Mechanical Ventilation and Weaning

  • G. Iotti
  • L. Brochard
  • F. Lemaire

Abstract

Inspiration is realized by the combined activation of several inspiratory muscles in the presence of airway patency. These muscles have to oppose several forces to generate alveolar ventilation.

Keywords

Fatigue Catheter Depression Pneumonia Titration 

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References

  1. 1.
    Agostini E, Hyatt RE (1986) Static behavior of the respiratory system. In: Macklem PT, Mead J (eds) Handbook of physiology. Respiration, section 3, vol III. American Physiological Society, Bethesda, pp 113–130Google Scholar
  2. 2.
    Al-Saady N, Bennett ED (1985) Decelerating inspiratory flow wave form improves lung mechanics and gas exchange in patients on intermittent positive-pressure ventilation. Intensive Care Med 11: 68–75PubMedCrossRefGoogle Scholar
  3. 3.
    Bach JR, Alba AS, Bohatiuk G, Saporito L, Lee M (1987) Mouth intermittent positive pressure ventilation in the management of postpolio respiratory insufficiency. Chest 91: 859–864PubMedCrossRefGoogle Scholar
  4. 4.
    Baehrendtz S, Hedenstierna G (1984) Differential ventilation and selective positive end-expiratory pressure: effects on patients with acute bilateral lung disease. Anesthesiology 61: 511–517PubMedCrossRefGoogle Scholar
  5. 5.
    Biondi JW, Schulman DS, Matthay RA (1988) Effects of mechanical ventilation on right and left ventricular function. In: Morganroth ML (ed) Mechanical ventilation. Saunders, Philadelphia, pp 55–71Google Scholar
  6. 6.
    Boyer F, Jay S, Gaussorgues P, Methani K, Robert D (1985) A new approach to mandatory ventilation: pressure support mandatory minute frequency. Intensive Care Med 14: 262 (abstract)Google Scholar
  7. 7.
    Braschi A, Iotti G, Locatelli A, Bellinzona G (1985) Functional evaluation of a CPAP circuit with high-compliance reservoir bag. Intensive Care Med 11: 85–89PubMedCrossRefGoogle Scholar
  8. 8.
    Braschi A, Iotti G, Locatelli A, Bellinzona G (1987) A continuous flow intermittent mandatory ventilation with continuous positive airway pressure circuit with high-compliance reservoir bag. Crit Care Med 15: 947–950PubMedCrossRefGoogle Scholar
  9. 9.
    Braschi A, Iotti G, Rodi G, Emmi V, Sala Gallini G (1988) Dynamic pulmonary hyperinflation during intermittent mandatory ventilation. Intensive Care Med 14: 284 (abstract)Google Scholar
  10. 10.
    Braun NMT (1988) Intermittent mechanical ventilation. Clin Chest Med 9: 153–162PubMedGoogle Scholar
  11. 11.
    Brochard L, Pluskwa F, Lemaire F (1987) Improved efficacy of spontaneous breathing with inspiratory pressure support. Am Rev Respir Dis 136: 411–415PubMedCrossRefGoogle Scholar
  12. 12.
    Brochard L, Isabey D, Piquet J et al. (1990) Reversal of acute exacerbations of chronic obstructive lung disease by face mask inspiratory assistance. N Engl J Med 323: 1523–1530PubMedCrossRefGoogle Scholar
  13. 13.
    Brochard L, Rua F, Lorino H, Lemaire F, Harf A (1988) The extra work of breathing due to the endotracheal tube is abolished during inspiratory pressure support breathing. Am Rev Respir Dis 137 (Suppl): 64 (abstract)Google Scholar
  14. 14.
    Brochard L, Harf A, Lorino H, Lemaire F (1989) Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation. Am Rev Respir Dis 139: 513–521PubMedCrossRefGoogle Scholar
  15. 15.
    Brun-Buisson C, Abrouk F, Ben Lakhal S, Lemaire F (1987) Reduction of venous admixture with PEEP during human ARF. Respective role of alveolar recruitment vs decrease in blood flow. Am Rev Respir Dis 135: A6Google Scholar
  16. 16.
    Carroll N, Branthwaite MA (1988) Intermittent positive pressure ventilation by nasal mask: technique and applications. Intensive Care Med 14: 115–117PubMedCrossRefGoogle Scholar
