EFFECTS OF BREATHING PATTERNS ON MECHANICALLY VENTILATED PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE AND DYNAMIC HYPERINFLATION

被引:23
作者
GEORGOPOULOS, D
MITROUSKA, I
MARKOPOULOU, K
PATAKAS, D
ANTHONISEN, NR
机构
[1] UNIV THESSALONIKI,G PAPANICOLAOU HOSP,RESP FAILURE UNIT,EXOHI,GREECE
[2] UNIV MANITOBA,RESP INVEST UNIT,WINNIPEG,MB R3T 2N2,CANADA
关键词
RESPIRATORY SYSTEM MECHANICS; GAS EXCHANGE; HEMODYNAMICS;
D O I
10.1007/BF01712328
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective. To examine the circulatory and respiratory effects of breathing pattern in patients with chronic obstructive pulmonary disease (COPD) and dynamic hyperinflation (DH) during controlled mechanical ventilation. Design: Prospective, controlled, randomized, non-blinded study. Setting: Respiratory intensive care unit of a university hospital. Patients: Nine patients with acute respiratory failure and DH due to acute exacerbations of COPD. Interventions: Keeping tidal volume and total breath duration (T-TOT) constant, patients were ventilated at six different values of expiratory time (T-E). T-E changes were randomly induced by alterations of constant inspiratory flow (V-I) and,or end-inspiratory pause (EIP). Patients were studied at three levels of V-I(0.93 +/- 0.08, 0.72 +/- 0.06 and 0.55 +/- 0.04 1/s, mean +/- SE), with and without EIP (10% of T-TOT). Measurements and results: Lung volumes, airflows, airways pressures: oxygenation indices and dead space were measured. Alveolar pressure and airway resistance (Rmin), as well as the additional resistance (delta R) due to viscoelastic pressure dissipation and time-constant inequalities, were estimated by rapid airway occlusion during inflation. In seven out of nine patients, right-heart catheterization was performed and hemodynamic parameters were obtained at each value of T-E. A significant decrease of intrinsic positive end-expiratory pressure (PEEPi), end-inspiratory static and mean (mPaw) airway pressures, end-expiratory lung; volume above passive FRC (Vtrap), delta R and venous admixture and a significant increase of peak airway pressure, Rmin, stroke volume index and mixed venous PO2 (PvO(2)) were observed when V-I increased. At each V-I, the addition of EIP significantly decreased iso-volume expiratory flows and PvO(2) and increased Vtrap and mPaW. Conclusions. We conclude that in mechanically ventilated patients with COPD, the pattern of lung inflation and T-E alteration have a significant impact on respiratory system mechanics, gas exchange and hemodynamics. Addition of EIP in patients with COPD may be detrimental.
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页码:880 / 886
页数:7
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