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Ventilator settings and gas exchange in respiratory distress syndrome

  • Burkhard Lachmann
  • Eberhard Danzmann
  • Barbara Haendly
  • Björn Jonson
Chapter
Part of the Developments in Critical Care Medicine and Anaesthesiology book series (DCCA, volume 1)

Abstract

Despite great advances in the treatment of acute respiratory failure, many patients do not respond to accepted methods of resuscitation. The great majority of these critically ill patients fall into the category of adult respiratory distress syndrome (ARDS). The name of this syndrome was given by Ashbaugh et al. [1], who based it upon the severe respiratory distress in illness closely resembling the infant RDS (IRDS). Although the pathogenesis varies highly, it is useful to group various categories of patients together if they meet the clinical, physiological and pathological conditions of the RDS, and respond in a similar manner to a given type of treatment [2]. Infant respiratory distress syndrome is closely related to immaturity [73], whereas ARDS develops in conjunction with severe diseases such as trauma, fat embolism, aspiration pneumonitis or virus pneumonitis, acute renal failure or gas intoxication [79].

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References

  1. 1.
    Ashbaugh DG, Bigelow DB, Petty TL, Levine BE: Acute respiratory distress in adults. Lancet 2: 319–323, 1967.PubMedCrossRefGoogle Scholar
  2. 2.
    Ashbaugh DG, Petty TL, Bigelow DB, Harris TM: Continuous positive-pressure breathing (CPPB) in adult respiratory distress syndrome. J Thorac Cardiovasc Surg 57: 3120 1341, 1969.Google Scholar
  3. 3.
    Ashbaugh DG: Acute respiratory failure after surgery or trauma. In: Petty TL (ed) Respiratory care, 2nd edn. Philadelphia: Lea and Febiger, 1974, pp 190–204.Google Scholar
  4. 4.
    Baum M, Benzer H, Mutz N, Pauser G, Tonczar L: Inversed ratio ventilation (IRV). Die Rolle des Atemzeitverhaltnisses in der Beatmung beim ARDS. Anaesthetist 29: 592–596, 1980.Google Scholar
  5. 5.
    Benzer H, Coraim F, Mutz N, Geyer A, Pauser G: Probleme der “Respiratorischen” Beatmung bei der Schocklunge. In: Mayrhofer-Krammel O, Schlag G, Stoeckel H (eds) Acute respiratory failure Stuttgart: Georg-Thieme-Verlag, 1979, pp 263–270.Google Scholar
  6. 6.
    Blaisdell FW, Lewis FR Jr: Respiratory distress syndrome of shock and trauma: post-traumatic respiratory failure. In: Ebert PA (ed) Major problems in clinical surgery. Philadelphia: WB Saunders, 1977, pp 28–132.Google Scholar
  7. 7.
    Bleyl U: Die Histophysiologie und Histopathologic der terminalen Lungenstrombahn bei akutem Lungenversagen. In: Ahnefeld FW, Bergmann H, Burri C, Dick W, Halmagyi M, Hossli G, Rugheimer E (eds) Akutes Lungenversagen. Berlin: Springer-Verlag, 1979, pp 1–13.CrossRefGoogle Scholar
  8. 8.
    Bohn DJ, Miyasaka K, Marchak BE, Thompson WK, Froese AB, Bryan AC: Ventilation by high-frequency oscillation. J Appl Physiol (Respir Environ Exerc Physiol) 48: 710–716, 1980.Google Scholar
  9. 9.
    Boros SJ, Matalon SV, Ewald R, Leonard AS, Hunt CE: The effect of independent variations in inspiratory-expiratory ratio and end-expiratory pressure during mechanical ventilation in hyaline membrane disease: the significance of mean airway pressure. J Pediatr 91: 794–798, 1977.PubMedCrossRefGoogle Scholar
  10. 10.
    Boros SJ: Variations in inspiratory: expiratory ratio and airway pressure wave form during mechanical ventilation: the significance of mean airway pressure. J Pediatr 94: 114–117, 1979.PubMedCrossRefGoogle Scholar
  11. 11.
