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1

RAZZAQUE, Usman, RAHEEL AZHAR, TASSADAQ KHURSHID, Khalid Zaeem, and Syed Majid. "POSITIVE END EXPIRATORY PRESSURE (PEEP);." Professional Medical Journal 19, no. 01 (2012): 098–104. http://dx.doi.org/10.29309/tpmj/2012.19.01.1953.

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Introduction: Thoracic surgeries and aesthesia for lung resection has presented anaesthesiologists with certain uniquephysiological problems. These include placing (lateral decubitus position) in order to obtain optimal access for most operations on lungs, pleura,esophagus, and great vessels, opening the chest wall (open pneumothorax) and one lung ventilation anaesthesia. One lung ventilationanaesthesia and lateral decubitus position produces decrease in functional residual capacity and an obligatory right to left shunt that rangesfrom 15% to 40% leading to increase in ventilation perfusion (V
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Matuschak, G. M., M. R. Pinsky, and R. M. Rogers. "Effects of positive end-expiratory pressure on hepatic blood flow and performance." Journal of Applied Physiology 62, no. 4 (1987): 1377–83. http://dx.doi.org/10.1152/jappl.1987.62.4.1377.

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Positive end-expiratory pressure (PEEP) may impair extrapulmonary organ function. However, the effects of PEEP on the liver are unclear. We tested the hypothesis that at a constant cardiac output (CO), PEEP does not induce changes in hepatic blood flow (QL) and parenchymal performance. In splenectomized, close-chested canine preparations (group I, n = 6), QL was derived as hepatic outflow using electromagnetic flow probes (QLemf), and hepatic performance was defined by extraction and clearance of indocyanine green (ICG). In a noninvasive model (group II, n = 7), the effects of PEEP on hepatic
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Östberg, Erland, Arnar Thorisson, Mats Enlund, Henrik Zetterström, Göran Hedenstierna, and Lennart Edmark. "Positive End-expiratory Pressure and Postoperative Atelectasis." Anesthesiology 131, no. 4 (2019): 809–17. http://dx.doi.org/10.1097/aln.0000000000002764.

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Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Positive end-expiratory pressure (PEEP) increases lung volume and protects against alveolar collapse during anesthesia. During emergence, safety preoxygenation preparatory to extubation makes the lung susceptible to gas absorption and alveolar collapse, especially in dependent regions being kept open by PEEP. We hypothesized that withdrawing PEEP before starting emergence preoxygenation would limit postoperative atelectasis formation. Methods This was a randomized controlled ev
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Mazzinari, Guido, Oscar Diaz-Cambronero, Jose Miguel Alonso-Iñigo, et al. "Intraabdominal Pressure Targeted Positive End-expiratory Pressure during Laparoscopic Surgery." Anesthesiology 132, no. 4 (2020): 667–77. http://dx.doi.org/10.1097/aln.0000000000003146.

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Abstract Background Pneumoperitoneum for laparoscopic surgery is associated with a rise of driving pressure. The authors aimed to assess the effects of positive end-expiratory pressure (PEEP) on driving pressure at varying intraabdominal pressure levels. It was hypothesized that PEEP attenuates pneumoperitoneum-related rises in driving pressure. Methods Open-label, nonrandomized, crossover, clinical trial in patients undergoing laparoscopic cholecystectomy. “Targeted PEEP” (2 cm H2O above intraabdominal pressure) was compared with “standard PEEP” (5 cm H2O), with respect to the transpulmonary
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Henning, R. J. "Effects of positive end-expiratory pressure on the right ventricle." Journal of Applied Physiology 61, no. 3 (1986): 819–26. http://dx.doi.org/10.1152/jappl.1986.61.3.819.

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Transmural cardiac pressures, stroke volume, right ventricular volume, and lung water content were measured in normal dogs and in dogs with oleic acid-induced pulmonary edema (PE) maintained on positive-pressure ventilation. Measurements were performed prior to and following application of 20 cmH2O positive end-expiratory pressure (PEEP). Colloid fluid was given during PEEP for ventricular volume expansion before and after the oleic acid administration. PEEP significantly increased pleural pressure and pulmonary vascular resistance but decreased right ventricular volume, stroke volume, and mea
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6

Brandolese, R., C. Broseghini, G. Polese, et al. "Effects of intrinsic PEEP on pulmonary gas exchange in mechanically-ventilated patients." European Respiratory Journal 6, no. 3 (1993): 358–63. http://dx.doi.org/10.1183/09031936.93.06030358.

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The aim of the study was to assess the impact of the intrinsic positive end-expiratory pressure (PEEPi) on pulmonary gas exchange in mechanically-ventilated patients, by comparing the effects of similar levels (0.8-0.9 kPa) of positive end-expiratory pressure (PEEP) and PEEPi. Ten patients with acute respiratory failure, without chronic airway disease, were studied with three ventilatory modes: 1) intermittent positive pressure ventilation with zero end-expiratory pressure (ZEEP mode); 2) continuous positive pressure ventilation with PEEP set by the ventilator (PEEP mode); and 3) intrinsic PEE
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Formenti, Paolo, Sara Miori, Andrea Galimberti, and Michele Umbrello. "The Effects of Positive End Expiratory Pressure and Lung Volume on Diaphragm Thickness and Thickening." Diagnostics 13, no. 6 (2023): 1157. http://dx.doi.org/10.3390/diagnostics13061157.

