Abstract
Objectives
To study the ability of different ventilatory approaches to keep the lung open.
Design
Different ventilatory patterns were applied in surfactant deficient lungs with PEEP set to achieve pre-lavage PaO2.
Setting
Experimental laboratory of a University Department of Anaesthesiology and Intensive Care.
Animals
15 anaesthetised piglets.
Interventions
One volume-controlled mode (L-IPPV201:1.5) and two pressure-controlled modes at 20 breaths per minute (bpm) and I:E ratios of 2:1 and 1.5:1 (L-PRVC202:1 and L-PRVC201.5:1), and two pressure-controlled modes at 60 bpm and I:E of 1:1 and 1:1.5 (L-PRVC601:1 and L-PRVC601:1.5) were investigated. The pressure-controlled modes were applied using “Pressure-Regulated Volume-Controlled Ventilation” (PRVC).
Measurements and results
Gas exchange, airway pressures, hemodynamics, FRC and intrathoracic fluid volumes were measured. Gas exchange was the same for all modes. FRC was 30% higher with all post-lavage settings. By reducing inspiratory time MPAW decreased from 25 cmH2O by 3 cmH2O with L-PRVC201.5:1 and L-PRVC601:1.5. End-inspiratory airway pressure was 29 cmH2O with L-PRVC201.5:1 and 40 cmH2O with L-IPPV201:1.5, while the other modes displayed intermediate values. End-inspiratory lung volume was 65 ml/kg with L-IPPV201:1.5, but it was reduced to 50 and 49 ml/kg with L-PRVC601:1 and L-PRVC601:1.5. Compliance was 16 and 18 ml/cmH2O with L-PRVC202:1 and L-PRVC201.5:1, while it was lower with L-IPPV201:1.5, L-PRVC601:1 and L-PRVC601:1.5. Oxygen delivery was maintained at prelavage level with L-PRVC201.5:1 (657 ml/min·m2), the other modes displayed reduced oxygen delivery compared with pre-lavage.
Conclusion
Neither the rapid frequency modes nor the low frequency volume-controlled mode kept the surfactant deficient lungs open. Pressure-controlled inverse ratio ventilation (20 bpm) kept the lungs open at reduced end-inspiratory airway pressure and hence reduced risk of barotrauma. Reducing I:E ratio in this latter modality from 2:1 to 1.5:1 further improved oxygen delivery.
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References
Kolobow T, Moretti MP, Fumagalli R, Mascheroni D, Prato P, Chen V, Joris M (1987) Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation. An experimental study. Am Rev Respir Dis 135:312–315
Hickling KG, Henderson SJ, Jackson R (1990) Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med 16:372–377
Dreyfuss D, Basset G, Soler P, Saumon GI (1985) Intermittent positive-pressure hyperventilation with high inflation pressures produces pulmonary microvascular injury in rats. Am Rev Respir Dis 132:880–884
Dreyfuss D, Soler P, Basset G, Saumon G (1988) High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis 137:1159–1164
Lachmann B (1992) Open the lung and keep the lung open. Intensive Care Med 18:319–321
Nielsen JB, Sjöstrand UH, Edgren EL, Lichtwarck-Aschoff M, Svensson BA (1991) An experimental study of different ventilatory modes in piglets in severe respiratory distress induced by surfactant depletion. Intensive Care Med 17:225–233
Lichtwarck-Aschoff M, Nielsen JB, Sjöstrand UH, Edgren EL (1992) An experimental randomized study of five different ventilatory modes in a piglet model of severe respiratory distress. Intensive Care Med 18:339–347
Pepe PE, Marini JJ (1982) Occult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction: the auto-PEEP effect. Am Rev Respir Dis 126:166–170
Al-Saady N, Bennet E (1985) Decelerating inspiratory waveform improves lung mechanics and gas exchange in patients on intermittent positive-pressure ventilation. Intensive Care Med 11:68–75
Knelson J, Howatt W, DeMuth G (1970) Effects of respiratory pattern on alveolar gas exchange. J Appl Physiol 29:328–331
Modell H, Cheney F (1979) Effects of inspiratory flow patterns on gas exchange in normal and abnormal lungs. J Appl Physiol 46:1103–1107
Lachmann B, Danzmann E, Haendley B, Jonson B (1982) Ventilator settings and gas exchange in respiratory distress syndrome. In: Prakash O (ed) Applied physiology in clinical respiratory care. Nijhoff, The Hague, pp 141–176