    Burchardi H: Verteilungsstorungen bei Langzeitbeatmung. In: Wiemers K, Scholler KL (eds) Lungenveranderungen bei Langzeitbeatmung. International symposium, Freiburg, 1971. Stuttgart: Georg-Thieme-Verlag, 1973, pp 100–105.Google Scholar
  12. 12.
    Busing CM, Bleyl U, Rtifer R: Correlation between plasma proteins and surfactants. In: Wichert PV (ed) Progress in respiration research. Clinical importance of surfactant defects. Basel: S Karger, 1981, pp 224–233.Google Scholar
  13. 13.
    Douglas MME, Downs JB: Pulmonary function following severe acute respiratory failure and high levels of positive end-expiratory pressure. Chest 71: 18–23, 1977.PubMedGoogle Scholar
  14. 14.
    Downs JB, Klein EF Jr, Desautels D, Modell JH, Kirby RR: Intermittent mandatory ventilation: a new approach to weaning patients from mechanical ventilators. Chest 64:331–335, 1973.Google Scholar
  15. 15.
    Downs JB. Douglas ME, Sanfelippo PM, Stanford W, Hodges MR: Ventilatory pattern, intrapleural pressure and cardiac output. Anesth Analg 56: 88–94, 1977.PubMedCrossRefGoogle Scholar
  16. 16.
    Fairley HB, Blenkarn GD: Effect of pulmonary gas exchange of variations in inspiratory flow rate during intermittent positive pressure ventilation. Br J Anaesth 38: 320–328, 1966.PubMedCrossRefGoogle Scholar
  17. 17.
    Fujiwara T, Chida S, Watabe Y, Maeta H, Morita T, Abe T: Artificial surfactant therapy in hyaline membrane disease. Lancet 1: 55–59, 1980.PubMedCrossRefGoogle Scholar
  18. 18.
    Fuleihan SF, Wilson RS, Pontoppidan H: Effect of mechanical ventilation with end-inspiratory pause on blood-gas exchange. Anesth Analg 55: 122–130, 1976.PubMedCrossRefGoogle Scholar
  19. 19.
    Gattinoui L, Pesenti A, Rossi GP, Vesconi S, Fox U, Kolobow T, Agostini A, Pelizzola A, Langer M, Uziel L, Longoni F, Damia G: Treatment of acute respiratory failure with low- frequency positive-pressure ventilation and extracorporeal removal of C02. Lancet 2:292– 294, 1980.Google Scholar
  20. 20.
    Gilston A: The effects of PEEP on arterial oxygenation: an examination of some possible mechanisms. Intensive Care Med 3: 267–271, 1977.PubMedCrossRefGoogle Scholar
  21. 21.
    Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK: Treatment of the idiopathic respiratory distress syndrome with continuous positive airway pressure. N Engl J Med 284: 1333–1340, 1971.PubMedCrossRefGoogle Scholar
  22. 22.
    Herman S, Reynolds EOR: Methods for improving oxygenation in infants mechanically ventilated for severe hyaline membrane disease. Arch Dis Child 48: 612–617, 1973.PubMedCrossRefGoogle Scholar
  23. 23.
    Hughes JMB, Hoppin FG, Mead J: Effect of lung inflation on bronchial length and diameter in excised lungs. J Appl Physiol 32: 25–35, 1972.PubMedGoogle Scholar
  24. 24.
    Jonson B: Positive airway pressure - some physical and biological effects. This book, ch 8.Google Scholar
  25. 25.
    Jonson B, Ahlstrom H, Lindroth M, Svenningsen NW: Continuous positive airway pressure: modes of action in relation to clinical applications. Pediatr Clin North Am 27: 687–699, 1980.PubMedGoogle Scholar
  26. 26.
    Kirby RR, Downs JB, Civetta JM, Modell JH, Dannemiller FJ, Klein EF, Hodges M: High level positive end-expiratory pressure (PEEP) in acute respiratory insufficiency. Chest 67: 156–163, 1975.PubMedCrossRefGoogle Scholar
  27. 27.
    Klain M, Smith RB: High frequency percutaneous transtracheal jet ventilation. Crit Care Med 5: 280–287, 1977.PubMedCrossRefGoogle Scholar
  28. 28.
    Knelson JH, Howatt WF, DeMuth GR: Effect of respiratory pattern on alveolar gas exchange. J Appl Physiol 29: 328–331, 1970.PubMedGoogle Scholar
  29. 29.
