Extracorporeal carbon dioxide removal technique improves oxygenation without causing overinflation
Autor: | Jean-Paul Mira, J Dall'Ava-Santucci, M. Belghith, M Monchi, I. Hamy, Bertrand Renaud, JF Dhainaut, F. Brunet, L. Fierobe |
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Rok vydání: | 1994 |
Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Artificial ventilation ARDS Adolescent Functional Residual Capacity medicine.medical_treatment Lung Overinflation Lung injury Critical Care and Intensive Care Medicine Cardiography Impedance Severity of Illness Index Positive-Pressure Respiration Extracorporeal Membrane Oxygenation Risk Factors Tidal Volume medicine Humans Tidal volume Mechanical ventilation Respiratory Distress Syndrome Pulmonary Gas Exchange business.industry Airway Resistance Lung Injury Carbon Dioxide medicine.disease Combined Modality Therapy Hypoventilation Treatment Outcome Barotrauma Evaluation Studies as Topic Anesthesia Modes of mechanical ventilation Female medicine.symptom business |
Zdroj: | American Journal of Respiratory and Critical Care Medicine. 149:1557-1562 |
ISSN: | 1535-4970 1073-449X |
Popis: | Extracorporeal CO2 removal combined with low frequency positive pressure ventilation (ECCO2R-LFPPV) improves gas exchange and decreases peak pressures, respiratory rates, and tidal volumes in animals and in humans. Recent evidence suggests that pulmonary barotrauma results from lung overinflation rather than from high pressures. This study was to test the hypothesis whether ECCO2R-LFPPV could improve gas exchange without causing lung overinflation, despite the use of higher levels of PEEP, when compared with conventional mechanical ventilation. Eleven patients with severe adult respiratory distress syndrome (ARDS) who failed to respond to different modes of mechanical ventilation were treated with ECCO2R-LFPPV. Risk of pulmonary barotrauma was evaluated by static pressure-volume (P-V) curves and dynamic changes in volumes monitored by respiratory inductive plethysmography (Respitrace). ECCO2R-LFPPV PaO2/FIO2 increased from 79 +/- 21 to 207 +/- 108 (p = 0.003). Risk of barotrauma, as shown by the shape of the P-V curve, was present in all patients receiving mechanical ventilation even though most of them were treated with permissive hypoventilation. By contrast, no evidence of persistent lung overinflation could be detected by either static P-V curves or dynamic measurements in nine of 11 patients who were treated by ECCO2R-LFPPV. The two remaining patients had severe airway obstruction because of bleeding, and they remained ventilated with persistent risk of barotrauma. We conclude that ECCO2R-LFPPV improves gas exchange without causing lung overinflation in a majority of patients with ARDS. |
Databáze: | OpenAIRE |
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