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Intensive Care Medicine

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01-05-2004 | Experimental

Ventilation with biphasic positive airway pressure in experimental lung injury

Influence of transpulmonary pressure on gas exchange and haemodynamics

Authors: Dietrich Henzler, Rolf Dembinski, Ralf Bensberg, Nadine Hochhausen, Rolf Rossaint, Ralf Kuhlen

Published in: Intensive Care Medicine | Issue 5/2004

Abstract

Objective

We investigated whether improvement in ventilation perfusion (V̇_A/Q̇) distribution during mechanical ventilation using biphasic positive airway pressure (BIPAP) with spontaneous breathing may be attributed to an effectively increased transpulmonary pressure (P_TP) and can also be achieved by increasing P_TP during controlled ventilation.

Design

In 12 pigs with saline lavage-induced lung injury we compared the effects of BIPAP to pressure-controlled ventilation with equal airway pressure (PCV_AW) or equal transpulmonary pressure (PCV_TP) on V̇_A/Q̇ distribution assessed by the multiple inert gas elimination technique (MIGET).

Setting

Animal laboratory study.

Measurements and results

Intrapulmonary shunt was 33±11% during BIPAP, 36±10% during PCV_AW and 33±15% during PCV_TP (p= n.s.). BIPAP resulted in higher PaO₂ than PCV_AW (188±83 versus 147±82 mmHg, p<0.05), but not than PCV_TP (187±139 mmHg). Oxygen delivery was significantly higher during BIPAP (530±109 ml/min) versus 374±113 ml/min during PCV_AW and 353±93 ml/min during PCV_TP (p<0.005). Tidal volume with PCV_TP increased to 11.9±2.3 ml/kg, compared to 8.5±0.8 with BIPAP and 7.6±1.4 with PCV_AW (p<0.001) and cardiac output decreased to 3.5±0.6 l/min (BIPAP 4.9±0.8 and PCV_AW 3.9±0.8, p<0.006).

Conclusions

In experimental lung injury, BIPAP with preserved spontaneous breathing was effective in increasing regional P_TP, since pressure-controlled ventilation with the same P_TP resulted in similar gas exchange effects. However, PCV_TP caused increased airway pressures and tidal volumes, whereby, with BIPAP, less depression of oxygen delivery and cardiac output were observed. BIPAP could be useful in maintaining pulmonary gas exchange and slightly improving oxygenation without interfering with circulation as strongly as PCV does.

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Title: Ventilation with biphasic positive airway pressure in experimental lung injury
Influence of transpulmonary pressure on gas exchange and haemodynamics
Authors: Dietrich Henzler
Rolf Dembinski
Ralf Bensberg
Nadine Hochhausen
Rolf Rossaint
Ralf Kuhlen
Publication date: 01-05-2004
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 5/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-003-2146-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Ventilation with biphasic positive airway pressure in experimental lung injury

Influence of transpulmonary pressure on gas exchange and haemodynamics

Abstract

Objective

Design

Setting

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Setting

Measurements and results

Conclusions

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