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Introduction: Diaphragm dysfunction is common in patients undergoing mechanical ventilation. The application of positive end-expiratory pressure (PEEP) and the varying end-expiratory lung volume cause changes in diaphragm geometry. We aimed to assess the impact of the level of PEEP and lung inflation on diaphragm thickness, thickening fraction and displacement. Methods: An observational study in a mixed medical and surgical ICU was conducted. The patients underwent a PEEP-titration trial with the application of three random levels of PEEP: 0 cmH2O (PEEP0), 8 cmH2O (PEEP8) and 15 cmH2O (PEEP15)
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Takeuchi, Muneyuki, Sven Goddon, Marisa Dolhnikoff, et al. "Set Positive End-expiratory Pressure during Protective Ventilation Affects Lung Injury." Anesthesiology 97, no. 3 (2002): 682–92. http://dx.doi.org/10.1097/00000542-200209000-00023.

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Background The most appropriate method of determining positive end-expiratory pressure (PEEP) level during a lung protective ventilatory strategy has not been established. Methods In a lavage-injured sheep acute respiratory distress syndrome model, the authors compared the effects of three approaches to determining PEEP level after a recruitment maneuver: (1) 2 cm H(2)O above the lower inflection point on the inflation pressure-volume curve, (2) at the point of maximum curvature on the deflation pressure-volume curve, and (3) at the PEEP level that maintained target arterial oxygen partial pre
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9

Risoe, C., C. Hall, and O. A. Smiseth. "Splanchnic vascular capacitance and positive end-expiratory pressure in dogs." Journal of Applied Physiology 70, no. 2 (1991): 818–24. http://dx.doi.org/10.1152/jappl.1991.70.2.818.

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We have investigated the effect of positive end-expiratory pressure ventilation (PEEP) on regional splanchnic vascular capacitance. In 12 anesthetized dogs hepatic and splenic blood volumes were assessed by sonomicrometry. Vascular pressure-diameter curves were defined by obstructing hepatic outflow. With 10 and 15 cmH2O PEEP portal venous pressure increased 3.1 +/- 0.3 and 5.1 +/- 0.4 mmHg (P less than 0.001) while hepatic venous pressure increased 4.9 +/- 0.4 and 7.3 +/- 0.4 mmHg (P less than 0.001), respectively. Hepatic blood volume increased (P less than 0.01) 3.8 +/- 0.9 and 6.3 +/- 1.4
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10

van den Berg, B., H. Stam, and JM Bogaard. "Effects of PEEP on respiratory mechanics in patients with COPD on mechanical ventilation." European Respiratory Journal 4, no. 5 (1991): 561–67. http://dx.doi.org/10.1183/09031936.93.04050561.

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We studied the effects of positive end-expiratory pressure (PEEP) applied by the ventilator on respiratory mechanics in ventilated patients with chronic obstructive pulmonary disease (COPD). Airway pressures, relaxed expiratory flow-volume curves and end-expiratory volumes (EEV) were measured. In all patients investigated without PEEP applied by the ventilator, an intrinsic PEEP level (PEEPi) and a concavity in the flow-volume curve was present. Ventilator-PEEP caused a significant decrease in PEEPi in all patients (p less than 0.01). In patients in whom ventilator-PEEP exceeded PEEPi, signifi
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Carroll, Gilbert C., Kenneth J. Tuman, Berton Braverman, et al. "Minimal Positive End-Expiratory Pressure (PEEP) May be “Best PEEP”." Chest 93, no. 5 (1988): 1020–25. http://dx.doi.org/10.1378/chest.93.5.1020.

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Veddeng, O. J., E. S. Myhre, C. Risoe, and O. A. Smiseth. "Selective positive end-expiratory pressure and intracardiac dimensions in dogs." Journal of Applied Physiology 73, no. 5 (1992): 2016–20. http://dx.doi.org/10.1152/jappl.1992.73.5.2016.

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Effects of differential ventilation with general vs. selective right (R) and left (L) positive end-expiratory pressure (PEEP) on left (LV) and right ventricular (RV) end-diastolic dimensions were compared in seven pentobarbital-anesthetized dogs. All three modes of PEEP reduced LV cross-sectional area: general PEEP more than RPEEP and RPEEP more than LPEEP. General PEEP and, to a lesser degree, RPEEP decreased both the LV anteroposterior diameter and LV septum-free wall diameter, whereas LPEEP reduced the LV septum-free wall diameter only. Cardiac output was unaffected by LPEEP, whereas genera
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Kumaresan, Abirami, Robert Gerber, Ariel Mueller, Stephen H. Loring, and Daniel Talmor. "Effects of Prone Positioning on Transpulmonary Pressures and End-expiratory Volumes in Patients without Lung Disease." Anesthesiology 128, no. 6 (2018): 1187–92. http://dx.doi.org/10.1097/aln.0000000000002159.

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Abstract Background The effects of prone positioning on esophageal pressures have not been investigated in mechanically ventilated patients. Our objective was to characterize effects of prone positioning on esophageal pressures, transpulmonary pressure, and lung volume, thereby assessing the potential utility of esophageal pressure measurements in setting positive end-expiratory pressure (PEEP) in prone patients. Methods We studied 16 patients undergoing spine surgery during general anesthesia and neuromuscular blockade. We measured airway pressure, esophageal pressures, airflow, and volume, a
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Smith, T. C., and J. J. Marini. "Impact of PEEP on lung mechanics and work of breathing in severe airflow obstruction." Journal of Applied Physiology 65, no. 4 (1988): 1488–99. http://dx.doi.org/10.1152/jappl.1988.65.4.1488.