  17. 17.
    Chang HK (1984) Mechanisms of gas transport during ventilation by high-frequency oscillation. Appl Physiol 56: 553–563Google Scholar
  18. 18.
    Chevrolet JC, Martin JG, Flood R, Martin RR, Engel LA (1978) Topographical ventilation and perfusion distribution during IPPB in the lateral posture. Am Rev Respir Dis 118: 847–854PubMedGoogle Scholar
  19. 19.
    Cohen CA, Zagelbaum G, Gross D, Roussos C, Macklem PT (1982) Clinical manifestations of inspiratory muscle fatigue. Am J Med 73: 308–316PubMedCrossRefGoogle Scholar
  20. 20.
    Coles AGH, Weller SF, Sykes Mk (1984) Inverse ratio ventilation compared with PEEP in adult respiratory failure. Intensive Care Med 10: 227–232Google Scholar
  21. 21.
    Corbeil C, Cantineau JP, Albala M et al. (1989) Effect of flow and volume on respiratory system resistance in anesthetized-paralyzed humans. Am Rev Respir Dis 139: A100CrossRefGoogle Scholar
  22. 21a.
    Corbridge TC, Wood LDH, Crawford GP et al. (1990) Adverse effects of large tidal volume and low PEEP in canine acid aspiration. Am Rev Respir Dis 142: 311–315PubMedGoogle Scholar
  23. 22.
    Cournand A, Motley HL, Richards DW (1948) Physiological studies of the effects of intermittent positive pressure breathing on cardiac output in man. Am J Physiol 152: 162–174PubMedGoogle Scholar
  24. 23.
    Cox D, Tinloi SF, Farrimond JG (1988) Investigation of the spontaneous modes of breathing of different ventilators. Intensive Care Med 14: 532–537PubMedCrossRefGoogle Scholar
  25. 24.
    Danzman E, Lachmann B, Hohmann H et al. (1980) Effects of different inspiratory/expiratory ratios and PEEP-ventilation on blood gases, lung mechanics and hemodynamics in dogs with severe respiratory distress syndrome. Intensive Care Med 6: 165 (abstract)Google Scholar
  26. 24a.
    Darioli R, Perret C (1984) Mechanical controlled hypoventilation in Status asthmaticus. Am Rev Respir Dis 129: 385–387PubMedGoogle Scholar
  27. 25.
    Derenne JP, Fleury B, Pariente R (1988) Acute respiratory failure of chronic obstructive pulmonary disease. Am Rev Respir Dis 138: 1006–1033PubMedCrossRefGoogle Scholar
  28. 26.
    Downs JB (1980) Inappropriate application of IMV. Chest 78: 897PubMedCrossRefGoogle Scholar
  29. 27.
    Downs JB, Stock MC (1987) Airway pressure release ventilation: a new concept in ventilatory support. Crit Care Med 15: 459–461PubMedCrossRefGoogle Scholar
  30. 27a.
    Dreyfuss D, Soler P, Basset G, Saumon G (1988) High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume and positive end expiratory pressure. Am Rev Respir Dis 137: 1159–1164PubMedGoogle Scholar
  31. 27b.
    Fiastro JF, Habib MP, Quan SF (1988) Pressure support compensation for inspiratory work due to endotracheal tubes and demand continuous positive airway pressure. Chest 93: 499–505PubMedCrossRefGoogle Scholar
  32. 28.
    Field S, Kelly SM, Macklem PT (1982) The oxygen cost of breathing in patients with cardiorespiratory disease. Am Rev Respir Dis 126: 9–13PubMedGoogle Scholar
  33. 29.
    Froese AB, Bryan AC (1974) Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 41: 242–255PubMedCrossRefGoogle Scholar
  34. 30.
    Garner W, Downs JB, Stock MC, Rasanen J (1988) Airway pressure release ventilation (APRV). A human trial. Chest 94: 779–781PubMedCrossRefGoogle Scholar
  35. 31.
    Gattinoni L, Agostoni A, Pesenti A et al. (1980) Treatment of acute respiratory failure with low-frequency-positive-pressure ventilation and extracorporeal removal of CO2. Lancet 11: 292–294CrossRefGoogle Scholar
  36. 32.
    Gattinoni L, Mascheroni D, Torresin D et al. (1986) Morphological response to positive end-expiratory pressure in acute respiratory failure. A computerized study. Intensive Care Med 12: 137–142PubMedCrossRefGoogle Scholar
  37. 33.
