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Related Experiment Videos

Different ventilatory approaches to keep the lung open

U H Sjöstrand1, M Lichtwarck-Aschoff, J B Nielsen

  • 1Department of Anesthesiology and Intensive Care, University Hospital, Uppsala, Sweden.

Intensive Care Medicine
|April 1, 1995
PubMed
Summary

Pressure-controlled inverse ratio ventilation effectively keeps surfactant-deficient lungs open, reducing barotrauma risk. Adjusting the inspiratory-to-expiratory ratio further enhances oxygen delivery in these critical ventilation strategies.

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Area of Science:

  • Respiratory Physiology
  • Mechanical Ventilation
  • Critical Care Medicine

Background:

  • Surfactant deficiency leads to lung collapse, impairing gas exchange.
  • Maintaining lung aeration is crucial in managing acute lung injury.
  • Various ventilatory strategies aim to optimize lung recruitment and minimize ventilator-induced lung injury.

Purpose of the Study:

  • To evaluate the efficacy of different mechanical ventilation modes in maintaining lung aeration in surfactant-deficient lungs.
  • To compare the effects of volume-controlled and pressure-controlled ventilation strategies on lung mechanics and gas exchange.
  • To assess the impact of varying respiratory rates and inspiratory-to-expiratory ratios on lung protection and oxygen delivery.

Main Methods:

  • An experimental study was conducted on 15 anesthetized piglets with induced surfactant deficiency.

Related Experiment Videos

  • Ventilatory patterns included one volume-controlled mode (L-IPPV201:1.5) and four pressure-controlled modes (Pressure-Regulated Volume-Controlled Ventilation - PRVC) at different respiratory rates (20 and 60 bpm) and I:E ratios.
  • Measurements included gas exchange, airway pressures, hemodynamics, functional residual capacity (FRC), and intrathoracic fluid volumes.

    • Main Results:

    • Gas exchange was comparable across all tested ventilation modes.
    • Functional residual capacity (FRC) increased by 30% post-lavage with all settings.
    • Pressure-controlled inverse ratio ventilation at 20 bpm with an I:E of 1.5:1 maintained oxygen delivery and reduced mean airway pressure (MPAW) compared to other modes, suggesting a lower risk of barotrauma.
    • Lower frequency PRVC modes (60 bpm) reduced end-inspiratory lung volume compared to L-IPPV201:1.5.

    Conclusions:

    • Neither rapid frequency modes nor low-frequency volume-controlled ventilation effectively maintained lung aeration in surfactant-deficient lungs.
    • Pressure-controlled inverse ratio ventilation at 20 bpm with an I:E ratio of 2:1 or 1.5:1 successfully kept lungs open while reducing end-inspiratory airway pressures, mitigating barotrauma risk.
    • Optimizing the I:E ratio to 1.5:1 in pressure-controlled inverse ratio ventilation further improved oxygen delivery.