Reynolds EOR (1971) Effect of alterations in mechanical ventilator setting on pulmonary gas exchange in hyaline membrane disease. Arch Dis Child 46:152–159
Lachmann B, Robertson B, Vogel J (1980) In vivo lung lavage as an experimental model of the respiratory distress syndrome. Acta Anaesthesiol Scand 24:231–236
Pfeiffer UJ, Birk M, Aschenbrenner H, Blümel G (1982) The system for quantitating thermal-dye extravascular lung water. In: Prakash O (ed) Computers in critical care and pulmonary medicine, vol 2. Plenum Publishing Corporation, London, pp 123–125
Newman EV, Merrell M, Genecin A, Monge C, Milnor WR, McKeever WP (1951) The dye dilution method for describing the central circulation. An analysis of factors shaping the time-concentration curves. Circulation 4:735–746
Matamis D, Lemaire F, Harf A, Brun-Buisson C, Ansquer JC, Atlan G (1984) Total respiratory pressure-volume curves in the adult respiratory distress syndrome. Chest 86:58–66
Suratt PM, Owens DH, Kilgore WT, Harry RR, Hsiao HS (1980) A pulse method of measuring respiratory system compliance. J Appl Physiol 49: 1116–1121
Larsson A, Linnarsson D, Jonmarker C, Jonson B, Larsson H, Werner O (1987) Measurement of lung volume by sulfur hexafluoride washout during spontaneous and controlled ventilation. Further development of a method. Anesthesiology 67:543–550
Froese AB (1989) Role of lung volume in lung injury: HFO in the atelectasisprone lung. Acta Anaesthesiol Scand 33: [Suppl 90]:126–130
Boros S, Matalon S, Ewald R, Leonard A, Hunt C (1977) The effect of independent variations in inspiratory-expiratory ratio and end-expiratory pressure during mechanical ventilation in hyaline membrane disease: the significance of mean airway pressure. J. Pediatr 91:794–798
Boros S (1979) Variations in inspiratory: expiratory ratio and airway pressure wave form during mechanical ventilation: the significance of mean airway pressure. J Pediatr 94:114–117
Rouby JJ, Fusciardi J, Bourgain JL, Viars P (1983) High-frequency jet ventilation in postoperative respiratory failure: determinants of oxygenation. Anesthesiology 59:281–287
Cheney F, Martin W (1971) Effects of continuous positive-pressure ventilation on gas exchange in acute pulmonary edema. J Appl Physiol 30:378–381
Ciszek T, Modanlou H, Owings D, Nelson P (1981) Mean airway pressure —significance during mechanical ventilation in neonates. J Pediatr 99:121–126
Gattinoni L, Marcolin R, Caspani ML, Fumagalli R, Mascheroni D, Pesenti A (1985) Constant mean airway pressure with different patterns of positive pressure breathing during the adult respiratory distress syndrome. Bull Eur Physiopathol Respir 21:275–279
Pesenti A, Marcolin R, Prato P, Borelli M, Riboni A, Gattinoni L (1985) Mean airway pressure vs. positive end-expiratory pressure during mechanical ventilation. Crit Care Med 13:34–37
Lichtwarck-Aschoff M, Zeravik J, Pfeiffer UJ (1992) Intrathoracic blood volume accurately reflects circulatory volume status in critically ill patients with mechanical ventilation. Intensive Care Med 18:142–147
Sykes M, Lumley J (1969) The effect of varying inspiratory: expiratory ratios on gas exchange during anesthesia for open-hear surgery. Br J Anaesth 41:374–380
Cole AG, Weller SF, Sykes MK (1984) Inverse ratio ventilation compared with PEEP in adult respiratory failure. Intensive Care Med 10:227–232
Abraham E, Yoshihara G (1989) Cardiorespiratory effects of pressure controlled inverse ratio ventilation in severe respiratory failure. Chest 96:1356–1359
Marcy Th W, Marini JJ (1991) Inverse ratio ventilation in ARDS. Rationale and implementation. Chest 100: 494–504
Slutsky AS (1994) Consensus conference on mechanical ventilation — January 28–30, 1993, at Northbrook, Illinois, USA. Intensive Care Med 20: 64–79
Dreyfuss D, Saumon G (1992) Barotrauma is volutrauma, but which volume is the one responsible? Intensive Care Med 18:139–141
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Sjöstrand, U.H., Lichtwarck-Aschoff, M., Nielsen, J.B. et al. Different ventilatory approaches to keep the lung open. Intensive Care Med 21, 310–318 (1995). https://doi.org/10.1007/BF01705409
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DOI: https://doi.org/10.1007/BF01705409