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Ventilatory strategy in catastrophic lung disease. Inversed ratio ventilation (IRV) and combined high frequency ventilation (CHFV)
Author(s) -
ANDERSEN JENS B.
Publication year - 1989
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.1399-6576.1989.tb03021.x
Subject(s) - medicine , ventilation (architecture) , anesthesia , positive end expiratory pressure , tidal volume , mechanical ventilation , high frequency ventilation , artificial ventilation , intermittent mandatory ventilation , cardiology , lung , respiratory disease , respiratory system , mechanical engineering , engineering
In 105 patients with well‐defined catastrophic lung disease, in whom conventional settings were unable to maintain life‐sustaining gas exchange, the ventilatory strategy was changed from volume‐controlled ventilation with an inspiratory‐expiratory ratio (I:E) of 1:2 and PEEP of 15–20 cm H 2 O to pressure‐controlled inverse ratio ventilation with an I:E of 2:1, 3:1 or 4:1 and a set PEEP of 4–8 cm H 2 O. All patients were ventilated on a Servo 900 B or C ventilator, the primary goal being to decrease the F1O 2 below 0.6 and the peak pressure to below 50 cm H 2 O, while maintaining a Pao 2 of 8.00 kPa and a Paco 2 within 10% of the upper limit of normal. In 67 patients the intervention was successful and peak pressure could be reduced to a median of 44 cm H 2 O (range 37–50). Fio 2 could be reduced to a median of 0.50 (range 0.40‐0.60). The auto‐PEEP effect of IRV increased to a median of 12 cm H 2 O (range 7–22). No consistent pattern of change in cardiac output was observed. Sixty patients survived more than 3 weeks and 48 were discharged from hospital. The 38 IRV “failures” were changed to pressure‐controlled ventilation with superimposed high frequency ventilation (CHFV). In 30 cases the Fio 2 could be reduced to a median of 0.60 (range 0.50‐0.60) and peak pressures to a median of 50 cm H 2 O (range 45–60). In 21 patients the Paco 2 increased. Auto‐PEEP with CHFV had a median value of 15 cm H 2 O (range 10–25). Only 12 patients survived more than 3 weeks and only four were discharged. It is concluded that changing the ventilatory strategy to IRV or CHFV can improve gas‐exchange and might alter the outcome in catastrophic lung disease.