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Differential Lung Ventilation with Unilateral PEEP Following Unilateral Hydrochloric Acid Aspiration in the Dog
Author(s) -
East T. D.,
Pace N. L.,
Westenskow D. R.,
Lund K.
Publication year - 1983
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.1399-6576.1983.tb01967.x
Subject(s) - medicine , tidal volume , positive end expiratory pressure , anesthesia , supine position , lung , ventilation (architecture) , lung volumes , artificial ventilation , mechanical ventilation , atelectasis , respiratory system , respiratory disease , mechanical engineering , engineering
Differential lung ventilation with positive end expiratory pressure (PEEP) improves pulmonary gas exchange when used in the supportive care of patients with severe unilateral or asymmetrical lung disease. Once the provision of selective PEEP to the two lungs is accomplished, the best method of partitioning the tidal volume between the two lungs is unknown. Twelve mongrel dogs were given a unilateral hydrochloric acid (HCl) aspiration injury. A computer controlled differential lung ventilation system was used to ventilate four dogs with equal volumes to each lung, four dogs with equal driving pressure (end inspiratory pressure‐PEEP) to each lung, and four dogs with equal end‐tidal CO 2 fraction from each lung. The respiratory rate was feedback controlled to maintain Paco 2 at 4.67 kPa. The dogs were kept supine and ventilated with 30% O 2 . Following injury, the PEEP was set at 0 kPa for 1 h. The dogs were then given 1.36 kPa and 2.72 kPa PEEP to the injured lung for 2 h in a cross‐over fashion. The assignment of the tidal volume controller, the side of injury, and the PEEP sequence was random. Oxygen tension fell and pulmonary venous admixture increased after giving the HCl injury. In all three groups considered simultaneously, unilateral PEEP improved Pao 2 and venous admixture. The equal tidal volume distribution was the only group to show a significant improvement in Pao 2 at both PEEP increments (0 to 1.36 kPa and 2.72 kPa). There was a significant difference in tidal volume allocation between the three groups with the equal end‐tidal and equal pause pressure groups only minimally ventilating the injured lung. With differential lung ventilation and unilateral PEEP, equal partitioning of tidal volume provides the highest Pao 2 , compared to the other two methods of partitioning tidal volume.