Document Detail

Effects of expiratory tracheal gas insufflation in patients with severe head trauma and acute lung injury.
MedLine Citation:
PMID:  15372148     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This study analyzed the effect of phasic tracheal gas insufflation at mid- to end-expiration in patients with severe head trauma and acute lung injury (ALI)/acute respiratory distress syndrome (ARDS).
DESIGN AND SETTING: A prospective interventional study in a 16-bed intensive care unit.
PATIENTS: Seven patients with severe head trauma (Glasgow Coma Scale <9) and ALI/ARDS.
INTERVENTIONS: Patients were ventilated in assist/control mode with a ventilatory strategy providing adequate oxygenation (PaO(2) >70 mmHg) and normocapnia (PaCO(2) between 35-40 mmHg). Mid to end expiratory tracheal gas insufflation at 8 l/min flow rate was delivered for 90 min while normocapnia was maintained by simultaneous reductions in tidal volume. We measured (hemodynamics, oxygenation, lung mechanics, and cerebral parameters) in basal situation and during and after tracheal insufflation.
MEASUREMENTS AND RESULTS: Tracheal gas insufflation allowed a significant decrease in tidal volume from 9.1 to 7.2 ml/kg, with associated reduction in driving pressure (plateau pressure minus positive end-expiratory pressure, PEEP) from 18.1 to 13.2 cm H(2)O. Total PEEP increased from 9.3 to 12.7 cm H(2)O due to the generation of lung hyperinflation. Oxygenation improved slightly during tracheal gas insufflation, and this improvement remained after stopping tracheal insufflation. No changes in hemodynamic or cerebral parameters were observed during the study.
CONCLUSIONS: In patients with severe head trauma and ALI receiving mechanical ventilation, expiratory tracheal gas insufflation allowed the targeted arterial PCO(2) level to be maintained together with a substantial reduction in tidal volume.
Melcior Martínez-Pérez; Francesca Bernabé; Rocío Peña; Rafael Fernández; Avi Nahum; Lluís Blanch
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2004-09-14
Journal Detail:
Title:  Intensive care medicine     Volume:  30     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-11-19     Completed Date:  2005-03-22     Revised Date:  2012-01-23    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2021-7     Citation Subset:  IM    
Critical Care Center, Hospital de Sabadell, Corporació Parc Taulí, Institut Universitari Fundació Parc Taulí, Universitat Autonoma de Barcelona [corrected] 08206 Sabadell, Spain.
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MeSH Terms
Aged, 80 and over
Craniocerebral Trauma / therapy*
Insufflation / methods*
Middle Aged
Prospective Studies
Pulmonary Gas Exchange
Respiration, Artificial / methods*
Respiratory Distress Syndrome, Adult / therapy*
Statistics, Nonparametric
Erratum In:
Intensive Care Med. 2012 Jan;38(1):181

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

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