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Critical Care
Published in: Critical Care 2/2012

Open Access 01-04-2012 | Research

Dead space and CO2 elimination related to pattern of inspiratory gas delivery in ARDS patients

Authors: Jerome Aboab, Lisbet Niklason, Leif Uttman, Laurent Brochard, Björn Jonson

Published in: Critical Care | Issue 2/2012

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Abstract

Introduction

The inspiratory flow pattern influences CO2 elimination by affecting the time the tidal volume remains resident in alveoli. This time is expressed in terms of mean distribution time (MDT), which is the time available for distribution and diffusion of inspired tidal gas within resident alveolar gas. In healthy and sick pigs, abrupt cessation of inspiratory flow (that is, high end-inspiratory flow (EIF)), enhances CO2 elimination. The objective was to test the hypothesis that effects of inspiratory gas delivery pattern on CO2 exchange can be comprehensively described from the effects of MDT and EIF in patients with acute respiratory distress syndrome (ARDS).

Methods

In a medical intensive care unit of a university hospital, ARDS patients were studied during sequences of breaths with varying inspiratory flow patterns. Patients were ventilated with a computer-controlled ventilator allowing single breaths to be modified with respect to durations of inspiratory flow and postinspiratory pause (TP), as well as the shape of the inspiratory flow wave. From the single-breath test for CO2, the volume of CO2 eliminated by each tidal breath was derived.

Results

A long MDT, caused primarily by a long TP, led to importantly enhanced CO2 elimination. So did a high EIF. Effects of MDT and EIF were comprehensively described with a simple equation. Typically, an efficient and a less-efficient pattern of inspiration could result in ± 10% variation of CO2 elimination, and in individuals, up to 35%.

Conclusions

In ARDS, CO2 elimination is importantly enhanced by an inspiratory flow pattern with long MDT and high EIF. An optimal inspiratory pattern allows a reduction of tidal volume and may be part of lung-protective ventilation.
Appendix
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Metadata
Title
Dead space and CO2 elimination related to pattern of inspiratory gas delivery in ARDS patients
Authors
Jerome Aboab
Lisbet Niklason
Leif Uttman
Laurent Brochard
Björn Jonson
Publication date
01-04-2012
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2012
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc11232

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