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Positive end-expiratory pressure (PEEP) has generally been withheld from the treatment of patients with chronic airflow obstruction (CAO), in view of the risk of hyperinflation and lack of documented benefit. We studied 10 mechanically ventilated patients with exacerbated CAO and air trapping to determine the impact of PEEP on lung mechanics, alveolar pressure, and the work of breathing. PEEP levels of 5 and 10 cmH2O were applied to patients whose end-expiratory alveolar pressures were documented to be positive when breathing against ambient pressure (the auto-PEEP effect). All patients were s
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Brady, Ken M., R. Blaine Easley, Kathleen Kibler, et al. "Positive end-expiratory pressure oscillation facilitates brain vascular reactivity monitoring." Journal of Applied Physiology 113, no. 9 (2012): 1362–68. http://dx.doi.org/10.1152/japplphysiol.00853.2012.

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The pressure reactivity index (PRx) identifies optimal cerebral perfusion pressure after traumatic brain injury. We describe a method to improve PRx precision by induced variations in arterial blood pressure (ABP) using positive end-expiratory pressure (PEEP) modulation ( iPRx). Neonatal swine ( n = 10) were ventilated with static PEEP and then with PEEP oscillated between 5 and 10 cmH2O at a frequency of 1/min. PRx was recorded as a moving correlation coefficient between ABP and intracranial pressure (ICP) from spontaneous ABP activity (0.05-0.003 Hz) during static PEEP. iPRx was similarly re
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Thio, Marta, Jennifer A. Dawson, Kelly J. Crossley, et al. "Delivery of positive end-expiratory pressure to preterm lambs using common resuscitation devices." Archives of Disease in Childhood - Fetal and Neonatal Edition 104, no. 1 (2018): F83—F88. http://dx.doi.org/10.1136/archdischild-2017-314064.

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BackgroundIn neonatal resuscitation, a ventilation device providing positive end-expiratory pressure (PEEP) is recommended. There is limited information about PEEP delivery in vivo, using different models of self-inflating bag (SIB) at different inflation rates and PEEP settings.MethodsWe compared PEEP delivery to intubated preterm lambs using four commonly available models of paired SIBs and PEEP valves, with a T-piece, with gas flow of 8 L/min. Peak inspiratory pressure inflations of 30 cmH2O, combined with set PEEP of 5, 7 and 10 cmH2O, were delivered at rates of 20, 40 and 60/min. These co
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Slinger, Peter D., Marelise Kruger, Karen McRae, and Timothy Winton. "Relation of the Static Compliance Curve and Positive End-expiratory Pressure to Oxygenation during One-lung Ventilation." Anesthesiology 95, no. 5 (2001): 1096–102. http://dx.doi.org/10.1097/00000542-200111000-00012.

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Background Positive end-expiratory pressure (PEEP) is commonly applied to the ventilated lung to try to improve oxygenation during one-lung ventilation but is an unreliable therapy and occasionally causes arterial oxygen partial pressure (PaO(2)) to decrease further. The current study examined whether the effects of PEEP on oxygenation depend on the static compliance curve of the lung to which it is applied. Methods Forty-two adults undergoing thoracic surgery were studied during stable, open-chest, one-lung ventilation. Arterial blood gases were measured during two-lung ventilation and one-lu
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Juhl-Olsen, Peter, Johan Fridolf Hermansen, Christian Alcaraz Frederiksen, Linda Aagaard Rasmussen, Carl-Johan Jakobsen, and Erik Sloth. "Positive End-expiratory Pressure Influences Echocardiographic Measures of Diastolic Function." Anesthesiology 119, no. 5 (2013): 1078–86. http://dx.doi.org/10.1097/aln.0b013e3182a10b40.

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Abstract Background: Ultrasonography of the cardiovascular system is pivotal for hemodynamic assessment. Diastolic function is evaluated with a combination of tissue Doppler (e’ and a’) and pulsed Doppler (E and A) measures of transmitral- and mitral valve annuli velocities. However, accurate echocardiographic evaluation in the intensive care unit or perioperative setting is contingent on relative resistance to positive pressure ventilation and changes in preload. This study aimed to evaluate the effects of positive end-expiratory pressure (PEEP) and positioning on echocardiographic measures o
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Blevins, Stephen S., Martha J. Connolly, and Drew E. Carlson. "Baroreceptor-mediated compensation for hemodynamic effects of positive end-expiratory pressure." Journal of Applied Physiology 86, no. 1 (1999): 285–93. http://dx.doi.org/10.1152/jappl.1999.86.1.285.

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The roles of the carotid arterial baroreceptor reflex and of vagally mediated mechanisms during positive end-expiratory pressure (PEEP) were determined in pentobarbital-anesthetized dogs with isolated carotid sinuses. Spontaneously breathing dogs were placed on PEEP (5–10 cmH2O) with the carotid sinus pressure set to the systemic arterial pressure (with feedback) or to a constant pressure (no feedback). Right atrial volume was measured with a conductance catheter. With carotid baroreceptor feedback before bilateral cervical vagotomy, total peripheral resistance increased ( P < 0.01) and mea
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Fuhrman, B. P., D. L. Smith-Wright, S. Venkataraman, and D. F. Howland. "Pulmonary vascular resistance after cessation of positive end-expiratory pressure." Journal of Applied Physiology 66, no. 2 (1989): 660–68. http://dx.doi.org/10.1152/jappl.1989.66.2.660.