    Kolobow T, Solca M, Gattioni L, Pesenti A: Adult respiratory distress syndrome (ARDS): why did ECMO fail? Int J Artificial Organs 4: 58–59, 1981.Google Scholar
  30. 30.
    Kumar A, Falke KJ, Geffin B, Aldredge CF, Laver MB, Lowenstein E, Pontoppidan H: Continuous positive-pressure ventilation in acute respiratory failure. Effects on hemodynamics and lung function. N Engl J Med 283: 1430–1436, 1970.PubMedCrossRefGoogle Scholar
  31. 31.
    Lachmann B, Robertson B, Vogel J: In vivo lung lavage as an experimental model of the respiratory distress syndrome. Acta Anaesthesiol Scand 24: 231–236, 1980.PubMedCrossRefGoogle Scholar
  32. 32.
    Lachmann B, Fujiwara T, Chida S, Morita T, Konishi M, Nakamura K, Maeta H: Improved gas exchange after tracheal instillation of surfactant in the experimental adult respiratory distress syndrome [abstr]. Crit Care Med 9: 158, 1981.CrossRefGoogle Scholar
  33. 33.
    Lachmann B: The role of lung surfactant in etiology, pathogenesis and therapy of acute respiratory distress syndrome in newborn infants and adults. Eur J Respir Dis [Suppl 113] 62: 123–125, 1981.Google Scholar
  34. 34.
    Lachmann B, Grossmann G, Freyse J, Robertson B: Lung-thorax compliance in the artificially ventilated premature rabbit neonate in relation to variations in inspiration/expiration ratio. Pediatr Res 15: 833–838, 1981.PubMedGoogle Scholar
  35. 35.
    Lachmann B, Jonson B, Lindroth M, Robertson B: Modes of artificial ventilation in severe respiratory distress syndrome. Lung function and morphology studied in rabbits after washout of alveolar surfactant. Crit Care Med (in press).Google Scholar
  36. 36.
    Lamy M: Management of ventilatory supports in adult respiratory distress syndrome (ARDS). In: Mayrhofer-Krammel O, Schlag G, Stoeckel H (eds) Acute respiratory failure. Stuttgart: Georg-Thieme-Verlag, 1979, pp 245–255.Google Scholar
  37. 37.
    Lawin P, Scherer R: Beatmung. In: La win P (ed) Praxis der Intensivbehandlung, 4. Aufl. Stuttgart: Georg-Thieme-Verlag, 1981, pp 16. 1–16. 39.Google Scholar
  38. 38.
    Luce JM, Pierson DJ, Hudson LD: Intermittent mandatory ventilation. Chest 79: 678–685, 1981.PubMedCrossRefGoogle Scholar
  39. 39.
    Manginello FP, Grassi AE, Schechner S, Krauss AN, Auld PAM: Evaluation of methods of assisted ventilation in hyaline membrane disease. Arch Dis Child 53: 878–881, 1978.PubMedCrossRefGoogle Scholar
  40. 40.
    Mittermayer Ch, Riede UN, McEwan JR: Pathologisch-anatomische Untersuchungen der Schocklunge. II. Spatschaden und Irreversibility. In: Mayrhofer-Krammel O, Schlag G, Stoeckel H (eds) Acute respiratory failure. Stuttgart: Georg-Thieme-Verlag, 1979, pp 163–170.Google Scholar
  41. 41.
    Modell HI, Cheney FW: Effects of inspiratory flow pattern on gas exchange in normal and abnormal lungs. J Appl Physiol (Respir Environ Exerc Physiol) 46: 1103–1107, 1979.Google Scholar
  42. 42.
    Murray JF: Mechanism of acute respiratory failure, conference report. Am Rev Respir Dis 115: 1071–1078, 1977.Google Scholar
  43. 43.
    Nash G, Blennerhassett JB, Pontoppidan H: Pulmonary lesions associated with oxygen therapy and artificial ventilation. N Engl J Med 276: 368–374, 1967.PubMedCrossRefGoogle Scholar
  44. 44.
    Nilsson R, Grossmann G, Robertson B: Bronchiolar epithelial lesions induced in the premature rabbit neonate by short periods of artificial ventilation. Acta Pathol Microbiol Scand [A] 88: 359–367, 1980.Google Scholar
  45. 45.
    Nilsson R: Artificial ventilation in the newborn rabbit. MD thesis, Karolinska Institute, Stockholm, Sweden, 1980.Google Scholar
  46. 46.
    Nilsson R, Grossmann G, Robertson B: Pathogenesis of neonatal lung lesions induced by artificial ventilation: evidence against the role of barotrauma. Respiration 40: 218–225, 1980.PubMedCrossRefGoogle Scholar
