Abstract
The indications for support in acute respiratory failure are based on clinical, radiological and laboratory evidence: dyspnoea, tachypnoea and panlobar alveolar infiltrates of one or both lungs accompanied by severe hypoxaemia with an arterial oxygen tension (PaO2) or less than 75 mmHg when breathing a fraction of inspired oxygen (FiO2) of more than 0.5 (Artigas et al. 1985). These clinical signs often require an immediate response: in an attempt to improve arterial oxygenation, continuous positive airways pressure (CPAP) is applied via a facemask or an endotracheal tube, but frequently some sort of mechanical ventilation is required. However, the mode of mechanical ventilation depends essentially upon a process of trial and error in which success is monitored by blood gas analysis. Although reliable, this empirical method does not disclose where the failure or potential for improvement in ventilation lies. A method by which the optimal ventilatory pattern could be found should encompass the different anatomical levels of the lungs and their function as well as their mechanics.
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References
Artigas A, Carlet J, Chastang C, Le Gall JR, Cox P (1985) Protocol of adult respiratory distress syndrome study: clinical predictors, prognostic factors and outcome. European Society of Intensive Care Medicine.
Bowes C, Cumming G, Horsfield K, Loughhead J, Preston S (1982) Gas mixing in a model of the pulmonary acinus with asymmetrical alveolar ducts. J Appl Physiol 52:624–633.
Bshouty ZH, Roeseler J, Reynaert MS, Rodenstein D (1986) The importance of the balloon reservoir volume of a CPAP system in reducing the work of breathing. Intensive Care Med 12:153–156.
Cole AGH, Weiler SF, Sykes MK (1984) Inversed ratio ventilation compared with PEEP in adult respiratory failure. Intensive Care Med 10:227–232.
Cumming G, Horsfield K, Preston SB (1971) Diffusion equilibrium in the lungs examined by nodal analysis. Respir Physiol 12:329–345.
Cumming G, Guyatt A (1982) Alveolar gas mixing efficiency in the human lung. Clin Sci 62:541–547.
Downs JB (1983) Ventilatory pattern and modes of ventilation in acute respiratory failure. Resp Care 28:586–591.
Engel LA, Wood LDH, Utz G, MackCern PT (1973) Gas mixing during inspiration. J Appl Physiol 35:18.
Feiton CR, Montenegro HD, Saidel GM (1984) Inspiratory flow effects on mechanically ventilated patients: lung volume, inhomogeneity and arterial oxygenation. Intensive Care Med 10:281–286.
Fischer AB (1980) Oxygen therapy: side effects and toxicity. Am Rev Respir Dis 122:61–69.
Fowler WS (1948) Lung function studies. II. The respiratory dead space. Am J Physiol 154:405–461.
Hillman DR (1986) Physiological aspects of intermittent positive pressure ventilation. Anaesthesiol Intensive Care 14:226–235.
Ibanez J, Rawich JM, Moris SG (1983) Measurement of functional residual capacity during mechanical ventilation by simultaneous exchange of two insoluble gases. Anaesthesiol 54:413–417.
Kox W, Langley F, Horsfield K, Cumming G (1982) The effect of atropine on alveolar gas mixing in man. Clin Sci 62:549–551.
Krogh A, Lindhard J (1917) The volume of dead space in breathing and the mixing of gases in the lungs of man. J Physiol (Lond) 51:59–90.
Lanczos C (1957) Applied analysis. Prentice-Hall mathematics series. Pitman, London.
Loewy A (1894) Ueber die Bestimmung der Groesse des “Schaedlichen Luftraumes” im Thorax und der alveolaeren Sauerstoffspannung. Arch Ges Physiol 58:416–427.
Ozanne GM, Zinn SE, Fairley HB (1981) Measurement of functional residual capacity during mechanical ventilation by simultaneous exchange of two insoluble gases. Anaesthesiol 54:413–417.
Paloski WH, Newell JC, Gisser DG, Stratton HH, Annest SJ, Gottlieb ME, Shah DM (1981) A system to measure functional residual capacity in critically ill patients. Crit Care Med 4:342–346.
Reynolds EOR (1971) Effect of alterations in mechanical ventilation settings on pulmonary gas exchange in hyaline membrane disease. Arch Dis Childh 46:152–159.
Severinghaus JW (1966) Blood gas calculator. J Appl Physiol 4:102.
Suter PM, Fairley HB, Isenberg MD (1975) Optimum end-expiratory airway pressure in patients with acute pulmonary failure. N Engl J Med 292:284–289.
Wagner PD, Saltzman HA, West JB (1974) Measurement of continuous distributions of ventilationperfusion ratios: theory. J Appl Physiol 36:588–599.
West J (1979) Respiratory physiology. Williams and Wilkins, Baltimore.
West J (1982) Ventilation-perfusion relationship. In: Scurr C, Feldman S (eds) Anaesthesia, scientific foundations. Heinemann, London.
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© 1988 Springer-Verlag Berlin Heidelberg
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Kox, W. (1988). The Physiological Basis of Ventilatory and Respiratory Support. In: Kox, W., Bihari, D. (eds) Shock and the Adult Respiratory Distress Syndrome. Current Concepts in Critical Care. Springer, London. https://doi.org/10.1007/978-1-4471-1443-7_9
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DOI: https://doi.org/10.1007/978-1-4471-1443-7_9
Publisher Name: Springer, London
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