Tracheal gas insufflation: catheter effectiveness determined by expiratory flush volume

Used adjunctively during mechanical ventilation, tracheal gas insufflation (TGI) improves CO2 elimination, principally by decreasing effective anatomic dead space. Continuing lung deflation at end- expiration raises the end-expiratory C02 concentration within the proximal airway, and could theoretically reduce the efficiency of a given catheter flow. To test this possibility, we designed a series of experiments that examined the influence of TGI delivery patterns on the efficiency of CO2 elimination. Using a gating device, catheter flow was delivered selectively during desired portions of expiration. Paralyzed, ventilated dogs were studied at short and extended inspiratory time fractions (TI/TT) with inspiratory tidal volume and ventilator frequency held constant. The expiratory flush volume, not the pattern of gas delivery, determined the observed decline in PaCO2, provided that the end-expiratory period was included in the catheter flush period. Despite continuing end-expiratory lung deflation (extended TI/TT), catheter effectiveness remained the same at matched expiratory flush volumes. To determine if enhanced distal mixing at the higher catheter flows required during the extended TI/TT (to match expiratory flush volume) masked a decrease in efficiency, we repeated the experiment with a tip-inverted catheter. We again found that matched catheter delivered expiratory volumes were similarly effective. With or without ongoing lung deflation, the volume of gas flushed during the expiratory period determined the effectiveness of TGI, provided that inspired minute ventilation remains unchanged and end-expiration is included in the catheter flush period.