The effects of 10 cm H 2O positive endexpiratory pressure (PEEP) were studied in 26 unrestrained Hampshire and Corriedale lambs, breathing spontaneously air or pure oxygen. No changes in lung morphology, pulmonary mechanics or arterial blood gas tensions were detected after air breathing with 10 cm H 2O PEEP for one week. No changes were found in mean pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance or cardiac output in oxygen breathing lambs until minutes before death. Addition of PEEP to oxygen breathing accelerated the development of respiratory acidemia and death (PEEP group mean lifespan 54 3 4 hr, without PEEP mean lifespan 71 3 4 hr). Morphologic changes of acute oxygen toxicity were present in oxygen breathing lambs and lung water was increased. Oxygen breathing lambs died from apnea with hypercarbia and a markedly increased ( A-a) DO 2. An increase in pulmonary vascular resistance or right ventricular failure do not appear to be major factors in the syndrome of fulminant acute respiratory insufficiency due to oxygen toxicity in lambs.
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