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2017, Number 4

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Med Crit 2017; 31 (4)

The use of final positive expiratory pressure (FPEP) in the management of acute respiratory failure

Sandoval ZJ, Martínez SJ, Shapiro RM

Language: Spanish
References: 40
Page: 183-189
PDF size: 220.29 Kb.


ABSTRACT

A group of 19 patients with acute respiratory failure (ARF) of diverse etiology received as a part of their treatment positive end expiratory pressure (PEEP). All of them were evaluated clinicaly and with several respiratory parameters. The response to treatment, complications and mortality rates are analyzed.
The addition of PEEP in the management of this patients was accompanied by a significant increase of the PAO2 (p ‹ 0.001) and a simultaneous decrease in the following parameters: FiO2/PaO2 index, Alveolo-arterial oxygen gradient (A-aDO2) and the pulmonary shunt (Qs/Qt). No hemodynamic deterioration was observed. None of the clinical parameters such as: blood pressure, heart rate and diuresis was significantly modified; neither a significant change in the arterious-venous oxygen gradient (a-vDO2) was detected.
Pneumothorax as a complication of the use of PEEP was present in the 10.4% of the patients.
The course of the ARF was toward the improvement in most of them at the end of the evolution. The high mortality rate in this study was considered to be secondary to uncontrolable sepsis and also to the presence of multiple organ failure. In none of the cases the poor outcome was secondary to refractory acute hypoxemia.
PEEP which is one of the varieties of continuos positive pressure ventilation (CPPV) represents one of the most importants therapeutic advances in the last decade in the management of patients with acute respiratory failure.


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