PEEP. In normal compliance (0.05 L/cm H2O) there was a significant decrease in PEF (P < 0.01, d = 1.45) for a PEEP more than 10 cm H2O in the Mapleson-C circuit. The Laerdal MRB at PEEP levels of more than 10 cm H2O did not generate a PEF that is theoretically capable of producing two-phase gas-liquid flow and, consequently, mobilizing pulmonary secretions. If MHI is indicated as a result of mucous plugging, the Mapleson-C MRB may be the most effective method of secretion mobilization.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.