Advertisement

Ventilation in Severe ARDS: Inverted Ratio Ventilation and CO2 Removal

  • L. Gattinoni
  • D. Mascheroni
  • M. Borelli
  • E. Basilico
  • A. Pesenti

Abstract

The incidence of adult acute respiratory distress syndrome (ARDS) in Western Europe is unknown. However, inferring from data available in the USA (Petty and Newmann 1978) and considering the population of the USA and Western Europe to be equivalent as a first approximation, the number of ARDS cases should be close to 150 000. The mortality rate, in different reported series ranges from 15% (Gallagher et al. 1978) to 90% (Zapol et al. 1979), according to the patient population in the study.

Keywords

Continuous Positive Airway Pressure Acute Respiratory Distress Syndrome Peak Pressure Functional Residual Capacity Adult Respiratory Distress Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Barsch J, Bibara C, Eggers GWN, Krumlofsky F, Sanit YW, Smith W, Smith Webster J (1970) Positive pressure as a cause of respirator induced lung disease. Ann Intern Med 72: 810Google Scholar
  2. Baum M, Benzer H, Mutz N, Pauser G, Tonczar L (1980) Inverted ratio ventilation (IRV). Die Rolle des Atemzeitverhältnisses in der Beatmung beim ARDS. Anaesthesist 29: 592PubMedGoogle Scholar
  3. Cheney F, Burnam C (1971) Effect of ventilatory pattern on oxygenation on pulmonary edema. J Appl Physiol 31: 909PubMedGoogle Scholar
  4. Cole AGH, Weller SF, Sykes MK (1984) Inverse ratio ventilation compared with PEEP in adult respiratory failure. Intensive Care Med 10: 227PubMedCrossRefGoogle Scholar
  5. Conors A, McCaffree DR, Gray BA (1981) Effect of inspiratory flow rate on gas exchange during mechanical ventilation. Am Rev Respir Dis 124: 537Google Scholar
  6. Dantzker D, Brook CJ, Dehart P, Lynch JP, Weg JG (1979) Ventilation-perfusion distributions in adult respiratory distress syndrome. Am Rev Respir Dis 120: 1039PubMedGoogle Scholar
  7. Deneke SM, Fanburg BL (1988) Oxygen toxicity of the lung: an update. Br J Anaesth 54: 737CrossRefGoogle Scholar
  8. Dreyfuss D, Basset G, Soler P, Saumon G (1985) Intermittent positive pressure hyperventilation with high inflation pressures produces pulmonary microvascular injury in rats. Am Rev Respir Dis 132: 880PubMedGoogle Scholar
  9. Dreyfuss D, Basset G, Soler P, Saumon G (1986) Permeability pulmonary edema due to ventilation with high peak pressure is related to changes in volume, not in pressure. Am Rev Respir Dis 133:A 266Google Scholar
  10. Faridy EE (1977) Effect of food and water deprivation on surface activity of lungs of rats. J Appl Physiol 12: 123Google Scholar
  11. Faridy EE, Permutt S, Riley RL (1966) Effect of ventilation on surface forces in excised dogs’lungs. J Appl Physiol 21: 1453PubMedGoogle Scholar
  12. Frumin MJ, Epstein RM, Choen G (1959) Apneic oxygenation in man. Anesthesiology 20: 789PubMedCrossRefGoogle Scholar
  13. Fulheihan S, Wilson R, Pontoppidan H (1976) Effect of mechanical ventilation with end-inspiratory pause on blood gas exchange. Anesth Analg 55: 122Google Scholar
  14. Gallagher TJ, Civetta JM, Kirby RR (1978) Terminology update: optimal PEEP. Crit Care Med 6: 323PubMedCrossRefGoogle Scholar
  15. Gattinoni L, Kolobow T, Tomlinson T, White D, Pierce J (1978a) Control of intermittent positive pressure breathing ( IPPV) by extracorporeal carbon dioxide removal. Br J Anaesth 50: 753PubMedCrossRefGoogle Scholar
