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Effect of expiratory resistance on gas‐exchange and breathing pattern in chronic obstructive pulmonary disease (COPD) patients being weaned from the ventilator
Author(s) -
Lourens M. S.,
Berg B. Van Den,
Hoogsteden H. C.,
Bogaard J. M.
Publication year - 2001
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1034/j.1399-6576.2001.450917.x
Subject(s) - medicine , copd , tidal volume , ventilation (architecture) , anesthesia , dynamic hyperinflation , cardiology , work of breathing , respiratory system , mechanical ventilation , lung volumes , lung , mechanical engineering , engineering
Background: The majority of patients with severe chronic obstructive pulmonary disease (COPD) have flow limitation, which has deleterious side effects. If these patients are mechanically ventilated, this often results in difficult weaning. Spontaneously breathing COPD patients experience a beneficial effect of pursed lip breathing. We investigated whether in intubated COPD patients application of an external resistance could produce the same beneficial effects on breathing pattern and gas‐exchange as pursed lip breathing. Methods: Ten COPD patients with flow limitation were studied during pressure support mechanical ventilation. Two types of expiratory resistances were applied: one fixed level of resistance and one with a resistive pressure decay. Each resistance was applied in 5 patients and the highest level was chosen that did not cause hyperinflation. Blood gas values and breathing pattern with and without resistance were compared. Results: With resistance 1, gas‐exchange and breathing pattern did not change significantly; average PCO 2 changed from 8.0 to 8.1 kPa, PO 2 from 10.2 to 10.3 kPa, tidal volume from 0.380 to 0.420 l, respiratory rate from 25 to 23 bpm and inspiratory:expiratory ratio from 1:1.9 to 1:2.0. With resistance 2, gas‐exchange and breathing pattern did not change significantly; average PCO 2 changed from 5.8 to 6.0 kPa, PO 2 from 11.1 to 12.1 kPa, tidal volume from 0.733 to 0.695 l, respiratory rate from 16 to 18 bpm and inspiratory:expiratory ratio from 1:2.3 to 1:2.9. Conclusion: In intubated COPD patients being weaned from the ventilator, application of an external resistance did not have the same beneficial effects as pursed lip breathing.