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This report describes the pulmonary vascular response of infant lamb lung to abrupt cessation of positive end-expiratory pressure (PEEP) during volume-regulated continuous positive-pressure breathing (CPPB). In an intact, endobronchially ventilated preparation, the increase in left lung blood flow (QL) after abrupt cessation of 11 Torr left lung PEEP was found to be gradual, although peak airway pressure (Pmax) fell promptly from 36 to 14 Torr; 49% of the increase in QL occurred greater than 10 s after cessation of PEEP. Recruitment of zone I vasculature that had been created by balloon occlus
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Johnston, William E., Brendan P. Conroy, Gregory S. Miller, Cheng Y. Lin, and Donald J. Deyo. "Hemodynamic Benefit of Positive End-expiratory Pressure during Acute Descending Aortic Occlusion." Anesthesiology 97, no. 4 (2002): 875–81. http://dx.doi.org/10.1097/00000542-200210000-00019.

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Background Acute aortic occlusion in vascular surgery patients abruptly increases arterial resistance and blood pressure, which, in turn, makes subsequent volume expansion during cross-clamp application difficult. The use of vasodilatory drugs or volatile anesthetic agents to attenuate this response may have persistent detrimental effects after clamp removal. Another potential therapy that produces rapid effects on myocardial loading conditions is positive end-expiratory pressure (PEEP). In a porcine model of acute aortic clamping, the hemodynamic consequences of 15 cm H(2)O PEEP with and with
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Östberg, Erland, Arnar Thorisson, Mats Enlund, Henrik Zetterström, Göran Hedenstierna, and Lennart Edmark. "Positive End-expiratory Pressure Alone Minimizes Atelectasis Formation in Nonabdominal Surgery." Anesthesiology 128, no. 6 (2018): 1117–24. http://dx.doi.org/10.1097/aln.0000000000002134.

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Abstract Background Various methods for protective ventilation are increasingly being recommended for patients undergoing general anesthesia. However, the importance of each individual component is still unclear. In particular, the perioperative use of positive end-expiratory pressure (PEEP) remains controversial. The authors tested the hypothesis that PEEP alone would be sufficient to limit atelectasis formation during nonabdominal surgery. Methods This was a randomized controlled evaluator-blinded study. Twenty-four healthy patients undergoing general anesthesia were randomized to receive ei
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Syring, Rebecca S., Cynthia M. Otto, Rebecca E. Spivack, Klaus Markstaller, and James E. Baumgardner. "Maintenance of end-expiratory recruitment with increased respiratory rate after saline-lavage lung injury." Journal of Applied Physiology 102, no. 1 (2007): 331–39. http://dx.doi.org/10.1152/japplphysiol.00002.2006.

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Cyclical recruitment of atelectasis with each breath is thought to contribute to ventilator-associated lung injury. Extrinsic positive end-expiratory pressure (PEEPe) can maintain alveolar recruitment at end exhalation, but PEEPe depresses cardiac output and increases overdistension. Short exhalation times can also maintain end-expiratory recruitment, but if the mechanism of this recruitment is generation of intrinsic PEEP (PEEPi), there would be little advantage compared with PEEPe. In seven New Zealand White rabbits, we compared recruitment from increased respiratory rate (RR) to recruitment
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Mancebo, Jordi, Pierre Albaladejo, Dominique Touchard, et al. "Airway Occlusion Pressure to Titrate Positive End-expiratory Pressure in Patients with Dynamic Hyperinflation." Anesthesiology 93, no. 1 (2000): 81–90. http://dx.doi.org/10.1097/00000542-200007000-00016.

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Background Although the use of external positive end-expiratory pressure (PEEP) is recommended for patients with intrinsic PEEP, no simple method exists for bedside titration. We hypothesized that the occlusion pressure, measured from airway pressure during the phase of ventilator triggering (P0.1t), could help to indicate the effects of PEEP on the work of breathing (WOB). Methods Twenty patients under assisted ventilation with chronic obstructive pulmonary disease were studied with 0, 5, and 10 cm H2O of PEEP while ventilated with a fixed level of pressure support. Results PEEP 5 significant
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Markos, J., C. M. Doerschuk, D. English, B. R. Wiggs, and J. C. Hogg. "Effect of positive end-expiratory pressure on leukocyte transit in rabbit lungs." Journal of Applied Physiology 74, no. 6 (1993): 2627–33. http://dx.doi.org/10.1152/jappl.1993.74.6.2627.

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Previous experiments in humans and animals have shown that neutrophils (PMN) are delayed in the lung by the inhalation of cigarette smoke. Others have shown that cigarette smoking raises airway resistance, and it follows that this will increase the expiratory time constant of the airways. When the expiratory time constant of the airways exceeds that of the chest wall, alveolar pressure will rise and compress alveolar capillaries. To determine the effect of alveolar compression on PMN retention, we measured the arteriovenous (A-V) difference for leukocytes across the lung and determined the ret
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Duncan, A. W., T. E. Oh, and D. R. Hillman. "PEEP and CPAP." Anaesthesia and Intensive Care 14, no. 3 (1986): 236–50. http://dx.doi.org/10.1177/0310057x8601400304.