  47. 47.
    Northway WH, Rosan RC, Porter DY: Pulmonary disease following respirator therapy of hyaline-membrane disease. N Engl J Med 276: 357–367, 1967.PubMedCrossRefGoogle Scholar
  48. 48.
    Osswald PM, Hartung HJ, Klose R, Spier R: Die Wirkung von verlangerter Inspirationszeit und PEEP auf die Compliance und den Gasaustausch bei der mechanischen Ventilation. Anaesthetist 30: 71–76, 1981.Google Scholar
  49. 49.
    Petty TL, Ashbaugh DG: The adult respiratory distress syndrome clinical features, factors influencing prognosis and principles of management. Chest 60: 233–239, 1971.PubMedGoogle Scholar
  50. 50.
    Petty TL, Ashbaugh DG: The adult respiratory distress syndrome. In: Petty TL (ed) Respiratory care, 2nd edn. Philadelphia: Lea and Febiger, 1974, pp 205–222.Google Scholar
  51. 51.
    Petty TL, Reiss OK, Paul GW, Silvers GW, Elkins ND: Characteristics of pulmonary surfactant in adult respiratory distress syndrome associated with trauma and shock. Am Rev Respir Dis 115: 531–536, 1977.PubMedGoogle Scholar
  52. 52.
    Petty TL, Newman JH: Adult respiratory distress syndrome. West J Med 128: 399–407, 1978.PubMedCentralPubMedGoogle Scholar
  53. 53.
    Petty TL, Silvers GW, Paul GW, Stanford RE: Abnormalities in lung elastic properties and surfactant function in adult respiratory distress syndrome. Chest 75:571–-574, 1979.Google Scholar
  54. 54.
    Petty TL: Why (not) try PEEP? Crit Care Med 9: 67–68, 1981.PubMedCrossRefGoogle Scholar
  55. 55.
    Pontoppidan H, Geffin B, Lowenstein E: Acute respiratory failure. Part I. N Engl J Med 287: 690–698, 1972.PubMedCrossRefGoogle Scholar
  56. 56.
    Pontoppidan H, Geffin B, Lowenstein E: Acute respiratory failure. Part II. N Engl J Med 287: 743–752, 1972.PubMedCrossRefGoogle Scholar
  57. 57.
    Pontoppidan H, Geffin B, Lowenstein E: Acute respiratory failure in the adult. Part III. N Engl J Med 287: 799–806, 1972.PubMedCrossRefGoogle Scholar
  58. 58.
    Pontoppidan H, Geffin B, Lowenstein E: Acute respiratory failure in the adult. Boston: Little Brown and Co, 1973, pp 1–89.Google Scholar
  59. 59.
    Pontoppidan H, Wilson RS, Rie MA, Schneider RC: Respiratory intensive care. Anesthesiology 47: 96–116, 1977.PubMedCrossRefGoogle Scholar
  60. 60.
    Qvist J, Pontoppidan H, Wilson RS, Lowenstein E, Laver MB: Hemodynamic responses to mechanical ventilation with PEEP; the effect of hypervolemia. Anesthesiology 42: 45–55, 1975.PubMedCrossRefGoogle Scholar
  61. 61.
    Reynolds EOR: Effect of alterations in mechanical ventilator settings on pulmonary gas exchange in hyaline membrane disease. Arch Dis Child 46: 152–159, 1971.PubMedCrossRefGoogle Scholar
  62. 62.
    Reynolds EOR: Pressure waveform and ventilator settings for mechanical ventilation in severe hyaline membrane disease. Int Anesthesiol Clin 12: 259–280, 1974.PubMedCrossRefGoogle Scholar
  63. 63.
    Reynolds EOR, Taghizadeh A: Improved prognosis of infants mechanically ventilated for hyaline membrane disease. Arch Dis Child 49: 505–515, 1974.PubMedCrossRefGoogle Scholar
  64. 64.
    Robertson B: Surfactant substitution: experimental models and clinical applications. Lung 158: 57–68, 1980.PubMedCrossRefGoogle Scholar
  65. 65.
    Robertson B: Review of experimental hyaline membrane disease. Diagn Histopathol 4:49– 60, 1981.Google Scholar
  66. 66.
    Safar P, Grenvik A, Smith J: Progressive pulmonary consolidation: review of cases and pathogenesis. J Trauma 12: 955–967, 1972.PubMedCrossRefGoogle Scholar
  67. 67.
    Schlimgen R: Die Bedeutung des endinspiratorischen Beatmungsplateaus von Respiratoren. Prakt Anaesth 12:505–-510, 1977.Google Scholar
