This chapter addresses section F10(i) of the CICM 2017 syllabus document, “Describe the physiological consequences of intermittent positive pressure ventilation and positive end-expiratory pressure”. Though the original intention was to fashion a brief summary of these effects (because how much material could there possibly be), after marinading in the literature the "summary" bloated out to truly absurd proportions, and had to be split into three sections. However, this does not negate the need for a summary. Thus, this chapter is offered as a shorter quicker option for those who do not necessarily need every last reference.
For something we intensivists do so routinely, it is surprising that the effects of mechanical ventilation have only attracted three past paper questions:
These questions are essentially identical, in the sense that all of them ask about the physiological effects of positive pressure ventilation. Question 2 from the first paper of 2016 asked specifically for the effects of 10cm of PEEP, whereas Question 3 from the second paper of 2014 and Question 5(p.2) from the first paper of 2009 asked about PEEP in general.
In summary:
Respiratory effects of positive pressure ventilation:
Cardiovascular effects of positive pressure ventilation:
Other organ system effects of positive pressure ventilation:
Oakes, Dennis L. Physiological Effects of Positive Pressure Ventilation. AIR FORCE INST OF TECH WRIGHT-PATTERSON AFB OH, 1992. -this is somebody's Masters of Science thesis! They received their degree in 1992, but one expects that the fundamentals of physiology have remained the same since then.
Kumar, Anil, et al. "Continuous positive-pressure ventilation in acute respiratory failure: effects on hemodynamics and lung function." New England Journal of Medicine 283.26 (1970): 1430-1436.
Luce, John M. "The cardiovascular effects of mechanical ventilation and positive end-expiratory pressure." Jama 252.6 (1984): 807-811.
Morgan, Beverly C., et al. "Hemodynamic effects of intermittent positive pressure respiration." Anesthesiology 27.5 (1966): 584-590.