Biologically variable ventilation improves gas exchange and respiratory mechanics in a model of severe bronchospasm*

2007 ◽  
Vol 35 (7) ◽  
pp. 1749-1755 ◽  
Author(s):  
W Alan C. Mutch ◽  
Timothy G. Buchman ◽  
Linda G. Girling ◽  
Elizabeth K-Y. Walker ◽  
Bruce M. McManus ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Respiratory Mechanics ◽  
Variable Ventilation

Biologically Variable Ventilation Improves Oxygenation and Respiratory Mechanics during One-lung Ventilation

2006 ◽  
Vol 105 (1) ◽  
pp. 91-97 ◽  
Author(s):  
Michael C. McMullen ◽  
Linda G. Girling ◽  
M Ruth Graham ◽  
W Alan C. Mutch
Keyword(s):  
Tidal Volume ◽  
Respiratory Mechanics ◽  
Lung Ventilation ◽  
Group Effect ◽  
Shunt Fraction ◽  
Static Compliance ◽  
One Lung Ventilation ◽  
Time Interaction ◽  
Variable Ventilation ◽  
Dead Space Ventilation

Background Hypoxemia is common during one-lung ventilation (OLV). Atelectasis contributes to the problem. Biologically variable ventilation (BVV), using microprocessors to reinstitute physiologic variability to respiratory rate and tidal volume, has been shown to be advantageous over conventional monotonous control mode ventilation (CMV) in improving oxygenation during the period of lung reinflation after OLV in an experimental model. Here, using a porcine model, the authors compared BVV with CMV during OLV to assess gas exchange and respiratory mechanics. Methods Eight pigs (25-30 kg) were studied in each of two groups. After induction of anesthesia-tidal volume 12 ml/kg with CMV and surgical intervention-tidal volume was reduced to 9 ml/kg. OLV was initiated with an endobronchial blocker, and the animals were randomly allocated to either continue CMV or switch to BVV for 90 min. After OLV, a recruitment maneuver was undertaken, and both lungs were ventilated for a further 60 min. At predetermined intervals, hemodynamics, respiratory gases (arterial, venous, and end-tidal samples) and mechanics (airway pressures, static and dynamic compliances) were measured. Derived indices (pulmonary vascular resistance, shunt fraction, and dead space ventilation) were calculated. Results By 15 min of OLV, arterial oxygen tension was greater in the BVV group (group x time interaction, P = 0.003), and shunt fraction was lower with BVV from 30 to 90 min (group effect, P = 0.0004). From 60 to 90 min, arterial carbon dioxide tension was lower with BVV (group x time interaction, P = 0.0001) and dead space ventilation was less from 60 to 90 min (group x time interaction, P = 0.0001). Static compliance was greater by 60 min of BVV and remained greater during return to ventilation of both lungs (group effect, P = 0.0001). Conclusions In this model of OLV, BVV resulted in superior gas exchange and respiratory mechanics when compared with CMV. Improved static compliance persisted with restoration of two-lung ventilation.

scholarly journals Tracking respiratory mechanics around natural breathing rates via variable ventilation

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Samer Bou Jawde ◽  
Allan J. Walkey ◽  
Arnab Majumdar ◽  
George T. O’Connor ◽  
Bradford J. Smith ◽  
...  
Keyword(s):  
Respiratory Mechanics ◽  
Variable Ventilation ◽  
Natural Breathing

scholarly journals Correction to: Effect of PEEP decremental on respiratory mechanics, gas exchange, pulmonary regional ventilation, and hemodynamics in patients with SARS-Cov-2-associated Acute Respiratory Distress Syndrome

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Vincent Bonny ◽  
Vincent Janiak ◽  
Savino Spadaro ◽  
Andrea Pinna ◽  
Alexandre Demoule ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Gas Exchange ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Respiratory Mechanics ◽  
Regional Ventilation

An amendment to this paper has been published and can be accessed via the original article.

Effects of positive end‐expiratory pressure titration on gas exchange, respiratory mechanics and hemodynamics in anesthetized horses

2013 ◽  
Vol 40 (6) ◽  
pp. 564-572 ◽  
Author(s):  
Aline M Ambrósio ◽  
Keila K Ida ◽  
Maria TMR Souto ◽  
Alexandre H Oshiro ◽  
Denise T Fantoni
Keyword(s):  
Gas Exchange ◽  
Respiratory Mechanics ◽  
Positive End Expiratory Pressure

scholarly journals Radiological pattern in ARDS patients: partitioned respiratory mechanics, gas exchange and lung recruitability

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Silvia Coppola ◽  
Tommaso Pozzi ◽  
Martina Gurgitano ◽  
Alessandro Liguori ◽  
Ejona Duka ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Respiratory System ◽  
Respiratory Mechanics ◽  
Recruitment Maneuver ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Driving Pressure ◽  
Lung Weight ◽  
Focal Pattern ◽  
Lung Ct

Abstract Background The ARDS is characterized by different degrees of impairment in oxygenation and distribution of the lung disease. Two radiological patterns have been described: a focal and a diffuse one. These two patterns could present significant differences both in gas exchange and in the response to a recruitment maneuver. At the present time, it is not known if the focal and the diffuse pattern could be characterized by a difference in the lung and chest wall mechanical characteristics. Our aims were to investigate, at two levels of PEEP, if focal vs. diffuse ARDS patterns could be characterized by different lung CT characteristics, partitioned respiratory mechanics and lung recruitability. Methods CT patterns were analyzed by two radiologists and were classified as focal or diffuse. The changes from 5 to 15 cmH2O in blood gas analysis and partitioned respiratory mechanics were analyzed. Lung CT scan was performed at 5 and 45 cmH2O of PEEP to evaluate lung recruitability. Results One-hundred and ten patients showed a diffuse pattern, while 58 showed a focal pattern. At 5 cmH2O of PEEP, the driving pressure and the elastance, both the respiratory system and of the lung, were significantly higher in the diffuse pattern compared to the focal (14 [11–16] vs 11 [9–15 cmH2O; 28 [23–34] vs 21 [17–27] cmH2O/L; 22 [17–28] vs 14 [12–19] cmH2O/L). By increasing PEEP, the driving pressure and the respiratory system elastance significantly decreased in diffuse pattern, while they increased or did not change in the focal pattern (Δ15-5: − 1 [− 2 to 1] vs 0 [− 1 to 2]; − 1 [− 4 to 2] vs 1 [− 2 to 5]). At 5 cmH2O of PEEP, the diffuse pattern had a lower lung gas (743 [537–984] vs 1222 [918–1974] mL) and higher lung weight (1618 [1388–2001] vs 1222 [1059–1394] g) compared to focal pattern. The lung recruitability was significantly higher in diffuse compared to focal pattern 21% [13–29] vs 11% [6–16]. Considering the median of lung recruitability of the whole population (16.1%), the recruiters were 65% and 22% in the diffuse and focal pattern, respectively. Conclusions An early identification of lung morphology can be useful to choose the ventilatory setting. A diffuse pattern has a better response to the increase of PEEP and to the recruitment maneuver.

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