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Positive end-expiratory pressure (PEEP) maintains airway pressure above atmospheric at the end of expiration, and may be used with mechanical ventilation or spontaneous breathing. CPAP, or continuous positive airway pressure, refers to spontaneous ventilation with a positive airway pressure being maintained throughout the whole respiratory cycle. PEEP/CPAP primarily improves oxygenation by increasing functional residual capacity, and may increase lung compliance and decrease the work of breathing. PEEP/CPAP may be applied using endotracheal tubes, nasal masks or prongs, or face masks or chambe
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Wilson, D. V., and L. R. Soma. "Cardiopulmonary effects of positive end-expiratory pressure in anesthetized, mechanically ventilated ponies." American Journal of Veterinary Research 51, no. 5 (1990): 734–39. http://dx.doi.org/10.2460/ajvr.1990.51.05.734.

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Summary To investigate the cardiopulmonary effects of positive end-expiratory pressure (peep), values of 10, 20, and 30 cm of H2O, were applied to anesthetized, dorsally recumbent, ventilated ponies. After iv induction of general anesthesia, peep was superimposed on controlled ventilation with 100% oxygen, and changes in gas exchange and cardiac function were measured. Increasing values of peep in these ponies caused a linear increase in the mean (± SEM) functional residual capacity, from a control value (zero end-expiratory pressure) of 1.7 ± 0.24 L to 2.2 ± 0.31, 2.9 ± 0.32 and 3.4 ± 0.3 L a
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Muders, Thomas, Henning Luepschen, Torsten Meier, et al. "Individualized Positive End-expiratory Pressure and Regional Gas Exchange in Porcine Lung Injury." Anesthesiology 132, no. 4 (2020): 808–24. http://dx.doi.org/10.1097/aln.0000000000003151.

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Abstract Background In acute respiratory failure elevated intraabdominal pressure aggravates lung collapse, tidal recruitment, and ventilation inhomogeneity. Low positive end-expiratory pressure (PEEP) may promote lung collapse and intrapulmonary shunting, whereas high PEEP may increase dead space by inspiratory overdistension. The authors hypothesized that an electrical impedance tomography–guided PEEP approach minimizing tidal recruitment improves regional ventilation and perfusion matching when compared to a table-based low PEEP/no recruitment and an oxygenation-guided high PEEP/full recrui
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Chernow, B., S. Soldano, D. Cook, et al. "Positive End-Expiratory Pressure Increases Plasma Catecholamine Levels in Non-Volume Loaded Dogs." Anaesthesia and Intensive Care 14, no. 4 (1986): 421–25. http://dx.doi.org/10.1177/0310057x8601400416.

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Positive end-expiratory pressure (PEEP) is commonly used in the treatment of critically ill patients whose sympathetic nervous system is stressed; however, PEEP's actions on sympathetic nervous system activity are unknown. We therefore measured the plasma noradrenaline response (an index of sympathetic nervous system activity) to graded doses of PEEP in nine mongrel dogs. After 30 minutes at each level of PEEP, plasma noradrenaline concentrations increased from baseline mean values of 300 (SD 108) pg/ml to 388 (SD 225) pg/ml (P< 0.05) at 5 cm, 433 (SD 255) pg/ml (P <0.01) at 10 cm and 11
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Valenza, Franco, Federica Vagginelli, Alberto Tiby, et al. "Effects of the Beach Chair Position, Positive End-expiratory Pressure, and Pneumoperitoneum on Respiratory Function in Morbidly Obese Patients during Anesthesia and Paralysis." Anesthesiology 107, no. 5 (2007): 725–32. http://dx.doi.org/10.1097/01.anes.0000287026.61782.a6.

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Background The authors studied the effects of the beach chair (BC) position, 10 cm H2O positive end-expiratory pressure (PEEP), and pneumoperitoneum on respiratory function in morbidly obese patients undergoing laparoscopic gastric banding. Methods The authors studied 20 patients (body mass index 42 +/- 5 kg/m2) during the supine and BC positions, before and after pneumoperitoneum was instituted (13.6 +/- 1.2 mmHg). PEEP was applied during each combination of position and pneumoperitoneum. The authors measured elastance (E,rs) of the respiratory system, end-expiratory lung volume (helium techn
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Aditya, Kumar Kejriwal, Kumar Rabindra, Damodar Singh Hari, Jha Anjali, and Kumar Ajay. "Comparative Study of Ventilation with and Without Positive End Expiratory Pressure during Anesthesia for Laparoscopic Surgeries." International Journal of Pharmaceutical and Clinical Research 16, no. 6 (2024): 1152–56. https://doi.org/10.5281/zenodo.12740108.

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<strong>Background:</strong>&nbsp;Respiratory dynamics are significantly altered during laparoscopic surgeries. Anesthesiologists should be well versed with the benefits as well as limitations of positive end expiratory pressure (PEEP) during laparoscopy. They can then judiciously use the same in different patient populations. In this study we have compared the effects of ventilation with and without PEEP of 10 cm on blood gases, airway pressures and hemodynamic parameters during laparoscopy.&nbsp;<strong>Methods:</strong>&nbsp;60 patients, from American Society of Anesthesiologists (ASA) phys
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Ashutosh, Ranjan, and Kumar Mahesh. "Comparative Study of Ventilation with and Without Positive End Expiratory Pressure during Anesthesia for Laparoscopic Surgeries." International Journal of Pharmaceutical and Clinical Research 16, no. 6 (2024): 1543–47. https://doi.org/10.5281/zenodo.12745186.

