[Early PEEP for improvement of prognosis in patients with acute respiratory insufficiency (author's transl)].

One hundred twenty-seven artificially ventilated patients with acute respiratory insufficiency (ARI) were investigated. In 61 patients positive endexpiratory pressure (PEEP) was used when ventilation with ZEEP proved to be insufficient for one or more of the following reasons: increasing I-aDO2m PaO3 below 60 Torr at FiO2 greater than or equal to 0.5, deterioration of clinical status (group = secondary PEEP). The time elapse between beginning of artificial ventilation and institution of PEEP was 46 +/- 47 h (median 33 h). In 66 patients PEEP was used from the beginning of artificial ventilation (group II = primary PEEP). The distribution of underlying diseases (severe poisoning, pancreatitis, polytrauma or major surgery, pneumonia, cardiovascular failure, sepsis) as well as the frequency of additional vital function failure (circulatory shock, acute renal failure) were comparable in both groups (p greater than 0.05). At the beginning of artificial ventilation both groups were comparable in respect to respiratory insufficiency. PaO2 was 75 +/- 26 Torr in group I and 70 +/- 29 Torr in group II at comparable levels of FiO2 (p greater than 0.05). PaCO2 was 34.7 +/- 8.2 Torr in group I and 37.4 +/- 10.5 Torr in group II. Significantly more patients in group II received corticosteroids (greater than 1 gr/die). Mortality was 48/61 (79%) in group I and 37/66 (56%) in group II (p less than 0.01). End-inspiratory pressure exceeding 35 cm H2O was necessary in 42/61 patients in group I and 28/66 patients in group II (p less than 0.01) and FiO2 greater than 0.5 was necessary to keep PaO2 above 60 Torr in 39/61 patients in group I and 27/66 patients in group II (p less than 0.01). It is concluded that early institution of PEEP improves the course and outcome of patients with ARI.