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Intensive Care Medicine
Published in: Intensive Care Medicine 9/2003

01-09-2003 | Original

Comparative effects of helium-oxygen and external positive end-expiratory pressure on respiratory mechanics, gas exchange, and ventilation-perfusion relationships in mechanically ventilated patients with chronic obstructive pulmonary disease

Authors: Philippe Jolliet, Christine Watremez, Jean Roeseler, J. C. Ngengiyumva, Marc de Kock, Thierry Clerbaux, Didier Tassaux, Marc Reynaert, Bruno Detry, Giuseppe Liistro

Published in: Intensive Care Medicine | Issue 9/2003

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Abstract

Objective

To compare the effects of He/O2 and external PEEP (PEEPe) on intrinsic PEEP (PEEPi), respiratory mechanics, gas exchange, and ventilation/perfusion (V̇A/Q̇) in mechanically ventilated COPD patients.

Design and setting

Prospective, interventional study in the intensive care unit of a university hospital.

Interventions

Ten intubated, sedated, paralyzed, mechanically ventilated COPD patients studied in the following conditions: (a) baseline settings made by clinician in charge, air/O2, ZEEP; (b) He/O2, ZEEP; (c) air/O2, ZEEP; (d) air/O2, PEEPe 80% of PEEPi. Measurements at each condition included V̇A/Q̇ by the multiple inert gas elimination technique (MIGET).

Results

PEEPi and trapped gas volume were comparably reduced by He/O2 (4.2±4 vs. 7.7±4 cmH2O and 98±82 vs. 217±124 ml, respectively) and PEEPe (4.4±1.3 vs. 7.8±3.6 cmH2O and 120±107 vs. 216±115 ml, respectively). He/O2 reduced inspiratory and expiratory respiratory system resistance (15.5±4.4 vs. 20.7±6.9 and 19±9 vs. 28.8±15 cmH2O l−1s−1, respectively) and plateau pressure (13±4 vs. 17±6 cmH2O). PEEPe increased airway pressures, including total PEEP, and elastance. PaO2/FIO2 was slightly reduced by He/O2 (225±83 vs. 245±82) without significant V̇A/Q̇ change.