  16. Gattinoni L, Kolobow T, Tomlinson T, Iapichino G, Samaya M, White D, Pierce J (1978b) Low frequency positive pressure ventilation with extracorporeal dioxide removal (LFPPV-ECCO2R): an experimental study. Anesth Analg 57: 470PubMedCrossRefGoogle Scholar
  17. Gattinoni L, Iapichino G, Kolobow T (1979) Hemodynamic, mechanical and renal effects during “apneic oxygenation” with extracorporeal carbon dioxide removal, at different levels of intrapulmonary pressure in lambs. Int J Artif Organs 2: 249PubMedGoogle Scholar
  18. Gattinoni L, Agostoni A, Pesenti A, Pelizzola A, Rossi GP, Langer M, Vesconi S, Uziel L, Fox U, Longoni F, Kolobow T, Damia G (1980a) Treatment of acute respiratory failure with low frequency positive pressure ventilation and extracorporeal CO2 removal. Lancet 2: 292PubMedCrossRefGoogle Scholar
  19. Gattinoni L, Agostoni A, Damia G, Cantaluppi D, Bernasconi C, Tarenzi L, Pelizzola A, Rossi GP (1980b) Hemodynamics and renal function during low frequency positive pressure ventilation with extracorporeal carbon dioxide removal. Intensive Care Med 6: 155PubMedCrossRefGoogle Scholar
  20. Gattinoni L, Pesenti A, Kolobow T, Damia G (1983a) A new look at therapy of the adult respiratory distress syndrome: motionless lungs. Int Anesthesiol Clin 21: 97PubMedCrossRefGoogle Scholar
  21. Gattinoni L, Solca M, Pesenti A (1983b) Combined use of artificial lung and kidney in the treatment of terminal acute respiratory distress syndrome. Life Support Syst [Suppl 1] 1: 315Google Scholar
  22. Gattinoni L, Pesenti A, Caspani ML, Pelizzola A, Mascheroni D, Marcolin R, Iapichino G, Langer M, Agostoni A, Kolobow T, Melrose DG, Damia G (1984) The role of total static lung compliance in the management of severe ARDS unresponsive to conventional treatment. Intensive Care Med 10: 121PubMedCrossRefGoogle Scholar
  23. Gattinoni L, Marcolin R, Caspani ML, Fumagalli R, Mascheroni D, Pesenti A (1990) Constant mean airways pressure with different patterns of positive pressure breathing during ARDS. Clin Respir Physiol (in press)Google Scholar
  24. Green JF, Sheldon M, Gurtner G (1983) Alveolar to arterial PCO2 differences. J Appl Physiol 54: 349PubMedGoogle Scholar
  25. Greenfield Li, Ebert PA, Benson DW (1984) Effects of positive pressure ventilation on surface tension properties of lung extracts. Anesthesiology 25: 312Google Scholar
  26. Hudson LD (1982) Causes of the adult respiratory distress syndrome: clinical recognition. Clin. Chest Med 3 (1): 195PubMedGoogle Scholar
  27. Knelson J, Howatt W, de Muth G (1970) Effects of respiratory pattern on alveolar gas exchange. J Appl Physiol 29: 328PubMedGoogle Scholar
  28. Knoch M (1989) Treatment of severe ARDS with extracorporeal CO2 removal. In: Gille JP (ed) Neonatal and adult respiratory failure. Elsevier, Brussels, pp 123–136Google Scholar
  29. Kolobow T, Gattinoni L, Tomlinson T, Pierce J (1977) Control of breathing using an extracorporeal membrane lung. Anesthesiology 46: 138PubMedCrossRefGoogle Scholar
  30. Kolobow T, Gattinoni L, Tomlinson T, Pierce J (1978) An alternative to breathing. J Thorac Cardiovasc Surg 75: 261PubMedGoogle Scholar
  31. Kolobow T, Spragg R, Pierce J (1981) Massive pulmonary infarction during total cardiopulmonary bypass in unanesthetized spontaneously breathing lambs. Int J Artif Organs 4: 76PubMedGoogle Scholar
