Computer-controlled positive end-expiratory pressure titration for effective oxygenation without frequent blood gases

We have previously designed a computerized system to automatically deliver PEEP to maintain functional residual capacity (FRC) at a desired value. The purpose of this study was to compare the computerized PEEP titration system with a standard clinical PEEP titration algorithm in the animal adult respiratory distress syndrome (ARDS) model. Thirty mongrel dogs were anesthetized, paralyzed, intubated, and ventilated. An acute pulmonary injury was produced using 0.09 ml/kg of oleic acid. The animals were then given PEEP for 5 h. Arterial and venous blood gases, BP, thermodilution cardiac output, heart rate, body temperature, total respiratory system compliance (Ctr), and end-tidal CO2 were measured every 30 min. FRC was measured using an automated sulfur hexafluoride washout system every 15 min. The animals were allocated randomly to three ten-animal groups. The first group had PEEP titrated using a standard clinical protocol; the remaining two groups had PEEP updated at 15-min intervals under computer control to maintain FRC at 1.4 times the postanesthetized, postparalyzed, preinjury value. The second group received fixed 3-cm H2O PEEP steps. The third group had variable size PEEP steps depending on the output of a proportional, integral, and derivative (PID) controller. PaCO2 was maintained at 35.8 +/- 3.4 (SD) torr. There was a significant difference in PEEP delivered between the three groups (p = .0006) and in FRC (p = .005). There was no significant difference in PaO2 (p = .80) or venous admixture (Qva/Qt) (p = .84) between the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)