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PEEP and "reverse mismatch". A case where less PEEP is best
F H Hawker1, P J Torzillo, A E Southee
1Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Chest
|April 1, 1991
Summary
Positive end-expiratory pressure (PEEP) adjustment can improve lung perfusion in patients with lung collapse. Reducing PEEP in a patient with left lower lobe collapse improved ventilation and oxygenation.
Area of Science:
- Pulmonary Medicine
- Radiology
- Critical Care
Background:
- Lung collapse can lead to ventilation-perfusion (V/Q) mismatch.
- Positive pressure ventilation, including intermittent positive-pressure ventilation (IPPV) and positive end-expiratory pressure (PEEP), is used to manage lung collapse.
Observation:
- A V/Q lung scan was performed on a patient with left lower lobe (LLL) collapse receiving IPPV and PEEP.
- The initial scan showed absent ventilation and hyperperfusion to the collapsed LLL.
Findings:
- PEEP was reduced from 12 to 5 cm H2O.
- A repeat V/Q scan demonstrated a more even distribution of pulmonary perfusion after PEEP reduction.
- Arterial hypoxemia improved following the PEEP adjustment.
Implications:
- Adjusting PEEP levels can optimize pulmonary perfusion in cases of lung collapse.
- V/Q scanning is a valuable tool for assessing the effects of ventilation strategies on lung perfusion.
- Optimizing PEEP may improve oxygenation in patients with lung collapse and V/Q mismatch.