  32. Lachmann B, Haendly H, Schultz H, Jonson B (1980) Improved arterial oxygenation, CO2 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 ratio of 4:1 in patients with severe adult respiratory distress syndrome ( ARDS ). Intensive Care Med 6: 64Google Scholar
  33. Lachmann B, Jonson B, Lindroth M, Robertson B (1982) Modes of artificial ventilation in severe respiratory distress syndrome. Crit Care Med 10: 724PubMedCrossRefGoogle Scholar
  34. Lemaire F, Amamou M, Rivara D, Simonneau G, Harf A (1980) Static pulmonary pressure-volume curve in acute respiratory failure ( Abstr ). Am Rev Respir Dis [Suppl] 121: 158Google Scholar
  35. Lemaire F, Harf A, Simmoneau G, Matamis D, Rivara D, Atlan G (1981) Echanges gazeux, courbe statique pression-volume et ventilation en pression positive de fin d’expiration: étude de seize cas d’insuffisance respiratoire aigue de l’adulte. Ann Anesthesiol Fr 5: 435Google Scholar
  36. Linton RC, Walter FW, Spoerel WE (1965) Respirator care in a general hospital. a five year survey. Can Anaesth Soc J 12: 450CrossRefGoogle Scholar
  37. Martin L (1980) Hypoventilation without elevated carbon dioxide tension. Chest 77: 720PubMedCrossRefGoogle Scholar
  38. Mascheroni D, Kolobow T, Fumagalli R, Chen V, Moretti D, Duckold B (1985) Respiratory failure following induced hyperventilation. An experimental study. Crit Care Med 13: 322–328Google Scholar
  39. 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: 58PubMedCrossRefGoogle Scholar
  40. McClenahan JB, Urtnowski A (1967) Effect of ventilation on surfactant and its turnover rate. J Appl Physiol 23: 215PubMedGoogle Scholar
  41. Murray IP, Modell JH, Gallagher TJ, Banner MJ (1984) Titration of PEEP by the arterial minus endtidal carbon dioxide gradient. Chest 85: 100PubMedCrossRefGoogle Scholar
  42. Mutz N, Duma ST, Goldschmied W (1983) Inversed ratio ventilation-PEEP ersatz. Anaesthesist [Suppl] 32: 83Google Scholar
  43. Nash G, Blennerhasset JB, Pontoppidan H (1967) Pulmonary lesions associated with oxygen therapy and artificial ventilation. N Engl J Med 276: 368PubMedCrossRefGoogle Scholar
  44. National Heart and Lung Institute (1974) Protocol for extracorporeal support for respiratory insufficiency. Collaborative program. NIH, BethesdaGoogle Scholar
  45. National Heart and Lung Institute (1979) Extracorporeal support for respiratory insufficiency. A collaborative study in response to request for proposal, NHLI 73–20, p. 6. NIH, BethesdaGoogle Scholar
  46. Osswald PM, Hartung HJ, Klose R, Spier R (1981) Die Wirkung von verlängerter Inspirationszeit and PEEP auf die Compliance and den Gasaustausch bei der mechanischen Ventilation. Anaesthesist 30: 71PubMedGoogle Scholar
  47. Pepe PE, Marini JJ (1982) Occult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction. Am Rev Respir Dis 126: 166PubMedGoogle Scholar
  48. Pesenti A, Pelizzola A, Mascheroni D, Uziel L, Pirovano E, Fox U, Gattinoni L (1981) Low frequency positive pressure ventilation with extracorporeal CO2 removal (LFPPV-ECCOZR) in acute respiratory failure (ARF): technique. Trans Am Soc Artif Intern Organs 27: 263PubMedGoogle Scholar
  49. Pesenti A, Kolobow T, Marcolin R, Riboni A, Rossi S, Romagnoli G, Gattinoni L (1982) A double lumen catheter allowing single vessel cannulation for extracorporeal respiratory assistance. Eur Surg Res 14: 119CrossRefGoogle Scholar
