Document Detail


Bilevel positive airway pressure ventilation: factors influencing carbon dioxide rebreathing.
MedLine Citation:
PMID:  20148321     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Use of bilevel positive airway pressure (BLPAP) ventilators for noninvasive ventilation (NIV) is an established treatment for both acute and chronic ventilatory failure. Although BLPAP ventilator circuits are simpler than those of conventional ventilators, one drawback to their use is that they allow variable amounts of rebreathing to occur. The aim of this work is to measure the amount of CO(2) reinsufflated in relation to the BLPAP ventilator circuit in patients, and to determine predictive factors for rebreathing. METHODS: Eighteen adult patients were ventilated on pressure support, either by intubation or with mask ventilation, during a weaning period. The mean inspiratory fraction of CO(2) (tidal FiCO(2)) reinsufflated from the circuit between the intentional leak and the ventilator was measured for each breath. The influence of end-tidal CO(2) concentration (ETCO(2)), respiratory rate (RR), percentage of inspiratory time (T (i)/T (TOT)), application of expiratory positive airway pressure (EPAP), and inspiratory tidal volume on magnitude of tidal FiCO(2), as well as the influence of intubation versus NIV, were studied by univariate comparisons and logistic regression analysis. RESULTS: In a total of 11,107 cycles, tidal FiCO(2) was 0.072 +/- 0.173%. Of fractions measured, 8,976 (81%) were under 0.10% and 2,131 (19%) were over 0.10%, with mean values of 0.026 +/- 0.027% and 0.239 +/- 0.326%, respectively. ETCO(2), EPAP, NIV versus intubation, and RR had significant predictive value for tidal FiCO(2) >0.10%. CONCLUSIONS: BLPAP ventilators present a specific rebreathing risk to patients. However, that risk remains modest, even in intubated patients, provided that EPAP is applied.
Authors:
Zbigniew Szkulmowski; Kheirallah Belkhouja; Quoc-Hung Le; Dominique Robert; Laurent Argaud
Publication Detail:
Type:  Journal Article     Date:  2010-02-11
Journal Detail:
Title:  Intensive care medicine     Volume:  36     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-12     Completed Date:  2010-06-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  688-91     Citation Subset:  IM    
Affiliation:
Katedra i Klinika Anestezjologii Intensywnej Terapii, Szpital Uniwersytecki w Bydgoszczy, Collegium Medicum w Bydgoszczy Uniwersytet Mikolaja Kopernika w Toruniu, ul. Sklodowskiej-Curie 9, 85-094, Bydgoszcz, Poland.
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MeSH Terms
Descriptor/Qualifier:
Carbon Dioxide / analysis*
Chi-Square Distribution
Female
Humans
Intubation, Intratracheal
Logistic Models
Male
Masks
Middle Aged
Observation
Positive-Pressure Respiration / instrumentation,  methods*
Predictive Value of Tests
Respiratory Insufficiency / therapy*
Ventilators, Mechanical
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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