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  • 1
    Electronic Resource
    Electronic Resource
    Different ventilatory approaches to keep the lung open (1995)
    Springer
    Intensive care medicine 21 (1995), S. 310-318 
    Details
    ISSN: 1432-1238
    Keywords: Intrinsic PEEP ; Respiratory failure ; Pressure-controlled ventilation ; Inverse ratio ventilation ; Functional residual capacity ; Alveolar distension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives To study the ability of different ventilatory approaches to keep the lung open. Design Different ventilatory patterns were applied in surfactant deficient lungs with PEEP set to achieve pre-lavage PaO2. Setting Experimental laboratory of a University Department of Anaesthesiology and Intensive Care. Animals 15 anaesthetised piglets. Interventions One volume-controlled mode (L-IPPV201:1.5) and two pressure-controlled modes at 20 breaths per minute (bpm) and I:E ratios of 2:1 and 1.5:1 (L-PRVC202:1 and L-PRVC201.5:1), and two pressure-controlled modes at 60 bpm and I:E of 1:1 and 1:1.5 (L-PRVC601:1 and L-PRVC601:1.5) were investigated. The pressure-controlled modes were applied using “Pressure-Regulated Volume-Controlled Ventilation” (PRVC). Measurements and results Gas exchange, airway pressures, hemodynamics, FRC and intrathoracic fluid volumes were measured. Gas exchange was the same for all modes. FRC was 30% higher with all post-lavage settings. By reducing inspiratory time MPAW decreased from 25 cmH2O by 3 cmH2O with L-PRVC201.5:1 and L-PRVC601:1.5. End-inspiratory airway pressure was 29 cmH2O with L-PRVC201.5:1 and 40 cmH2O with L-IPPV201:1.5, while the other modes displayed intermediate values. End-inspiratory lung volume was 65 ml/kg with L-IPPV201:1.5, but it was reduced to 50 and 49 ml/kg with L-PRVC601:1 and L-PRVC601:1.5. Compliance was 16 and 18 ml/cmH2O with L-PRVC202:1 and L-PRVC201.5:1, while it was lower with L-IPPV201:1.5, L-PRVC601:1 and L-PRVC601:1.5. Oxygen delivery was maintained at prelavage level with L-PRVC201.5:1 (657 ml/min·m2), the other modes displayed reduced oxygen delivery compared with pre-lavage. Conclusion Neither the rapid frequency modes nor the low frequency volume-controlled mode kept the surfactant deficient lungs open. Pressure-controlled inverse ratio ventilation (20 bpm) kept the lungs open at reduced end-inspiratory airway pressure and hence reduced risk of barotrauma. Reducing I:E ratio in this latter modality from 2:1 to 1.5:1 further improved oxygen delivery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01705409
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 2
    Electronic Resource
    Electronic Resource
    Oxygenation remains unaffected by increased inspiration-to-expiration ratio but impairs hemodynamics in surfactant-depleted piglets (1996)
    Springer
    Intensive care medicine 22 (1996), S. 329-335 
    Details
    ISSN: 1432-1238
    Keywords: Pressure-controlled inverse ratio ventilation kwEndinspiratory pressure ; Intrinsic PEEP ; Functional residual capacity ; Hemodynamics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives Prolongation of inspiratory time is used to reduce lung injury in mechanical ventilation. The aim of this study was to isolate the effects of inspiratory time on airway pressure, gas exchange, and hemodynamics, while ventilatory frequency, tidal volume, and mean airway pressure were kept constant. Design Randomized experimental trial. Setting Experimental laboratory of a University Department of Anesthesiology and Intensive Care. Animals Twelve anesthetised piglets. Interventions After lavage the reference setting was pressure-controlled ventilation with a decelerating flow; I∶E was 1∶1, and PEEP was set to 75% of the inflection point pressure level. The I∶E ratios of 1.5∶1, 2.3∶1, and 4∶1 were applied randomly. Under open lung conditions, mean airway pressure was kept constant by reduction of external PEEP. Measurement and results Gas exchange, airway pressures, hemodynamics, functional residual capacity (SF6 tracer), and intrathoracic fluid volumes (double indicator dilution) were measured. Compared to the I∶E of 1∶1, PaCO2 was 8% lower, with I∶E 2.3∶1 and 4∶1 (p≤0.01) while PaO2 remained unchanged. The decrease in inspiratory airway pressure with increased inspiratory time was due to the response of the pressure-regulated volume-controlled mode to an increased I∶E ratio. Stroke index and right ventricular ejection fraction were depressed at higher I∶E ratios (SI by 18% at 2.3∶1, 20% at 4∶1; RVEF by 10% at 2.3∶1, 13% at 4∶1;p≤0.05). Conclusion Under open lung conditions with an increased I∶E ratio, oxygenation remained unaffected while hemodynamics were impaired.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01700455
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 3
    Electronic Resource
    Electronic Resource
    Oxygenation remains unaffected by increased inspiration-to-expiration ratio but impairs hemodynamics in surfactant-depleted piglets (1996)
    Springer
    Intensive care medicine 22 (1996), S. 329-335 
    Details
    ISSN: 1432-1238
    Keywords: Key words Pressure-controlled inverse ratio ventilation ; End-inspiratory pressure ; Intrinsic PEEP ; Functional residual capacity ; Hemodynamics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract   Objectives: Prolongation of inspiratory time is used to reduce lung injury in mechanical ventilation. The aim of this study was to isolate the effects of inspiratory time on airway pressure, gas exchange, and hemodynamics, while ventilatory frequency, tidal volume, and mean airway pressure were kept constant. Design: Randomized experimental trial. Setting: Experimental laboratory of a University Department of Anesthesiology and Intensive Care. Animals: Twelve anesthetised piglets. Interventions: After lavage the reference setting was pressure-controlled ventilation with a decelerating flow; I:E was 1:1, and PEEP was set to 75% of the inflection point pressure level. The I:E ratios of 1.5:1, 2.3:1, and 4:1 were applied randomly. Under open lung conditions, mean airway pressure was kept constant by reduction of external PEEP. Measurements and results: Gas exchange, airway pressures, hemodynamics, functional residual capacity (SF6 tracer), and intrathoracic fluid volumes (double indicator dilution) were measured. Compared to the I:E of 1:1, PaCO2 was 8% lower, with I:E 2.3:1 and 4:1 (p≤0.01) while PaO2 remained unchanged. The decrease in inspiratory airway pressure with increased inspiratory time was due to the response of the pressure-regulated volume-controlled mode to an increased I:E ratio. Stroke index and right ventricular ejection fraction were depressed at higher I:E ratios (SI by 18% at 2.3:1, 20% at 4:1; RVEF by 10% at 2.3:1, 13% at 4:1; p≤0.05). Conclusion: Under open lung conditions with an increased I:E ratio, oxygenation remained unaffected while hemodynamics were impaired.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01700455
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
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