  50. Pesenti A, Riboni A, Marcolin R, Gattinoni L (1983) Venous admixture (Qva/Q) in ARF patients: effects of PEEP at constant Fi02. Intensive Care Med 9: 307PubMedCrossRefGoogle Scholar
  51. Pesenti A, Marcolin R, Prato P, Borelli M, Riboni A, Gattinoni L (1990) Mean airways pressure vs positive end-expiratory pressure during mechanical ventilation. Crit Care Med (in press)Google Scholar
  52. Peters J, Radermacher P, Kuntz ME, Rosenbauer A, Breulmann M, Bürrig KF, Hopf HB, Rossaint R, Schulte HD, Olsson P, Falke K (1988) Extracorporeal CO2 removal with a heparin coated artificial lung. Intensive, Care Med 14: 578–584Google Scholar
  53. Petty TL, Fowler AA (1982) Another look at ARDS. Chest 82: 98PubMedCrossRefGoogle Scholar
  54. Petty TL, Newmann JH (1978) Adult respiratory distress syndrome incidence. West J Med 128 (5): 399PubMedGoogle Scholar
  55. Reynolds FOR (1971) Effect of alterations in mechanical ventilator settings on pulmonary gas exchange for hyaline membrane disease. Arch Dis Child 49: 505CrossRefGoogle Scholar
  56. Rinaldo JE, Rogers RM (1982) Adult respiratory distress syndrome, changing concepts of lung injury and repair. N Engl J Med 306: 900PubMedCrossRefGoogle Scholar
  57. Safar P (1965) Respiratory therapy. Davis, PhiladelphiaGoogle Scholar
  58. Shapiro BA, Cane RD, Harrison RA (1983) Positive end-expiratory pressure in acute lung injury. Chest 83: 558PubMedCrossRefGoogle Scholar
  59. Smith JL (1899) The pathologic effects due to increase of oxygen tension in air breathed. J Physiol 24: 19PubMedGoogle Scholar
  60. Suter P, Fairley HB, Isenberg MD (1978) Effect of tidal volume and positive end expiratory pressure on compliance during mechanical ventilation. Chest 73: 158PubMedCrossRefGoogle Scholar
  61. Sykes MK, Lumley J (1969) The effect of varying inspiratory-expiratory ratios on gas exchange during anaesthesia for open-heart surgery. Br J Anaesth 41: 374PubMedCrossRefGoogle Scholar
  62. Thet LA, Alvarez H (1982) Effect of hyperventilation and starvation on rat lung mechanics and surfactant. Am Rev Respir Dis 126: 286PubMedGoogle Scholar
  63. Tyler D (1983) Positive end-expiratory pressure: a review. Crit Care med 11: 300PubMedCrossRefGoogle Scholar
  64. Uziel L, Agostoni A, Pirovano E, Sedini I, Pesenti A, Fox U, Gattinoni L, Kolobow T (1982) Hematologic survey during low frequency positive pressure ventilation with extracorporeal CO2 removal. Trans Am Soc Artif Intern Organs 28: 359PubMedGoogle Scholar
  65. Webb HH, Tierney DF (1974) Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures. Protection by positive end-expiratory pressures. Am Rev Respir Dis 110: 556PubMedGoogle Scholar
  66. Wyszogrodski I, Kyei-Aboagye K, Taeusch HW, et al. (1975) Surfactant inactivation by hyperventilation: conservation of end-expiratory pressure J Appl Physiol 38: 461PubMedGoogle Scholar
  67. Zapol WM, Snider MT, Hill JD, Fallat RJ, Bartlett RH, Edmunds LH, Morris AH, Pierce EC, Thomas AN, Proctor HJ, Drinker PA, Pratt PC, Bagniewsky A, Miller RG (1979) Extracorporeal membrane oxygenation in severe acute respiratory failure. JAMA 242: 2193PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • L. Gattinoni
  • D. Mascheroni
  • M. Borelli
  • E. Basilico
  • A. Pesenti

There are no affiliations available

Personalised recommendations