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<strong>Background:</strong>&nbsp;Respiratory dynamics are significantly altered during laparoscopic surgeries. Anesthesiologists should be well versed with the benefits as well as limitations of positive end expiratory pressure (PEEP) during laparoscopy. They can then judiciously use the same in different patient populations. In this study we have compared the effects of ventilation with and without PEEP of 10 cm on blood gases, airway pressures and hemodynamic parameters during laparoscopy.&nbsp;<strong>Methods:</strong>&nbsp;60 patients, from American Society of Anesthesiologists (ASA) phys
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Roveri, Giulia, Anna Camporesi, Alex Hofer, Simon Kahlen, Franziska Breidt, and Simon Rauch. "Preoxygenation With and Without Positive End-Expiratory Pressure in Lung-Healthy Volunteers." JAMA Network Open 8, no. 5 (2025): e2511569. https://doi.org/10.1001/jamanetworkopen.2025.11569.

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ImportanceOptimal preoxygenation is critical in emergency medicine to prevent desaturation during airway management, especially in high-risk populations. Identifying the most effective preoxygenation device across diverse patient groups remains a clinical priority.ObjectiveTo compare the efficacy of 3 preoxygenation devices—nonrebreather mask (NRM), bag-valve mask (BVM), and BVM with positive end-expiratory pressure (BVM plus PEEP)—in lung-healthy volunteers.Design, Setting, and ParticipantsThis crossover randomized clinical trial was conducted from May 26 to 31, 2024, at Eurac Research, Bolza
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Kallas, Harry J., Karen B. Domino, Robb W. Glenny, Emily A. Anderson, and Michael P. Hlastala. "Pulmonary Blood Flow Redistribution with Low Levels of Positive End-expiratory Pressure." Anesthesiology 88, no. 5 (1998): 1291–99. http://dx.doi.org/10.1097/00000542-199805000-00021.

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Background Recent studies have questioned the importance of the gravitational model of pulmonary perfusion. Because low levels of positive end-expiratory pressure (PEEP) are commonly used during anesthesia, the authors studied the distribution of pulmonary blood flow with low levels of PEEP using a high spatial resolution technique. They hypothesized that if hydrostatic factors were important in the distribution of pulmonary blood flow, PEEP would redistribute flow to more dependent lung regions. Methods The effects of zero cm H2O PEEP and 5 cm H2O PEEP on pulmonary gas exchange were studied u
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35

Loick, H. M., M. Wendt, J. Rotker, and J. L. Theissen. "Ventilation with positive end-expiratory airway pressure causes leukocyte retention in human lung." Journal of Applied Physiology 75, no. 1 (1993): 301–6. http://dx.doi.org/10.1152/jappl.1993.75.1.301.

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We examined the effect of assisted ventilation with different positive end-expiratory airway pressures (PEEP) on pulmonary leukocyte retention in humans after cardiopulmonary bypass. Eight patients who underwent heart surgery were ventilated in the postoperative phase briefly with 10 (39.6 +/- 0.9 s) and 20 cmH2O (40.3 +/- 1.0 s) PEEP. Before, during, and after this ventilatory maneuver, blood was withdrawn simultaneously from catheters placed in the pulmonary and radial arteries for blood cell differentials. At the same time points, pulmonary and systemic hemodynamics were recorded. During PE
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36

Christensen, G., J. F. Bugge, J. Ostensen, and F. Kiil. "Atrial natriuretic factor and renal sodium excretion during ventilation with PEEP in hypervolemic dogs." Journal of Applied Physiology 72, no. 3 (1992): 993–97. http://dx.doi.org/10.1152/jappl.1992.72.3.993.

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Controlled mandatory ventilation with positive end-expiratory pressure (PEEP) reduces renal sodium excretion. To examine whether atrial natriuretic factor (ANF) is involved in the renal response to alterations in end-expiratory pressure in hypervolemic dogs, experiments were performed on anesthetized dogs with increased blood volume. Changing from PEEP to zero end-expiratory pressure (ZEEP) increased sodium excretion by 145 +/- 61 from 310 +/- 61 mumol/min and increased plasma immunoreactive (ir) ANF by 104 +/- 27 from 136 +/- 21 pg/ml. Changing from ZEEP to PEEP reduced sodium excretion by 13
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37

Pereira, Sérgio M., Mauro R. Tucci, Caio C. A. Morais, et al. "Individual Positive End-expiratory Pressure Settings Optimize Intraoperative Mechanical Ventilation and Reduce Postoperative Atelectasis." Anesthesiology 129, no. 6 (2018): 1070–81. http://dx.doi.org/10.1097/aln.0000000000002435.

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Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Intraoperative lung-protective ventilation has been recommended to reduce postoperative pulmonary complications after abdominal surgery. Although the protective role of a more physiologic tidal volume has been established, the added protection afforded by positive end-expiratory pressure (PEEP) remains uncertain. The authors hypothesized that a low fixed PEEP might not fit all patients and that an individually titrated PEEP during anesthesia might improve lung function during a
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38

Dongare, Dhanashree, Girish S. aundattikar, and Payal Gupta. "Comparison of ventilation with and without positive end expiratory pressure during anesthesia for laparoscopic surgeries." Indian Journal of Clinical Anaesthesia 8, no. 1 (2021): 45–48. http://dx.doi.org/10.18231/j.ijca.2021.009.

