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Pattern of inspiratory gas delivery affects CO(2) elimination in health and after acute lung injury.

Åström, Elisabet LU ; Uttman, Leif LU ; Niklason, Lisbet LU ; Aboab, Jerome; Brochard, Laurent and Jonson, Björn LU (2008) In Intensive Care Medicine 34(2). p.377-384
Abstract
Objective To avoid ventilator induced lung injury, tidal volume should be low in acute lung injury (ALI). Reducing dead space may be useful, for example by using a pattern of inspiration that prolongs the time available for gas distribution and diffusion within the respiratory zone, the mean distribution time (MDT). A study was conducted to investigate how MDT affects CO2 elimination in pigs at health and after ALI.

Design and setting Randomised crossover study in the animal laboratory of Lund University Biomedical Center.

Subjects and intervention Healthy pigs and pigs with ALI, caused by surfactant perturbation and lung-damaging ventilation were ventilated with a computer-controlled ventilator. With this device each... (More)
Objective To avoid ventilator induced lung injury, tidal volume should be low in acute lung injury (ALI). Reducing dead space may be useful, for example by using a pattern of inspiration that prolongs the time available for gas distribution and diffusion within the respiratory zone, the mean distribution time (MDT). A study was conducted to investigate how MDT affects CO2 elimination in pigs at health and after ALI.

Design and setting Randomised crossover study in the animal laboratory of Lund University Biomedical Center.

Subjects and intervention Healthy pigs and pigs with ALI, caused by surfactant perturbation and lung-damaging ventilation were ventilated with a computer-controlled ventilator. With this device each breath could be tailored with respect to insufflation time and pause time (T I and T P) as well as flow shape (square, increasing or decreasing flow).

Measurements and results The single-breath test for CO2 allowed analysis of the volume of expired CO2 and the volume of CO2 re-inspired from Y-piece and tubes. With a long MDT caused by long T I or T P, the expired volume of CO2 increased markedly in accordance with the MDT concept in both healthy and ALI pigs. High initial inspiratory flow caused by a short T I or decreasing flow increased the re-inspired volume of CO2. Arterial CO2 increased during a longer period of short MDT and decreased again when MDT was prolonged.

Conclusions CO2 elimination can be enhanced by a pattern of ventilation that prolongs MDT. Positive effects of prolonged MDT caused by short T I and decreasing flow were attenuated by high initial inspiratory flow.

Electronic supplementary material The online version of this article (doi:10.1007/s00134-007-0840-7) contains supplementary material, which is available to authorized users. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Pulmonary gas exchange, Respiration, artificial, Capnography, Breath tests, Swine
in
Intensive Care Medicine
volume
34
issue
2
pages
377 - 384
publisher
Springer
external identifiers
  • wos:000252920100024
  • scopus:38849108046
ISSN
0342-4642
DOI
10.1007/s00134-007-0840-7
language
English
LU publication?
yes
id
06533e24-db97-4b55-9597-8b9f52f4e0fd (old id 608049)
alternative location
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17763841&dopt=Abstract
date added to LUP
2008-01-22 13:33:19
date last changed
2017-10-22 03:41:15
@article{06533e24-db97-4b55-9597-8b9f52f4e0fd,
  abstract     = {Objective To avoid ventilator induced lung injury, tidal volume should be low in acute lung injury (ALI). Reducing dead space may be useful, for example by using a pattern of inspiration that prolongs the time available for gas distribution and diffusion within the respiratory zone, the mean distribution time (MDT). A study was conducted to investigate how MDT affects CO2 elimination in pigs at health and after ALI.<br/><br>
Design and setting Randomised crossover study in the animal laboratory of Lund University Biomedical Center.<br/><br>
Subjects and intervention Healthy pigs and pigs with ALI, caused by surfactant perturbation and lung-damaging ventilation were ventilated with a computer-controlled ventilator. With this device each breath could be tailored with respect to insufflation time and pause time (T I and T P) as well as flow shape (square, increasing or decreasing flow).<br/><br>
Measurements and results The single-breath test for CO2 allowed analysis of the volume of expired CO2 and the volume of CO2 re-inspired from Y-piece and tubes. With a long MDT caused by long T I or T P, the expired volume of CO2 increased markedly in accordance with the MDT concept in both healthy and ALI pigs. High initial inspiratory flow caused by a short T I or decreasing flow increased the re-inspired volume of CO2. Arterial CO2 increased during a longer period of short MDT and decreased again when MDT was prolonged.<br/><br>
Conclusions CO2 elimination can be enhanced by a pattern of ventilation that prolongs MDT. Positive effects of prolonged MDT caused by short T I and decreasing flow were attenuated by high initial inspiratory flow.<br/><br>
Electronic supplementary material The online version of this article (doi:10.1007/s00134-007-0840-7) contains supplementary material, which is available to authorized users.},
  author       = {Åström, Elisabet and Uttman, Leif and Niklason, Lisbet and Aboab, Jerome and Brochard, Laurent and Jonson, Björn},
  issn         = {0342-4642},
  keyword      = {Pulmonary gas exchange,Respiration,artificial,Capnography,Breath tests,Swine},
  language     = {eng},
  number       = {2},
  pages        = {377--384},
  publisher    = {Springer},
  series       = {Intensive Care Medicine},
  title        = {Pattern of inspiratory gas delivery affects CO(2) elimination in health and after acute lung injury.},
  url          = {http://dx.doi.org/10.1007/s00134-007-0840-7},
  volume       = {34},
  year         = {2008},
}