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Mechanics of breathing during prolonged artificial ventilation
Resuscitation
|March 1, 1980
Summary
Long-term artificial ventilation in patients with respiratory muscle paralysis showed significant changes in respiratory mechanics, including decreased lung compliance and increased airway resistance. These changes suggest progressive structural alterations in the lungs and airways, particularly in amyotrophic lateral sclerosis.
Area of Science:
- Respiratory Medicine
- Neurology
- Pulmonology
Background:
- Patients with severe respiratory muscle paralysis require long-term mechanical ventilation.
- Understanding the impact of prolonged ventilation on respiratory mechanics is crucial for patient management.
Observation:
- Three patients with neuromuscular disorders (malignant myasthenia, amyotrophic lateral sclerosis, post-poliomyelitis) underwent continuous artificial ventilation for 7-18 years.
- Hyperventilation (PCO2 19.5–26.8 mmHg) was maintained during ventilation.
Findings:
- Significant decrease in total respiratory compliance (Ctot 23–28 ml/cmH2O) and lung tissue compliance (CL 24–30 ml/cmH2O).
- Marked increase in inspiratory (RresLI 15.0–23 cmH2O/L/s) and expiratory bronchial resistance (RresLE 16.5–30.7 cmH2O/L/s).
- Elevated chest wall compliance (Cw 358–555 ml/cmH2O) and reduced chest wall non-elastic resistance (Rres w 0.2–0.6 cmH2O/L/s).
Implications:
- Findings suggest progressive structural changes in lung tissue and tracheobronchial tree due to prolonged mechanical ventilation.
- Amyotrophic lateral sclerosis cases exhibited the most pronounced structural changes.
- These insights can inform strategies for managing patients on long-term mechanical ventilation.