    Gattinoni L, Pesenti A, Marcolin R, Damia G (1988) Extracorporeal support in acute respiratory failure. Intensive Care World 5: 42–45Google Scholar
  38. 34.
    Gottfried L, Simkowitz P, Skaburskis M (1987) Effect of constant negative extrathoracic pressure on breathing pattern and respiratory muscles function in severe chronic obstructive pulmonary disease. Am Rev Respir Dis 135 (Suppl): A201Google Scholar
  39. 35.
    Hedenstierna G (1975) The anatomical and alveolar dead-spaces during respiratory treatment. Br J Anaesth 47: 993–998PubMedCrossRefGoogle Scholar
  40. 36.
    Heenan TJ, Downs JB, Douglas ME, Ruiz BC, Jumper L (1980) Intermittent mandatory ventilation. Is synchronization important? Chest 77: 598–602PubMedCrossRefGoogle Scholar
  41. 37.
    Hewlett AM, Piatt AS, Terry VG (1977) Mandatory minute volume: a new concept in weaning from mechanical ventilation. Anesthesia 32: 163–169CrossRefGoogle Scholar
  42. 37a.
    Hickling Ng, Henderson SJ, Jackson R (1990) Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med 16: 372–377PubMedCrossRefGoogle Scholar
  43. 38.
    Hill NS (1986) Clinical applications of body ventilators. Chest 90: 897–905PubMedCrossRefGoogle Scholar
  44. 39.
    Hillman KM, Barber JD (1980) Asynchronous independent lung ventilation ( AILV ). Crit Care Med 8: 390–395PubMedCrossRefGoogle Scholar
  45. 40.
    Iotti G, Braschi A (1988) Ventilazione spontanea con supporto di pressione. In: Gattinoni L, Braschi A (eds) La ventilazione artificiale. Masson, Milano, pp 99–112Google Scholar
  46. 41.
    Iotti BG, Braschi A, Locatelli A, Bellinzona G (1985) Respiration spontanée au cours de la ventilation artificielle. Presse Med 14: 165–166PubMedGoogle Scholar
  47. 42.
    Jardin F, Farcot JC, Boisante L, Curien N, Margairaz A, Bourdarias JP (1981) Influence of positive end expiratory pressure on left ventricular performance. N Engl J Med 304: 387–392PubMedCrossRefGoogle Scholar
  48. 43.
    Kacmarek RM (1988) The role of pressure support ventilation in reducing work of breathing. Respir Care 33: 99–119Google Scholar
  49. 44.
    Katz JA, Marks JD (1985) Inspiratory work with and without continuous positive airway pressure in patients with acute respiratory failure. Anesthesiology 63: 598–607PubMedCrossRefGoogle Scholar
  50. 45.
    Katz JA, Kraemer RW, Gjerde GE (1985) Inspiratory work and airway pressure with continuous positive airway pressure delivery systems. Chest 88: 519–526PubMedCrossRefGoogle Scholar
  51. 46.
    Kirby RR, Downs JB, Civetta JM et al. (1975) High level positive end expiratory pressure ( PEEP) in acute respiratory insufficiency. Chest 67: 156–163PubMedCrossRefGoogle Scholar
  52. 47.
    Kvetan V, Carlon GC, Howland WS (1982) Acute pulmonary failure in asymétrie lung disease: approach to management. Crit Care Med 10: 114–118PubMedCrossRefGoogle Scholar
  53. 48.
    Lachmann B, Haendly B, Shulz H, Jonson B (1980) Improved arterial oxygenation, C02 elimination, compliance and decreased barotrauma following changes of volume-generated PEEP ventilation with inspiratory/ expiratory (I/E) ratio of 1:2 to pressure-generated ventilation with I/E of 4:1 in patients with severe adult respiratory distress syndrome. Intensive Care Med 6: 64 (abstract)Google Scholar
  54. 49.
    Lehnert BE, Oberdoster G, Slutsky AS (1982) Constant-flow ventilation of apneic dogs. J Appl Physiol 53: 483–489PubMedGoogle Scholar
  55. 50.
    Lemaire F, Harari A, Rapin M, Jardin F, Teisseire B, Laurent D (1976) Assessment of gas exchange during veno-arterial bypass using the membrane lung. In: Zapol W, Qvist J (eds) Artificial lungs for acute respiratory failure. Academic Press, New York, pp 421–433Google Scholar
  56. 51.
    Lemaire F, Teboul JL, Cinotti L et al. (1988) Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 69:171 — 179PubMedCrossRefGoogle Scholar
