Document Detail

Pressure-release tracheal gas insufflation reduces airway pressures in lung-injured sheep maintaining eucapnia.
MedLine Citation:
PMID:  10556106     Owner:  NLM     Status:  MEDLINE    
Although tracheal gas insufflation (TGI) has proved to be a useful adjunct to mechanical ventilation, end-inspiratory as well as end-expiratory pressures may increase. We investigated the ability of continuous-flow TGI to maintain eucapnia while reducing airway pressure (Paw) and tidal volume (VT). Seven sheep (36 +/- 2 kg) were ventilated using the Dräger Evita 4 in the pressure control plus mode where flow is released via the expiratory valve to maintain constant inspiratory pressure. To avoid TGI-generated positive end-expiratory pressure (PEEP), a prototype reverse flow TGI tube was used. Two TGI flows (5 and 10 L/min) were investigated pre- and postsaline lavage-induced lung injury. Inspiratory pressures and VT were significantly reduced as TGI flow increased. At 10 L/min TGI flow the carinal pressures (Pcar) and VT were reduced pre- and postinjury by 15% and 20%, and by 28% and 34%, respectively. Tidal volume to dead space ratio (VD/VT) decreased preinjury from 0.49 +/- 0.1 to 0.18 +/- 0.2 and postinjury from 0.62 +/- 0.1 to 0.33 +/- 0.1 at a TGI flow of 10 L/min. The combination of the reverse flow TGI tube and a ventilator with an inspiratory pressure relief mechanism kept set end-inspiratory and end-expiratory pressures constant. This TGI system effectively reduced set Paw and VT while maintaining eucapnia.
M Kirmse; Y Fujino; J Hromi; H Mang; D Hess; R M Kacmarek
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  160     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  1999 Nov 
Date Detail:
Created Date:  1999-12-21     Completed Date:  1999-12-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1462-7     Citation Subset:  AIM; IM    
Respiratory Care Department Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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MeSH Terms
Airway Resistance*
Carbon Dioxide / blood*
Pulmonary Gas Exchange
Respiration, Artificial / methods*
Respiratory Distress Syndrome, Adult / blood,  physiopathology*,  therapy
Tidal Volume
Reg. No./Substance:
124-38-9/Carbon Dioxide

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