Positive end expiratory pressure and critical oxygenation during transport in ventilated patients
| Autor: | D. R. Hillman, W. P. D. Woods, P. J. McQuillan |
|---|---|
| Rok vydání: | 1990 |
| Předmět: |
Male
Artificial ventilation ARDS Adolescent Fistula Respiratory rate medicine.medical_treatment Pulmonary compliance Critical Care and Intensive Care Medicine Positive-Pressure Respiration Humans Medicine Positive end-expiratory pressure Tidal volume Respiratory Distress Syndrome Ventilators Mechanical business.industry Oxygen Inhalation Therapy Pleural Diseases respiratory system medicine.disease respiratory tract diseases Models Structural Transportation of Patients Respiratory failure Anesthesia Bronchial Fistula business Respiratory minute volume circulatory and respiratory physiology |
| Zdroj: | Intensive Care Medicine. 16:513-516 |
| ISSN: | 1432-1238 0342-4642 |
| DOI: | 10.1007/bf01709403 |
| Popis: | Transportation of patients critically dependent on positive end expiratory pressure (PEEP) can be problematic, as a patient of ours with adult respiratory distress syndrome (ARDS) and bilateral broncho-pleural fistulae demonstrated. He required intermittent positive pressure ventilation (IPPV) (Siemens 900C) with 100% O2 and PEEP of 2 kPa to maintain his arterial O2 saturation (SaO2) greater than 90%. Severe hypoxemia (SaO2 less than 75%) occurred on change to a portable ventilator (Oxylog, Dräger) with a PEEP value (Ambu 20) at its expiratory port, despite adjusting the valve to 2 kPa, continuing use of 100% O2, and varying the ventilatory pattern. The problem appeared due to loss of PEEP because of gas leak from the lungs via his intercostal catheters. It was solved by introducing a continuous O2 flow of 5 l/min into the circuit between the Oxylog non-rebreathing valve and endotracheal tube. We used a model lung to investigate the effect of a gas leak from the lungs or circuit on the performance of the Oxylog IPPV/PEEP system. Lung compliance and ventilatory pattern were adjusted so that tidal volume (VT) = 0.61, peak inspiratory Airway pressure (PIP) = 5 kPa, PEEP = 1.5 kPa, and respiratory rate = 10/min. A small leak was introduced from the lung resulting in a decrease in PIP, VT, and PEEP. Adjustment of ventilator minute volume to restore PIP to 5 kPa failed to restore PEEP, airway pressure continuing to fall throughout the expiratory pause. PEEP was restored by providing a compensatory flow of O2 of 5 l/min to the system between the Oxylog non-rebreathing valve and the lung.(ABSTRACT TRUNCATED AT 250 WORDS) |
| Databáze: | OpenAIRE |
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