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Non-toxic alveolar oxygen concentration without hypoxemia during apnoeic oxygenation: an experimental study.
MedLine Citation:
PMID:  22092204     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Oxygenation without tidal breathing, i.e. apnoeic oxygenation in combination with extracorporeal carbon dioxide removal, might be an option in the treatment of acute respiratory failure. However, ventilation with 100% O(2) , which is potentially toxic, is considered a prerequisite to ensure acceptable oxygenation. We hypothesized that trapping nitrogen (N(2) ) in the lungs before the start of apnoeic oxygenation would keep the alveolar O(2) at a non-toxic level and still maintain normoxaemia. The aim was to test whether a predicted N(2) concentration would agree with a measured concentration at the end of an apnoeic period.
METHODS: Seven anaesthetized, muscle relaxed, endotracheally intubated pigs (22-27 kg) were ventilated in a randomized order with an inspired fraction of O(2) 0.6 and 0.8 at two positive end-expiratory pressure levels (5 cm and 10 cm H(2) O) before being connected to continuous positive airway pressure using 100% O(2) for apnoeic oxygenation. N(2) was measured before the start of and at the end of the 10-min apnoeic period. The predicted N(2) concentration was calculated from the initial N(2) concentration, the end-expiratory lung volume, and the anatomical dead space.
RESULTS: The mean difference and standard deviation between measured and predicted N(2) concentration was -0.5 ± 2%, P = 0.587. No significant difference in the agreement between measured and predicted N(2) concentrations was seen in the four settings.
CONCLUSIONS: This study indicates that it is possible to predict and keep alveolar N(2) concentration at a desired level and, thus, alveolar O(2) concentration at a non-toxic level during apnoeic oxygenation.
S Höstman; J Engström; F Sellgren; G Hedenstierna; A Larsson
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Publication Detail:
Type:  Journal Article     Date:  2011-09-08
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  55     ISSN:  1399-6576     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-11-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  England    
Other Details:
Languages:  eng     Pagination:  1078-84     Citation Subset:  IM    
Copyright Information:
© 2011 The Authors Acta Anaesthesiologica Scandinavica © 2011 The Acta Anaesthesiologica Scandinavica Foundation.
Hedenstierna Laboratory, Anesthesia and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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