Breathing near to residual volume with positive expiratory pressure

Breathing near to residual volume produces arterial desaturation demonstrable by ear oximetry. This paper describes the effect on arterial saturation measured by an ear oximeter of expiring to residual volume, taking a normal inspired volume of air from ambient pressure, and then expiring to residual volume against a pressure of 10-15 cm of water. This breathing pattern was continued for several minutes. Carbon dioxide output and oxygen consumption were measured during the study and the closing volume at ambient pressure was compared with that at increased expiratory pressure. Arterial desaturation was actually increased by the increased airways pressure, the increase being modified both by minute volume and tidal volume. Closing volume was only slightly increased, but residual volume was considerably increased, by the raised pressure. The desaturation is only partially explicable on a ventilatory basis, and there is probably a component concerned with perfusion, and the absence of perfusion adaptation from hypoxic areas does not appear to accord with current hypotheses.