Conclusions

He/O2 and PEEPe comparably reduced PEEPi and trapped gas volume. However, He/O2 decreased airway resistance and intrathoracic pressures, at a small cost in arterial oxygenation. He/O2 could offer an attractive option in COPD patients with PEEPi/dynamic hyperinflation.
Literature
1.
2.
Marini JJ (1989) Should PEEP be used in airflow obstruction? Am Rev Respir Dis 140:1–3
3.
Pepe, P Marini J (1982) Occult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction. Am Rev Respir Dis 126:166–170PubMed
4.
Rossi A, Polese G, Brandi G, Conti G (1995) Intrinsic positive end-expiratory pressure. Intensive Care Med 21:522–536PubMed
5.
Smith TC, Marini JJ (1988) Impact of PEEP on lung mechanics and work of breathing in severe airflow obstruction. J Appl Physiol 65:1488–1499PubMed
6.
Tuxen D, Lane S (1987) The effects of ventilatory pattern on hyperinflation, airway pressures, and circulation in mechanical ventilation of patients with severe airflow obstruction. Am Rev Respir Dis 136:872–879PubMed
7.
Bernasconi M, Brandolese R, Poggi R, Manzin E, Rossi A (1990) Dose-response effects and time course of effects of inhaled fenoterol on respiratory mechanics and arterial oxygen tension in mechanically ventilated patients with chronic airflow obstruction. Intensive Care Med 16:108–114PubMed
8.
Rossi A, Santos C, Roca J, Torres A, Félez MA, Rodriguez-Roisin R (1994) Effects of PEEP on VA/Q mismatching in ventilated patients with chronic airflow obstruction. Am J Respir Crit Care Med 149:1077–1084PubMed
9.
Tuxen D (1989) Detrimental effects of positive end-expiratory pressure during controlled mechanical ventilation of patients with severe airflow obstruction. Am Rev Respir Dis 140:5–9PubMed
10.
Georgopoulos D, Gianoulli E, Patakas D (1993) Effects of extrinsic positive end-expiratory pressure on mechanically ventilated patients with chronic obstructive pulmonary disease and dynamic hyperinflation. Intensive Care Med 19:197–203
11.
Baigorri F, De Monte A, Blanch L, Fernandez R, Vallés J, Mestre J, Saura P, Artigas A (1994) Hemodynamic responses to external counterbalancing of auto-positive end-expiratory pressure in mechanically ventilated patients with chronic obstructive pulmonary disease. Crit Care Med 22:1782–1791PubMed
12.
Papamoschou D (1995) Theoretical validation of the respiratory benefits of helium-oxygen mixtures. Respir Physiol 99:183–199CrossRefPubMed
13.
Tassaux D, Jolliet P, Roeseler J, Chevrolet JC (2000) Effects of helium-oxygen on intrinsic positive end-expiratory pressure in intubated and mechanically ventilated patients with severe chronic obstructive pulmonary disease. Crit Care Med 28:2721–2728PubMed
14.
Tassaux D, Jolliet P, Thouret JM, Roeseler J, Dorne R, Chevrolet JC (1999) Calibration of seven ICU ventilators for mechanical ventilation with helium-oxygen mixtures. Am J Respir Crit Care Med 160:22–32PubMed
15.
Manier G, Guénard H, Castaing Y, Varène N (1983) Respiratory gas exchange under heliox breathing in COPD studied by the inert gas method. Bull Eur Physiopathol Respir 19:401–406PubMed
16.
Thiriet M, Douguet D, Bonnet JC, Canonne C, Hatzfeld C (1979) The effect on gas mixing of a He-O2 mixture in chronic obstructive lung disease. Bull Eur Physiopathol Respir 15:1053–1068
17.
Pauwels RA, Buist S, Calverley PMA, Jenkins CR, Hurd SS (2001) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 163:1256–1276PubMed
18.
Jolliet P, Tassaux D, Thouret JM, Chevrolet JC (1999) Beneficial effects of helium-oxygen vs. air-oxygen non-invasive pressure support in decompensated COPD patients. Crit Care Med 27:2422–2429PubMed
19.
Brochard L (2002) Intrinsic (or auto-) PEEP during controlled mechanical ventilation. Intensive Care Med 28:1376–1378CrossRefPubMed
20.
Wagner PD, Saltzmann HA, West JB (1974) Measurement of continuous distributions of ventilation-perfusion ratios: theory. J Appl Physiol 36:588–599
21.
Wagner PD, Smith CM, Davies NJH, McEvoy RD, Gale GE (1985) Estimation of ventilation-perfusion inequality by inert gas elimination without arterial sampling. J Appl Physiol 59:376–383PubMed
22.
Evans JW, Wagner PD (1977) Limits on VA/Q distributions from analysis of experimental inert gas elimination. J Appl Physiol 42:889–898
23.
Roca J, Wagner PD (1994) Principles and information content of the multiple inert gas elimination technique. Thorax 49:815–824PubMed
24.
Paiva M, Engel LA (1979) Pulmonary interdependence of gas transport. J Appl Physiol 47:296–305PubMed
25.
Christopherson SK, Hlastala MP (1982) Pulmonary gas exchange during altered density gas breathing. J Appl Physiol 52:221–225PubMed
26.
Wagner PD, Dantzker DR, Dueck R, Clausen JL, West JB (1977) Ventilation-perfusion inequality in chronic obstructive pulmonary disease. J Clin Invest 59:203–216PubMed
27.
Torres A, Reyes A, Roca J, Wagner PD, Rodriguez-Roisin R (1989) Ventilation-perfusion mismatching in chronic obstructive pulmonary disease during ventilator weaning. Am Rev Respir Dis 140:1246–1250PubMed
28.
Jaber S, Fodil R, Carlucci A, Boussarsar M, Pigeot J, Lemaire F, Harf A, Lofaso F, Isabey D, Brochard L (2000) Noninvasive ventilation with helium-oxygen in acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 161:1191–1200PubMed
29.
Yang SC, Yang SP (2002) Effects of inspiratory flow waveforms on lung mechanics, gas exchange, and respiratory metabolism in COPD patients during mechanical ventilation. Chest 122:2096–2104CrossRefPubMed
30.
Guérin C, Milic-Emili J, Fournier G (2000) Effect of PEEP on work of breathing in mechanically ventilated COPD patients. Intensive Care Med 26:1207–1214PubMed
31.
Nava S, Bruschi C, Rubini F, Palo A, Iotti G, Braschi A (1995) Respiratory response and inspiratory effort during pressure support ventilation in COPD patients. Intensive Care Med 21:871–879PubMed
32.
Fernandez Mondejar E, Mata GV, Navarro PN, Fernandez RR, Ruiz JMT, Carazo E (1992) Increase in lung volume originated by extrinsic PEEP in patients with auto-PEEP. Intensive Care Med 18:269–273PubMed
33.
Gay P, Rodarte J, Hubmayr R (1989) The effects of positive expiratory pressure on isovolume flow and dynamic hyperinflation in patients receiving mechanical ventilation. Am Rev Respir Dis 139:621–626PubMed
34.
Ranieri VM, Giuliani R, Cinnella G, Pesce C, Brienza N, Ippolito EL, Pomo V, Fiore T, Gottfried SB, Brienza A (1993) Physiologic effects of positive end-expiratory pressure in patients with chronic obstructive pulmonary disease during acute ventilatory failure and controlled mechanical ventilation. Am Rev Respir Dis 147:5–13PubMed
35.
Patel H, Yang KL (1995) The variability of intrinsic positive end-expiratory pressure in patients receiving mechanical ventilation. Crit Care Med 23:1074–1079PubMed
Metadata
Title
Comparative effects of helium-oxygen and external positive end-expiratory pressure on respiratory mechanics, gas exchange, and ventilation-perfusion relationships in mechanically ventilated patients with chronic obstructive pulmonary disease
Authors
Philippe Jolliet
Christine Watremez
Jean Roeseler
J. C. Ngengiyumva
Marc de Kock
Thierry Clerbaux
Didier Tassaux
Marc Reynaert
Bruno Detry
Giuseppe Liistro
Publication date
01-09-2003
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 9/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-003-1864-2

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