  57. 52.
    Leger P, Jennequin J, Gaussorgues P, Robert D (1988) Acute respiratory failure in COPD patients treated with non invasive intermittent mechanical ventilation. Am Rev Respir Dis 137 (Suppl): 63 (abstract)Google Scholar
  58. 53.
    Lynch JP, Mhyre JG, Dantzker DR (1979) Influence of cardiac output on intra-pulmonary shunt 46: 315–321Google Scholar
  59. 53a.
    Maclntyre NR (1986) Respiratory function during pressure support ventilation. Chest 89: 677–683CrossRefGoogle Scholar
  60. 53b.
    Malo J, Ali J, Wood LDH (1984) How does PEEP reduce intra-pulmonary shunt in canine pulmonary edema? J Appl Physiol 57: 1002–1010PubMedGoogle Scholar
  61. 54.
    Marini JJ, Capps JS, Culver BH (1985) The inspiratory work of breathing during assisted mechanical ventilation. Chest 87: 612–618PubMedCrossRefGoogle Scholar
  62. 55.
    Marini JJ, Rodriguez RM, Lamb V (1986) The inspiratory workload of patient-initiated mechanical ventilation. Am Rev Respir Dis 134: 902–909PubMedGoogle Scholar
  63. 56.
    Marini JJ, Rodriguez RM, Lamb V (1986) Bedside estimation of the inspiratory work of breathing during mechanical ventilation. Chest 89: 56–63PubMedCrossRefGoogle Scholar
  64. 57.
    Marini JJ, Smith TC, Lamb JV (1988) External work output and force generation during synchronized intermittent mechanical ventilation. Am Rev Respir Dis 138: 1169–1179PubMedGoogle Scholar
  65. 58.
    Matamis D, Lemaire F, Harf A, Brun-Buisson C, Ansquer JC, Atlan G (1984) Total respiratory pressure-volume curves in the adult respiratory distress syndrome. Chest 86: 58–66PubMedCrossRefGoogle Scholar
  66. 59.
    Meduri GU, Conoscenti GC, Menashe P, Nair S (1989) Noninvasive face mask ventilation in patients with acute respiratory failure. Chest 95: 865–870PubMedCrossRefGoogle Scholar
  67. 60.
    Murciano D, Boczkowski J, Lecoguic Y, Milic-Emili J, Pariente R, Aubier M (1988) Tracheal occlusion pressure: a simple index to monitor respiratory muscle fatigue during ARF in patients with COPD. Ann Intern Med 108: 800–805PubMedGoogle Scholar
  68. 61.
    Nunn JF (1977) Applied respiratory physiology, 2nd edn. Butterworths, LondonGoogle Scholar
  69. 62.
    Pepe PE, Marini JJ (1982) Occult positive end expiratory pressure in mechanically ventilated patients with airflow obstruction. Am Rev Respir Dis 126: 166–170PubMedGoogle Scholar
  70. 62a.
    Petrof BJ, Legare M, Goldberg P, Milic-Emili J, Gottfried SB (1990) Continuous positive airway pressure reduces work of breathing and dyspnea in severe chronic obstructive pulmonary disease. Am Rev Respir Dis 141: 281–289PubMedGoogle Scholar
  71. 63.
    Pinsky MR, Summer WR (1983) Cardiac augmentation by phasic high intrathoracic pressure support in man. Chest 128: 370–375CrossRefGoogle Scholar
  72. 64.
    Qvist J, Pontoppidan H, Wilson RS, Lowenstein E, Laver MB (1975) Hemodynamic response to mechanical ventilation with PEEP. Anesthesiology 42: 45–55PubMedCrossRefGoogle Scholar
  73. 65.
    Rizk NW, Murray JF (1982) PEEP and pulmonary edema. Am J Med 381: 381–383CrossRefGoogle Scholar
  74. 66.
    Rochester DF, Martin LL (1985) Respiratory muscle rest. In: Roussos C, Macklem PT (eds) The thorax. Marcel Dekker, New York, pp 1303–1308Google Scholar
  75. 67.
    Rodarte JR, Rehder K (1986) Dynamics of respiration. In Macklem PT, Mead J (eds). Handbook of physiology. Respiration, section 3, vol III. American Physiological Society, Bethesda, pp 131–144Google Scholar
  76. 68.
    Rossi A, Gottfried B, Zocchi L et al. (1985) Measurement of static compliance of the total respiratory system in patients with acute respiratory failure during mechanical ventilation. Am Rev Respir Dis 131: 672–677PubMedGoogle Scholar
  77. 69.
