Aspiration of airway dead space -: A new method to enhance CO2 elimination

Alveolar ventilation and CO2 elimination during mechanical ventilation can be enhanced by reducing dead-space ventilation. Aspiration of gas from the dead space (ASPIDS) is a new principle, according to which gas rich in CO2 during late expiration is aspirated through a channel ending at the distal end of the tracheal tube. Simultaneously, fresh gas injected into the inspiratory line fills the airway down to the same site. We hypothesized that ASPIDS would allow a reduction of tidal volume (VT) and airway pressure (Paw). To test our hypothesis we studied six anaesthetized and mechanically ventilated pigs (24 +/- 4 kg). The intention was to decrease VT while keeping Pa-CO2 constant by using ASPIDS. VT was reduced by decreasing the minute ventilation (V (over dot)E) in two seeps, of 1.8 L/min (V (over dot)E - 1.8) and 2.2 L/min (V (over dot)E - 2.2), respectively, and by Increasing respiratory rate (RR) from 20 to 46 breaths/min. At ASPIDS, peak Paw was reduced by 35% at V (over dot)E - 1.8 and at V (over dot)E - 2.2 (p < 0.001), and by 20% at, an RR of 46 (p < 0.01). Pa-CO2 was maintained or reduced at ASPIDS. No intrinsic positive end-expiratory pressure developed. Arterial blood pressure and heart rare were unaffected. The results show that ASPIDS allows a reduction in VT and Paw while Pa-CO2 is kept constant. ASPIDS does not lead to problems associated with jet streams of gas or with gas humidification, and can be developed as a safe technique.