Gas exchange by intratracheal insufflation in a ventilatory failure dog model

Respiratory insufficiency patients who need only partial ventilatory support are, nevertheless, intubated and connected to a respirator. In search of a partial respiratory assistance method we evaluated the gas exchange, mechanisms, and hemodynamic effects of intratracheal insufflation (ITI) via a narrow (0.2-cm) catheter. The effects of flow rate (0.05-0.2 liter/min per kg), catheter tip position (carina, bronchus, and trachea), and superimposed chest vibration at 22 Hz were studied in seven anesthetized and partially paralyzed dogs. ITI in the carina induced CO2 removal (VCO2) of 48 +/- 16 ml/min in the periods between breaths, which was 39% of the control VCO2. CO2 removal rates between breaths with ITI in a bronchus and in the trachea were 63 and 28% of control, respectively (P < 0.05). ITI at 0.15-0.2 liter/min per kg augmented total VCO2 by > 50% over control (P < 0.05) and decreased PaCO2 by 10% (P < 0.05) despite a 28% fall in VE and 32% lower work of breathing (P < 0.05). Adding vibration to ITI at 0.15 liter/min per kg induced VCO2 of 162 +/- 34 ml/min, which was significantly greater than control, while PaCO2 fell from 69 +/- 24 to 47 +/- 6 mmHg (P < 0.05), despite complete cessation of spontaneous breathing. ITI with or without vibration did not cause any hemodynamic changes, except for a fall in the shunt fraction from 14.6 +/- 9.9% to 5.8 +/- 2.8% with vibration. Thus, ITI at low flow rates can support respiration with no hemodynamic side effects. Adding chest vibration further enhances gas exchange and can provide total ventilation.