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Respiratory dynamics are significantly altered during laparoscopic surgeries. Anesthesiologists should be well versed with the benefits as well as limitations of positive end expiratory pressure (PEEP) during laparoscopy. They can then judiciously use the same in different patient populations. In this study we have compared the effects of ventilation with and without PEEP of 10 cm on blood gases, airway pressures and hemodynamic parameters during laparoscopy. 60 patients, from American Society of Anesthesiologists (ASA) physical status I and II, in the age group of 18 to 60, posted for laparos
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39

Rossi, A., R. Brandolese, J. Milic-Emili, and SB Gottfried. "The role of PEEP in patients with chronic obstructive pulmonary disease during assisted ventilation." European Respiratory Journal 3, no. 7 (1990): 818–22. http://dx.doi.org/10.1183/09031936.93.03070818.

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In patients with acute respiratory failure (ARF) due to acute exacerbation of chronic obstructive pulmonary disease (COPD), the intrinsic positive end-expiratory pressure (PEEPi) can significantly increase workload for ventilation. It has been suggested that, in the presence of expiratory flow limitation, application of low levels of PEEP by the ventilator can be used to reduce PEEPi and therefore the magnitude of the inspiratory effort during assisted mechanical ventilation (or pressure support) and weaning. Clearly, pulmonary hyperinflation should not be further enhanced in order not to coun
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40

Wilson, D. V., and A. M. McFeely. "Positive end-expiratory pressure during colic surgery in horses: 74 cases (1986-1988)." Journal of the American Veterinary Medical Association 199, no. 7 (1991): 917–21. http://dx.doi.org/10.2460/javma.1991.199.07.917.

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Summary Positive end-expiratory pressure (peep) was applied in 74 anesthetized, ventilated horses during colic surgery, to attempt to increase arterial oxygen tensions. In 28 horses with an initial &lt; 70 mm of Hg, peep increased values to a mean of 173 ± 24 mm of Hg. Arterial oxygen content increased from 14.1 ± 0.05 ml/dl to 17.2 ± 0.05 ml/dl. In the remaining 46 horses, peep increased from a mean value of 101 ± 6 mm of Hg to 194 ± 15 mm of Hg, and arterial oxygen content increased from 14.9 ± 0.09 ml/dl to 16.9 ± 0.07 ml/dl. Cardiovascular depression and decrease in arterial blood pressure
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41

Lesur, Olivier, Marie-Anaïs Remillard, Catherine St-Pierre, and Simon Falardeau. "Prophylactic Positive End-Expiratory Pressure and Postintubation Hemodynamics: An Interventional, Randomized Study." Canadian Respiratory Journal 17, no. 3 (2010): e45-e50. http://dx.doi.org/10.1155/2010/269581.

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OBJECTIVE: To investigate the hemodynamic and outcome effects of implementing prophylactic positive end-expiratory pressure (PEEP) versus zero end-expiratory pressure (ZEEP) in patients during the postintubation period in the emergency setting.METHODS: The present study was a prospective, single-centre, interventional, single-blinded randomized trial performed in a 16-bed medical intensive care unit. The study cohort consisted of consecutive patients who urgently required intubation. During the postintubation period, patients received either 5 cmH2O PEEP or ZEEP. The primary aim was to assess
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42

Reinius, Henrik, Lennart Jonsson, Sven Gustafsson, et al. "Prevention of Atelectasis in Morbidly Obese Patients during General Anesthesia and Paralysis." Anesthesiology 111, no. 5 (2009): 979–87. http://dx.doi.org/10.1097/aln.0b013e3181b87edb.

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Background Morbidly obese patients show impaired pulmonary function during anesthesia and paralysis, partly due to formation of atelectasis. This study analyzed the effect of general anesthesia and three different ventilatory strategies to reduce the amount of atelectasis and improve respiratory function. Methods Thirty patients (body mass index 45 +/- 4 kg/m) scheduled for gastric bypass surgery were prospectively randomized into three groups: (1) positive end-expiratory pressure of 10 cm H2O (PEEP), (2) a recruitment maneuver with 55 cm H2O for 10 s followed by zero end-expiratory pressure,
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43

Venkataraman, Shekhar, and Bradley Fuhrman. "POSITIVE END-EXPIRATORY PRESSURE (PEEP) RAISES NEONATAL PULMONARY VASCULAR TONE." Critical Care Medicine 16, no. 4 (1988): 372. http://dx.doi.org/10.1097/00003246-198804000-00029.

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44

Shardonofsky, F. R., J. M. McDonough, and M. M. Grunstein. "Effects of positive end-expiratory pressure on lung tissue mechanics in rabbits." Journal of Applied Physiology 75, no. 6 (1993): 2506–13. http://dx.doi.org/10.1152/jappl.1993.75.6.2506.

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The effects of positive end-expiratory pressure (PEEP) on lung tissue resistance (Rti) and dynamic elastance (Edyn,L) were examined separately during histamine-induced lung constriction and after saline lung lavage in anesthetized paralyzed New Zealand White rabbits. During mechanical ventilation in the open-chest state, Rti and Edyn,L were estimated by fitting the appropriate signals to the equation of motion of the single-compartment linear model of the lung. Data were analyzed in relation to the structural damping hypothesis, which assumes that energy dissipation (Rti) and energy storage (E
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45

Dambrosio, Michele, Eric Roupie, Jean-Jacques Mollet, et al. "Effects of Positive End-expiratory Pressure and Different Tidal Volumes on Alveolar Recruitment and Hyperinflation." Anesthesiology 87, no. 3 (1997): 495–503. http://dx.doi.org/10.1097/00000542-199709000-00007.