  68. 68.
    Shah DM, Newell JC, Dutton RE, Powers SR: Continuous positive airway pressure versus positive end-expiratory pressure in respiratory distress syndrome. J Thorac Cardiovasc Surg 74: 557–562, 1977.PubMedGoogle Scholar
  69. 69.
    Shapiro BA: Airway pressure therapy for acute restrictive pulmonary pathology. In: Critical care, vol 2. State of the art. The Society of Critical Care Medicine, 1981, pp II C 1–53.Google Scholar
  70. 70.
    Sjostrand U: High-frequency positive-pressure ventilation (HVPPV): a review. Crit Care Med 8: 345–364, 1980.PubMedCrossRefGoogle Scholar
  71. 71.
    Skoskiewicz MJ: Role of pulmonary transplantation in patients with acute respiratory failure. In: Zapol WM, Quist J (eds) Artificial lungs for acute respiratory failure. Washington: Hemisphere Publishing Corporation: distributed by Academic Press, 1976, pp 483–488.Google Scholar
  72. 72.
    Smith PC, Daily WJR: Mechanical ventilation of newborn infants, II. Effects of independent variation of rate and pressure on arterial oxygenation of infants with RDS. Anesthesiology 37: 498–502, 1972.PubMedCrossRefGoogle Scholar
  73. 73.
    Strang LB: Neonatal respiration - physiological and clinical studies. Oxford: Blackwell Scientific, 1977, pp 181–249.Google Scholar
  74. 74.
    Suter PM, Fairley HB, Isenberg MD: Optimum end-expiratory airway pressure in patients with acute pulmonary failure. N Engl J Med 292: 284–289, 1975.PubMedCrossRefGoogle Scholar
  75. 75.
    Suter P: Individuell adaptierter Einsatz verschiedener Beatmungsmethoden zur Therapie des akuten Lungenversagens. In: Ahnefeld FW, Bergmann H, Burri C, Dick W, Halmagyi M, Hossli G, Riigheimer E (eds) Akutes Lungenversagen. Berlin: Springer-Verlag, 1979, pp 113–119.CrossRefGoogle Scholar
  76. 76.
    Suter PM: “Optimal” regulation of mechanical ventilation. Anaesthetist 29:163–164, 1980.Google Scholar
  77. 77.
    Suter PM: Respirator-Therapie. In: Peter K (ed) Akute respiratorische Insuffizienz. Berlin: Springer-Verlag, 1980, pp 94–97.CrossRefGoogle Scholar
  78. 78.
    Taghizadeh A, Reynolds EOR: Pathogenesis of bronchopulmonary dysplasia following hyaline membrane disease. Am J Pathol 82: 241–264, 1976.PubMedGoogle Scholar
  79. 79.
    Task Force Report on Problems Research Approaches Needs: The lung program. National Heart and Lung Institute, October 1972. Panel X: Respiratory distress syndrome. Washington: DHEW Publication no. (NIH) 73-432, pp 165–180.Google Scholar
  80. 80.
    Tyler DC, Cheyney FW: Comparison of positive end-expiratory pressure and inspiratory positive pressure plateau in ventilation of rabbits with experimental pulmonary edema. Anesth Analg 58: 288–292, 1979.PubMedCrossRefGoogle Scholar
  81. 81.
    Weinstein ME, Rice CL, Peters RM, Virgilio RW: Hemodynamic and respiratory response to varying gradients between end-expiratory pressure and end-inspiratory pressure in patients breathing on continuous positive airway pressure. J Trauma 18: 231–235, 1978.PubMedCrossRefGoogle Scholar
  82. 82.
    Wolff G: Was ist die akute respiratorische Insuffizienz? In: Peter K (ed) Akute respiratorische Insuffizienz. Berlin: Springer-Verlag, 1980, pp 21–59.CrossRefGoogle Scholar
  83. 83.
    Zapol WM, Snider M, Hill JD: Extracorporeal membrane oxygenation in severe acute respiratory failure. JAMA 242: 2193–2196, 1979.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1982

Authors and Affiliations

  • Burkhard Lachmann
  • Eberhard Danzmann
  • Barbara Haendly
  • Björn Jonson

There are no affiliations available

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