Review: Artifical ventilation with positive end-expiratory pressure (PEEP)

CPPV (continuous positive pressure ventilation) is obviously superior to IPPV (intermittent positive pressure ventilation) for the treatment of patients with acute respiratory insufficiency (ARI) and results within a few minutes in a considerable increase in the oxygen transport. The principle is to add a positive end-expiratory plateau (PEEP) to IPPV, with a subsequent increase in FRC (functional residual capacity) resulting in re-opening in first and foremost,the declive alveolae, which can then once again take part in the gas exchange and possibly re-commence the disrupted surfactant production. In this manner the ventilation/perfusion ratio in the diseased lungs is normalized and the intrapulmonary shunting of venous blood $(\dot Q_s /\dot Q_t )$ will decrease. At the same time the dead space ventilation fraction (V_D/V_T) normalizes and the compliance of the lungs (C_L) increases. The PEEP value, which results in a maximum oxygen transport, and the lowest dead space fraction, also appears to result in the greatest total static compliance (CT) and the greatest increase in mixed venous oxygen tension $(P\bar vo_2 )$ ; this value can be termed “optimal PEEP”. The greater the FRC is, with an airway pressure = atmospheric pressure, the lower the PEEP value required in order to obtain maximum oxygen transport. If the optimal PEEP value is exceeded the oxygen transport will fall because of a falling $\dot Q_t $ (cardiac output) due to a reduction in venous return. CT and $P\bar vO_2 $ will fall and V_D/V_T will increase. Increasing hyperinflation of the alveolae will result in a rising danger of alveolar rupture. The critical use of CPPV treatment means that the lungs may be safeguarded against high oxygen percents. The mortality of newborn infants with RDS (respiratory distress syndrome) has fallen considerably after the general introduction of CPPV and CPAP (continuous positive airway pressures). The same appears to be the case with adults suffering from ARI (acute respiratory insufficiency).