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Background The morphologic effect of positive end-expiratory pressure (PEEP) and of two tidal volumes were studied by computed tomography to determine whether setting the tidal volume (Vt) at the upper inflection point (UIP) of the pressure-volume (P-V) curve of the respiratory system or 10 ml/kg have different effects on hyperinflation and alveolar recruitment. Methods Alveolar recruitment and hyperinflation were quantified by computed tomography in nine patients with the acute respiratory distress syndrome (ARDS). First, end expiration was compared without PEEP and with PEEP set at the lower
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46

Hancı, P., ET Demir, B. Şekerci, and V. İnal. "Optimizing Positive End-Expiratory Pressure Based on Intra-Abdominal Pressure in Patients with Acute Respiratory Failure." Nigerian Journal of Clinical Practice 27, no. 8 (2024): 1033–37. http://dx.doi.org/10.4103/njcp.njcp_103_24.

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Background: Positive end-expiratory pressure (PEEP) is a crucial component of mechanical ventilation to improve oxygenation in critically ill patients with respiratory failure. The interaction between abdominal and thoracic compartment pressures is known well. Especially in intra-abdominal hypertension, lower PEEP may cause atelectotrauma by repetitive opening and closing of alveoli. Aim: In this study, it was aimed to investigate the effect of PEEP adjustment according to the intra-abdominal pressure (IAP) on oxygenation and clarify possible harms. Method: Patients older than 18 were mechanic
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47

Yessenbayeva, Gulfairus. "Optimization of positive end-expiratory pressure in reverse Trendelenburg position during laparoscopic surgery in adult patients." Astana Medical Journal 124, no. 4 (2024): 44–52. https://doi.org/10.54500/2790-1203-2024-4-124-44-52.

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The optimal level of PEEP during laparoscopic surgery without lung injury remains unclear and controversial. We hypothesized that personalized adjustment of positive end-expiratory pressure (PEEP) by best compliance could improve perioperative gas exchange and respiratory biomechanics in adult patients undergoing laparoscopic surgery in the reverse Trendelenburg (RT) position.Objective: The primary objective of the study was to determine the difference in oxygenation between the groups. Secondary objectives were differences in intraoperative dynamics of compliance and driving pressure.Methods.
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48

Johnston, W. E., J. Vinten-Johansen, H. E. Shugart, and W. P. Santamore. "Positive end-expiratory pressure potentiates the severity of canine right ventricular ischemia-reperfusion injury." American Journal of Physiology-Heart and Circulatory Physiology 262, no. 1 (1992): H168—H176. http://dx.doi.org/10.1152/ajpheart.1992.262.1.h168.

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Positive end-expiratory pressure (PEEP) increases right ventricular (RV) afterload and oxygen demands. However, whether increased RV oxygen demands with high levels of PEEP can potentiate the severity of RV ischemic damage is unknown. In 20 anesthetized, closed-chest dogs randomly assigned to 0 cmH2O PEEP (ZEEP; n = 10) or 15 cmH2O PEEP (PEEP; n = 10), RV blood flow (radioactive microspheres) and segmental shortening (ultrasonic crystals) were determined during 90 min ischemia and 120 min reperfusion while mean aortic pressure was maintained above 90 mmHg. The in vivo RV area at risk (gentian
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Hashemian, Seyed MohammadReza, Batoul Khoundabi, Ashkan Bahrami, et al. "Optimal Positive End-expiratory Pressure Levels in Tuberculosis-associated Acute Respiratory Distress Syndrome." International Journal of Mycobacteriology 13, no. 3 (2024): 247–51. http://dx.doi.org/10.4103/ijmy.ijmy_136_24.

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Background: The objective is to assess lung compliance and identify the optimal positive end-expiratory pressure (PEEP) levels in patients with tuberculosis-associated Acute Respiratory Distress Syndrome (TB-ARDS) compared to non-TB-ARDS patients. Methods: This observational case–control study utilized electrical impedance tomography to evaluate lung mechanics in 20 TB-ARDS and 20 non-TB-ARDS patients. Participants underwent PEEP titration from 23 to 5 cm H2O in 2 cm H2O decrements. Lung compliance and the rates of hyperdistention and collapse were assessed at each PEEP level. Results: Delta i
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Aibiki, M., S. Koyama, K. Ogli, and Y. Shirakawa. "Reflex mechanisms for changes in renal nerve activity during positive end-expiratory pressure." Journal of Applied Physiology 65, no. 1 (1988): 109–15. http://dx.doi.org/10.1152/jappl.1988.65.1.109.

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This study was designed to investigate the interaction between carotid sinus baroreceptors and cardiopulmonary receptors in the reflex control of renal nerve activity (RNA) during positive end-expiratory pressure (PEEP) in anesthetized dogs. PEEP at two different levels (10 and 20 cmH2O) was applied to the following groups: animals with neuraxis intact (I group, n = 12); vagal and aortic nerve denervated animals with carotid sinus nerves intact (V group, n = 6); carotid sinus denervated animals with vagal and aortic nerves intact (SD group, n = 6); and carotid sinus denervated animals also hav
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