Rir. Russell et al., THE EFFECT OF VARIATIONS IN POSITIVE END-EXPIRATORY PRESSURE ON GAS-EXCHANGE IN VENTILATED CHILDREN WITH LIVER-DISEASE, European journal of pediatrics, 152(9), 1993, pp. 742-744
The effect of varying the positive end expiratory pressure (PEEP) leve
l during mechanical ventilation has been assessed in ten children with
liver disease, mean age 3.8 years. PEEP was increased 3 cmH2O above t
he child's original (baseline) PEEP level and then decreased either by
3 cmH2O below the baseline or to 0 cmH2O. In all ten children increas
ing the PEEP above the baseline improved oxygenation; in the group ove
rall the median PaO2 increased from 90 mmHg to 97 mm Hg (P<0.01). In e
ight of the ten children decreasing the PEEP level below the baseline
resulted in a deterioration in oxygenation; in the group overall the m
edian PaO2 decreased from 91 mmHg to 82 mmHg (P < 0.05). Changes in PE
EP levels, however, did not result in clinically significant alteratio
ns in PaCO2, heart rate or blood pressure. We conclude that modest inc
reases in PEEP are well tolerated in children with liver disease and r
esult in an improvement in oxygenation.