Comparative effects of helium-oxygen and external positive end-expiratory pressure on respiratory mechanics, gas exchange, and ventilation-perfusion relationships in mechanically ventilated patients with chronic obstructive pulmonary disease.

Details

Serval ID
serval:BIB_CE8577AE255F
Type
Article: article from journal or magazin.
Collection
Publications
Title
Comparative effects of helium-oxygen and external positive end-expiratory pressure on respiratory mechanics, gas exchange, and ventilation-perfusion relationships in mechanically ventilated patients with chronic obstructive pulmonary disease.
Journal
Intensive Care Medicine
Author(s)
Jolliet P., Watremez C., Roeseler J., Ngengiyumva J.C., de Kock M., Clerbaux T., Tassaux D., Reynaert M., Detry B., Liistro G.
ISSN
0342-4642 (Print)
ISSN-L
0342-4642
Publication state
Published
Issued date
2003
Peer-reviewed
Oui
Volume
29
Number
9
Pages
1442-1450
Language
english
Notes
Publication types: Clinical Trial ; Comparative Study ; Journal ArticlePublication Status: ppublish
Abstract
OBJECTIVE: To compare the effects of He/O(2) and external PEEP (PEEPe) on intrinsic PEEP (PEEPi), respiratory mechanics, gas exchange, and ventilation/perfusion (V(A)/Q) in mechanically ventilated COPD patients.
DESIGN AND SETTING: Prospective, interventional study in the intensive care unit of a university hospital.
INTERVENTIONS: Ten intubated, sedated, paralyzed, mechanically ventilated COPD patients studied in the following conditions: (a) baseline settings made by clinician in charge, air/O(2), ZEEP; (b) He/O(2), ZEEP; (c) air/O(2), ZEEP; (d) air/O(2), PEEPe 80% of PEEPi. Measurements at each condition included V(A)/Q by the multiple inert gas elimination technique (MIGET).
RESULTS: PEEPi and trapped gas volume were comparably reduced by He/O(2) (4.2+/-4 vs. 7.7+/-4 cmH(2)O and 98+/-82 vs. 217+/-124 ml, respectively) and PEEPe (4.4+/-1.3 vs. 7.8+/-3.6 cmH(2)O and 120+/-107 vs. 216+/-115 ml, respectively). He/O(2) reduced inspiratory and expiratory respiratory system resistance (15.5+/-4.4 vs. 20.7+/-6.9 and 19+/-9 vs. 28.8+/-15 cmH(2)O l(-1)s(-1), respectively) and plateau pressure (13+/-4 vs. 17+/-6 cmH(2)O). PEEPe increased airway pressures, including total PEEP, and elastance. PaO(2)/FIO(2) was slightly reduced by He/O(2) (225+/-83 vs. 245+/-82) without significant V(A)/Q change.
CONCLUSIONS: He/O(2) and PEEPe comparably reduced PEEPi and trapped gas volume. However, He/O(2) decreased airway resistance and intrathoracic pressures, at a small cost in arterial oxygenation. He/O(2) could offer an attractive option in COPD patients with PEEPi/dynamic hyperinflation.
Keywords
Aged, Aged, 80 and over, Blood Gas Analysis, Drug Therapy, Combination, Helium/administration & dosage, Humans, Middle Aged, Oxygen Inhalation Therapy, Positive-Pressure Respiration, Prospective Studies, Pulmonary Disease, Chronic Obstructive/blood, Pulmonary Disease, Chronic Obstructive/physiopathology, Pulmonary Gas Exchange/drug effects, Pulmonary Gas Exchange/physiology, Respiratory Mechanics/drug effects, Respiratory Mechanics/physiology, Treatment Outcome, Ventilation-Perfusion Ratio/drug effects, Ventilation-Perfusion Ratio/physiology
Pubmed
Web of science
Create date
27/06/2013 14:38
Last modification date
20/08/2019 15:49
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