EZALIA I. LEFTWICH, M.D.; RAPHAEL J. WITORSCH, Ph.D.; PHILIP WITORSCH, M.D., F.A.C.P.
Positive end-expiratory pressure was used in 15 patients with severe hypoxemia because we could not attain an arterial Po2 of 50 mm Hg or greater with intermittent positive-pressure ventilation and an inspired O2 concentration of 50% or less. Before the institution of positive end-expiratory pressure, arterial Po2 levels ranged from 22 to 76 mm Hg, with inspired O2 concentrations of 40% to 100%. In all but one patient positive end-expiratory pressure, using inspired O2 concentrations of 30% to 50%, resulted in arterial Po2 levels ranging from 60 to 219 mm Hg. Measurements of central venous pressure, arterial blood pressure, pulse rate, and urine output showed no deleterious changes from this procedure. Positive end-expiratory pressure seems to effectively achieve adequate arterial Po2 levels without the use of potentially toxic inspired O2 concentrations, in patients with otherwise refractory hypoxemia. It apparently prevents alveolar collapse during expiration, thus improving ventilation-perfusion relationships.
LEFTWICH EI, WITORSCH RJ, WITORSCH P. Positive End-Expiratory Pressure in Refractory Hypoxemia: A Critical Evaluation. Ann Intern Med. ;79:187–193. doi: 10.7326/0003-4819-79-2-187
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Published: Ann Intern Med. 1973;79(2):187-193.
Emergency Medicine, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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