Fluctuating PEEP versus conventional PEEP in diffuse and unilateral lung injury induced by oleic acid

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Abstract
Effects of fluctuating positive end–expiratory pressure (F–PEEP), in which end–expiratory pressure (EEP) was periodically changed from 0.5 to 1.5 kPa with a periodic time of 6 min, and conventional PEEP (CPEEP) with a fixed EEP of 1.0 kPa, were comparatively studied in diffuse (Group 1) and unilaterally dominant lung injury (Group II). Although F–PEEP produced cyclic alterations of Pao2 in both groups, Pao2 changed in proportion to EEP in Group I and in reciprocal proportion to EEP in Group II. There was no significant difference between Pao2 and Qs/Qj during F–PEEP and those during C–PEEP in Group I, whereas in Group II, F–PEEP produced a significantly greater improvement of pulmonary oxygenation at the low EEP phase than C–PEEP. In both groups, the degree of hemodynamic depression was proportional to EEP. These results suggest that F–PEEP should be indicated for acute hypoxic respiratory failure with uneven distribution of lung injury.