Document Detail


Effects of partial ventilatory support modalities on respiratory function in severe hypoxemic lung injury.
MedLine Citation:
PMID:  16625116     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The early phase of acute respiratory distress syndrome (ARDS) is characterized by impaired respiratory mechanics, ventilation-perfusion mismatch, and severe hypoxemia. Partial ventilatory support can effectively unload the respiratory workload and improve pulmonary gas exchange with less hemodynamic compromise. The partial ventilatory support mode most indicated in early phases of ARDS has not been determined. This study compares the effects of assisted ventilatory techniques on breathing pattern, gas exchange, hemodynamic function, and respiratory effort with those of controlled mechanical ventilation in similarly sedated subjects. DESIGN: Prospectively randomized crossover animal study. SETTING: Animal research laboratory. SUBJECTS: Eleven anesthetized and mechanically ventilated pigs. INTERVENTIONS: Acute lung injury was induced by lung lavage. Pressure-controlled ventilation (PCV), pressure-controlled assisted ventilation (P-ACV), bilevel positive airway pressure (BIPAP), and pressure support ventilation (PSV) with equal airway pressures and sedation were applied in random order. MEASUREMENTS AND MAIN RESULTS: Gas exchange, respiratory effort, and hemodynamic function were measured, and ventilation-perfusion distributions were calculated by multiple inert-gas-elimination techniques. The results revealed that partial ventilatory support was superior to PCV in maintaining adequate oxygenation and hemodynamic function with reduced sedation. The effects of P-ACV, BIPAP, and PSV were comparable with respect to gas exchange and hemodynamic function, except for a more pronounced reduction in shunt during BIPAP. P-ACV and PSV were superior to BIPAP to reduce respiratory drive and work of breathing. PSV affected the pattern of breathing and deadspace to a greater degree than did P-ACV. CONCLUSIONS: In acute lung injury, P-ACV preserves oxygenation and hemodynamic function with less respiratory effort compared with BIPAP and reduces the need for sedation compared with PCV.
Authors:
Dietrich Henzler; Paolo Pelosi; Ralf Bensberg; Rolf Dembinski; Michael Quintel; Veronica Pielen; Rolf Rossaint; Ralf Kuhlen
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  34     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-05-22     Completed Date:  2006-06-15     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1738-45     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Aachen University Hospital, Germany. mail@d-henzler.de
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MeSH Terms
Descriptor/Qualifier:
Animals
Anoxia / complications*
Disease Models, Animal*
Positive-Pressure Respiration / methods*
Prospective Studies
Pulmonary Gas Exchange / physiology*
Pulmonary Wedge Pressure / physiology
Random Allocation
Respiratory Distress Syndrome, Adult / etiology,  physiopathology*,  therapy*
Respiratory Mechanics / physiology*
Swine
Treatment Outcome
Comments/Corrections
Comment In:
Crit Care Med. 2006 Jun;34(6):1844-5   [PMID:  16714998 ]

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


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