RESUMEN
PURPOSE: To analyze the effects of positive end-expiratory pressure (PEEP) on Bohr's dead space (VDBohr/VT) in patients with acute respiratory distress syndrome (ARDS). MATERIAL AND METHODS: Fourteen ARDS patients under lung protective ventilation settings were submitted to 4 different levels of PEEP (0, 6, 10, 16â¯cmH2O). Respiratory mechanics, hemodynamics and volumetric capnography were recorded at each protocol step. RESULTS: Two groups of patients responded differently to PEEP when comparing baseline with 16-PEEP: those in which driving pressure increased > 15% (∆PË15%, nâ¯=â¯7, pâ¯=â¯.016) and those in which the change was ≤15% (∆P≤15%, nâ¯=â¯7, pâ¯=â¯.700). VDBohr/VT was higher in ∆P≤15% than in ∆P≤15% patients at baseline ventilation [0.58 (0.49-0.60) vs 0.46 (0.43-0.46) pâ¯=â¯.018], at 0-PEEP [0.50 (0.47-0.54) vs 0.41 (0.40-0.43) pâ¯=â¯.012], at 6-PEEP [0.55 (0.49-0.57) vs 0.44 (0.42-0.45) pâ¯=â¯.008], at 10-PEEP [0.59 (0.51-0.59) vs 0.45 (0.44-0.46) pâ¯=â¯.006] and at 16-PEEP [0.61 (0.56-0.65) vs 0.47 (0.45-0.48) pâ¯=â¯.001]. We found a good correlation between ∆P and VDBohr/VT only in the ∆PË15% group (râ¯=â¯0.74, pâ¯<â¯.001). CONCLUSIONS: Increases in PEEP result in higher VDBohr/VT only when associated with an increase in driving pressure.