Tidal volumes for ventilated infants should be determined with a pneumotachometer placed at the endotracheal tube

被引:76
作者
Cannon, ML
Cornell, J
Tripp-Hamel, DS
Gentile, MA
Hubble, CL
Meliones, JN
Cheifetz, IM
机构
[1] Duke Univ, Med Ctr, Duke Childrens Hosp, Div Pediat Crit Care Med, Durham, NC 27710 USA
[2] Duke Univ, Med Ctr, Duke Childrens Hosp, Div Pediat Resp Care, Durham, NC 27710 USA
关键词
D O I
10.1164/ajrccm.162.6.9906112
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Many ventilators measure expired tidal volume (VT) without compensation either for the compliance of the ventilator circuit or for variations in the circuit setup. We hypothesized that the exhaled VT measured with a conventional ventilator at the expiratory valve would differ significantly from the exhaled VT measured with a pneumotachometer placed at the endotracheal tube. To investigate this we studied 98 infants and children requiring conventional ventilation. We used linear regression analysis to compare the VT Obtained with the pneumotachometer with the ventilator-measured volume. An additional comparison was made between the pneumotachometer volume and a calculated effective VT. For infant circuits (n = 70), our analysis revealed a poor correlation between the expiratory VT measured with the pneumotachometer and the ventilator-measured volume (r(2) = 0.54). Similarly, the expiratory VT measured with the pneumotachometer did not correlate with the calculated effective volume (r(2) = 0.58). For pediatric circuits (n = 28), there was improved correlation between the expiratory VT measured with the pneumotachometer and both the ventilator-measured volume and the calculated effective VT (r(2) = 0.84 and r(2) = 0.85, respectively). The data demonstrate a significant discrepancy between expiratory Vr measured at a ventilator and that measured with a pneumotachometer placed at the endotracheal tube in infants. Correcting for the compliance of the ventilator circuit by calculating the effective VT did not alter this discrepancy. In conventionally ventilated infants, exhaled VT should be determined with a pneumotachometer placed at the airway.
引用
收藏
页码:2109 / 2112
页数:4
相关论文
共 13 条
[1]   SHOULD MECHANICAL VENTILATION BE OPTIMIZED TO BLOOD CASES, LUNG-MECHANICS, OR THORACIC CT SCAN [J].
BRUNET, F ;
JEANBOURQUIN, D ;
MONCHI, M ;
MIRA, JP ;
FIEROBE, L ;
ARMAGANIDIS, A ;
RENAUD, B ;
BELGHITH, M ;
NOUIRA, S ;
DHAINAUT, JF ;
DALLAVASANTUCCI, J .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1995, 152 (02) :524-530
[2]   LUNG OVEREXPANSION INCREASES PULMONARY MICROVASCULAR PROTEIN PERMEABILITY IN YOUNG LAMBS [J].
CARLTON, DP ;
CUMMINGS, JJ ;
SCHEERER, RG ;
POULAIN, FR ;
BLAND, RD .
JOURNAL OF APPLIED PHYSIOLOGY, 1990, 69 (02) :577-583
[3]   Increasing tidal volumes and pulmonary overdistention adversely affect pulmonary vascular mechanics and cardiac output in a pediatric swine model [J].
Cheifetz, IM ;
Craig, DM ;
Quick, G ;
McGovern, JJ ;
Cannon, ML ;
Ungerleider, RM ;
Smith, PK ;
Meliones, JN .
CRITICAL CARE MEDICINE, 1998, 26 (04) :710-716
[4]   Ventilator-induced lung injury - Lessons from experimental studies [J].
Dreyfuss, D ;
Saumon, G .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1998, 157 (01) :294-323
[5]   HIGH INFLATION PRESSURE PULMONARY-EDEMA - RESPECTIVE EFFECTS OF HIGH AIRWAY PRESSURE, HIGH TIDAL VOLUME, AND POSITIVE END-EXPIRATORY PRESSURE [J].
DREYFUSS, D ;
SOLER, P ;
BASSET, G ;
SAUMON, G .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1988, 137 (05) :1159-1164
[6]   LOW MORTALITY ASSOCIATED WITH LOW-VOLUME PRESSURE LIMITED VENTILATION WITH PERMISSIVE HYPERCAPNIA IN SEVERE ADULT RESPIRATORY-DISTRESS SYNDROME [J].
HICKLING, KG ;
HENDERSON, SJ ;
JACKSON, R .
INTENSIVE CARE MEDICINE, 1990, 16 (06) :372-377
[7]   STRESS DISTRIBUTION IN LUNGS - A MODEL OF PULMONARY ELASTICITY [J].
MEAD, J ;
TAKISHIMA, T ;
LEITH, D .
JOURNAL OF APPLIED PHYSIOLOGY, 1970, 28 (05) :596-+
[8]   High-inflation pressure and positive end-expiratory pressure - Injurious to the lung? Yes [J].
Papadakos, PJ ;
Apostolakos, MJ .
CRITICAL CARE CLINICS, 1996, 12 (03) :627-&
[9]   MECHANISMS OF VENTILATOR-INDUCED LUNG INJURY [J].
PARKER, JC ;
HERNANDEZ, LA ;
PEEVY, KJ .
CRITICAL CARE MEDICINE, 1993, 21 (01) :131-143
[10]   EFFECTS OF VASCULAR PRESSURE ON THE PULMONARY MICROVASCULATURE IN ISOLATED DOG LUNGS [J].
RIPPE, B ;
TOWNSLEY, M ;
THIGPEN, J ;
PARKER, JC ;
KORTHUIS, RJ ;
TAYLOR, AE .
JOURNAL OF APPLIED PHYSIOLOGY, 1984, 57 (01) :233-239