Expiratory washout versus optimization of mechanical ventilation during permissive hypercapnia in patients with severe acute respiratory distress syndrome
DOI:
https://doi.org/10.22491/2357-9730.125243Keywords:
Acute lung injury, severe acute distress syndrome, mechanical ventilation, tracheal gas insufflation, expiratory washoutAbstract
OBJECTIVE: The aim of the present study was to compare three ventilatory techniques for reducing PaCO2
in patients with severe acute distress syndrome treated with permissive hypercapnia.
MATERIALS AND METHODS: In a group of six patients with severe acute distress syndrome who developed permissive hypercapnia with protective techniques of
mechanical ventilation, three ventilatory strategies were compared: expiratory washout alone, optimized mechanical ventilation, defined as an increase in respiratory frequency associated with a reduction of the instrumental dead space, and the combination of both methods. In all strategies, inspiratory plateau airway pressure was kept constant by setting the extrinsic positive end-expiratory pressure.
RESULTS: Expiratory washout and optimized mechanical ventilation had similar effects on CO2 elimination. A further decrease in PaCO2 was observed when both
methods were combined. Extrinsic positive end-expiratory pressure had to be reduced during expiratory washout, whereas it remained unchanged during optimized mechanical ventilation alone.
CONCLUSIONS: In patients with severe acute distress syndrome, who need lower plateau airway pressures in order to avoid overdistention, therefore developing
hypercapnia, the increasing respiratory rate and reducing instrumental dead space are as efficient as expiratory washout to reduce PaCO2 and, when used in
combination, both techniques have additive effects and result in PaCO2 levels close to normal values.
Downloads
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