    Rossi A, Gottfried SB, Higgs BD, Zocchi L, Grassino A, Milic-Emili J (1985) Respiratory mechanics in mechanically ventilated patients with respiratory failure. J Appl Physiol 58: 1849–1858PubMedGoogle Scholar
  78. 70.
    Rouby JJ, Simonneau G, Benhamou D et al. (1985) Factors influencing pulmonary volumes and C02 elimination during high-frequency jet ventilation. Anesthesiology 63: 473–482PubMedCrossRefGoogle Scholar
  79. 71.
    Roussos C, Campbell EJM (1986) Respiratory muscle energetics. In: Macklem PT, Mead J (eds) Handbook of physiology. Respiration, section 3, vol III. American Physiological Society, Bethesda, pp 481–510Google Scholar
  80. 72.
    Samodelov LF, Falke KJ (1988) Total inspiratory work with modern demand valve devices compared to continuous flow CPAP. Intensive Care Med 14: 632–639PubMedCrossRefGoogle Scholar
  81. 73.
    Sassoon CS, Te TT, Mahutte CK, Light RW (1987) Airway occlusion pressure: an important indicator for successful weaning in patients with COPD. Am Rev Respir Dis 135: 107–113PubMedGoogle Scholar
  82. 74.
    Schiavina M (1987) Treatment of patients with respiratory failure during wakefulness and sleep: use of tank ventilator. In: Grassino A, Fracchia C, Rampulla C, Zocchi L (eds) Respiratory muscles in chronic obstructive pulmonary disease. Springer,Berlin Heidelberg New York, pp 173–182Google Scholar
  83. 75.
    Shapiro BA, Carre RD, Harrison RA (1983) Positive end-expiratory pressure in acute lung injury. Chest 83: 558–563PubMedCrossRefGoogle Scholar
  84. 76.
    Sjostrand U (1980) High-frequency positive-pressure ventilation (HFPPV): a review. Crit Care Med 8: 345–364PubMedCrossRefGoogle Scholar
  85. 77.
    Slutsky AS (1988) Non conventional methods of ventilation. Am Rev Respir Dis 138: 175–183PubMedCrossRefGoogle Scholar
  86. 77a.
    Smith TC, Marini JJ (1988) Impact of PEEP on lung machanics and work of breathing in severe airflow obstruction. J Appl Physiol 65: 1488–1489PubMedGoogle Scholar
  87. 78.
    Smith TC, Marini JJ, Lamb VJ (1987) CPAP reduces drive and workload in COPD. Chest 92: 66s (abstract)Google Scholar
  88. 79.
    Steinhoff H, Falke K, Schwarzhoff W (1982) Enhanced renal function associated with intermittent mandatory ventilation in acute respiratory failure. Intensive Care Med 8: 69–74PubMedCrossRefGoogle Scholar
  89. 80.
    Stock MC, Downs JB, Frolicher DA (1987) Airway pressure release ventilation. Crit Care Med 15: 462–466PubMedCrossRefGoogle Scholar
  90. 81.
    Sullivan M, Parliotta J, Saklad M (1976) Endotracheal tube as a factor in measurement of respiratory mechanics. J Appl Physiol 41: 590–592PubMedGoogle Scholar
  91. 82.
    Suter PM, Fairey HB, Isenberg MD (1975) Optimum end-expiratory airway pressure in patients with acute pulmonary failure. N Engl J Med 292: 284–289PubMedCrossRefGoogle Scholar
  92. 83.
    Tharrat RS, Allen RP, Albertson TE (1988) Pressure controlled inverse ratio ventilation in severe adult respiratory failure. Chest 94: 755–762CrossRefGoogle Scholar
  93. 84.
    Thompson JD (1987) Computerized control of mechanical ventilation: closing the loop. Respir Care 32: 440–446Google Scholar
  94. 85.
    Tuxen DV, 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: 872–879PubMedCrossRefGoogle Scholar
  95. 86.
    Viquerat CE, Righetti A, Suter PM (1983) Biventricular volumes and function in patients with ARDS ventilated with PEEP. Chest 83: 509–514PubMedCrossRefGoogle Scholar
  96. 87.
    Zapol WM, Snider MT, Hill JD et al. (1979) Extracorporeal membrane oxygenation in severe acute respiratory failure. JAMA 242: 2193–2196PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 1992

Authors and Affiliations

  • G. Iotti
  • L. Brochard
  • F. Lemaire

There are no affiliations available

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