Document Detail


Positive pressure ventilation: what is the real cost?
MedLine Citation:
PMID:  18782885     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Positive pressure ventilation is a radical departure from the physiology of breathing spontaneously. The immediate physiological consequences of positive pressure ventilation such as haemodynamic changes are recognized, studied, and understood. There are other significant physiological interactions which are less obvious, more insidious, and may only produce complications if ventilation is prolonged. The interaction of positive pressure with airway resistance and alveolar compliance affects distribution of gas flow within the lung. The result is a wide range of ventilation efficacy throughout different areas of the lung, but the pressure differentials between alveolus and interstitium also influence capillary perfusion. The hydrostatic forces across the capillaries associated with the effects of raised venous pressures compound these changes resulting in interstitial fluid sequestration. This is increased by impaired lymphatic drainage which is secondary to raised intrathoracic pressure but also influenced by raised central venous pressure. Ventilation and PEEP promulgate further physiological derangement. In theory, avoiding these physiological disturbances in a rested lung may be better for the lung and other organs. An alternative to positive pressure ventilation might be to investigate oxygen supplementation of a physiologically neutral and rested lung. Abandoning heroic ventilation would be a massive departure from current practice but might be a more rationale approach to future practice.
Authors:
N Soni; P Williams
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  British journal of anaesthesia     Volume:  101     ISSN:  1471-6771     ISO Abbreviation:  Br J Anaesth     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-10     Completed Date:  2008-10-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  446-57     Citation Subset:  IM    
Affiliation:
Imperial College Medical School, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. n.soni@imperial.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Airway Resistance
Cardiovascular System / physiopathology
Humans
Lung Compliance
Lymphatic System / physiopathology
Oxygen Consumption
Positive-Pressure Respiration / adverse effects*
Pulmonary Alveoli / physiopathology
Pulmonary Circulation
Pulmonary Surfactants / metabolism
Respiration
Chemical
Reg. No./Substance:
0/Pulmonary Surfactants

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


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