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Tracheal gas insufflation-pressure control versus volume control ventilation. A lung model study
H Imanaka1, R M Kacmarek, R Ritz
1Respiratory Care Department, Massachusetts General Hospital, Boston, 02114, USA.
Summary
Tracheal gas insufflation (TGI) can increase airway pressures during mechanical ventilation. This study found TGI significantly elevates peak airway pressures and tidal volumes, especially with volume control ventilation and longer inspiratory times.
Area of Science:
- Mechanical Ventilation
- Respiratory Physiology
Background:
- Tracheal gas insufflation (TGI) is used to manage hypercapnia during mechanical ventilation.
- Concerns exist regarding potential increases in peak airway pressure with TGI, particularly during pressure control ventilation (PCV).
Purpose of the Study:
- To investigate the effects of continuous flow TGI on airway pressures and tidal volumes in a lung model during both PCV and volume control ventilation (VCV).
Main Methods:
- A lung model with an artificial trachea and endotracheal tube was used.
- Continuous flow TGI was applied at varying rates (0-12 L/min) with different inspiratory times (1.0-2.5 s).
- Ventilation was delivered via PCV or VCV, with varying lung mechanics (compliance and resistance).
Main Results:
- Auto-PEEP, tidal volume (Vt), and peak pressures significantly increased with higher TGI flow and inspiratory times, irrespective of lung mechanics.
- These increases were more pronounced during VCV compared to PCV.
- The combination of TGI and longer inspiratory times led to substantial increases in Vt and system pressures.
Conclusions:
- Continuous flow TGI can significantly elevate peak airway pressures and tidal volumes.
- These effects are more pronounced with VCV and prolonged inspiratory times.
- Clinicians should exercise caution when using TGI, especially with VCV, due to potential pressure and volume increases.