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Anesth Analg 2000;90:85
© 2000 International Anesthesia Research Society

CRITICAL CARE AND TRAUMA

Positive End-Expiratory Pressure Has Little Effect on Carbon Dioxide Elimination After Cardiac Surgery

Roger P. R. Smith, MB, ChB, FRCA, and Roger Fletcher, MD, FRCA

Directorate of Anaesthetics, Manchester Royal Infirmary, Central Manchester Hospitals Trust, Manchester, United Kingdom

Address correspondence and reprint requests to Dr. Roger Fletcher, Directorate of Anaesthetics, Manchester Royal Infirmary, Central Manchester Hospitals Trust, Oxford Rd., Manchester M13 9WL, United Kindgom.

We investigated the effects of positive end-expiratory pressure (PEEP) on carbon dioxide (CO2) elimination in a cross-over study of 14 patients whose lungs were ventilated after cardiac surgery. They initially received either 7.5 cm H2O PEEP or zero end-expiratory pressure and were then changed over to the other mode. We measured CO2 minute elimination ({image}CO2) and "efficiency," a quantification of the shape of CO2 single-breath test (SBT-CO2), the plot of expired CO2 against expired volume. {image}CO2 and efficiency (and therefore the shape of SBT-CO2) were not significantly affected by PEEP. These results agree with findings in patients with acute lung injury, but are in contrast with those in an open-chest dog model, in which 7.5 cm H2O PEEP caused a 19% decrease in {image}CO2 and significant changes in SBT-CO2.

Implications: During artificial ventilation, applying a positive pressure in expiration expands the lung and improves the uptake of oxygen, but there is a theoretical risk of reduced carbon dioxide elimination. We applied positive end-expiratory pressure to patients immediately after heart surgery and found that it has no effect on carbon dioxide elimination.




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U. Lucangelo, F. Bernabe, S. Vatua, G. Degrassi, A. Villagra, R. Fernandez, P. V. Romero, P. Saura, M. Borelli, and L. Blanch
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[Abstract] [Full Text] [PDF]


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 © 2000 by the International Anesthesia Research Society.