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Pneumatic Systems Facilitating Treatment of Respiratory Insufficiency with Alternative Use of IPPV/PEEP, HFPPV/PEEP, CPPB or CPAP
Author(s) -
Sjöstrand Ulf
Publication year - 1977
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 - 10.1111/j.1399-6576.1977.tb01267.x
Subject(s) - medicine , ventilation (architecture) , intensive care medicine , positive end expiratory pressure , mechanical ventilation , anesthesia , mechanical engineering , engineering
Some respiratory, circulatory and clinical conditions are reviewed in connection with the use of ventilator systems for intermittent positive‐pressure ventilation at a normal frequency (IPPV‐nf). Intermittent positive‐pressure ventilation with considerably higher frequencies (IPPV‐hf) can, with an appropriate pressure and flow pattern (but at the cost of an increased dead space ventilation) provide adequate alveolar ventilation. The type of IPPV‐hf that has been given the name high‐frequency positive‐pressure ventilation (HFPPV) gives a ventilatory pressure/flow pattern that interferes less with circulatory function than IPPV‐nf. Furthermore, the ventilatory pattern of HFPPV has been found to have desirable respiratory and other systemic effects, making this form of artificial ventilation of clinical interest. However, before HFPPV could be considered sufficiently well developed for routine clinical use, further technical refinement and simplification were necessary and the technical, functional and clinical demands on systems for modern respiratory care are therefore discussed. The ventilatory and circulatory implications of the ventilatory pressure/flow patterns generated in HFPPV have been investigated with previously described ventilator systems for HFPPV, and this has been the subject of separate reports. Under conditions of high airway resistance and low compliance, volume‐controlled respirator systems are required for efficient artificial ventilation. Satisfactory volume‐controlled ventilation can, however, only be obtained by using systems with a small compressible volume and low internal compliance. Three ventilator systems satisfying these two criteria are described and with these prototype systems for volume‐controlled IPPV the ventilatory pressure/flow pattern of HFPPV may be obtained, i.e. volume‐controlled HFPPV is achieved. Further, these prototype systems are versatile in the respect that they are both able to give ( a ) volume‐controlled IPPV‐nf or IPPV‐hf (HFPPV), and ( b ) continuous positive‐pressure breathing in the neonate (CPAP) or in the adult (CPAP or CPPB). One of the prototype systems has been developed for neonatal intensive care. It has been studied experimentally in a lung model and is used routinely for clinical treatment of neonatal respiratory distress; preliminary clinical reports have been presented previously. The other prototype systems presented have been developed according to the same principles for intensive respiratory care of adults, but they have not yet been used clinically. The effects of the pressure/flow pattern of the ventilatory systems described in this communication—i.e. pressure/flow‐generated volume‐controlled HFPPV—has been studied in dog experiments and compared with the ventilatory pattern of a conventional respirator system and this will be the subject of subsequent articles.