Tracheal gas insufflation combined with high-frequency oscillatory ventilation

Stephen Dolan, Stephen Derdak, Dale Solomon, Christopher Farmer, Jay Johanningman, Jerry Gelineau, R. B. Smith

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objectives: To determine the efficacy of tracheal gas insufflation delivered by two different catheter designs on CO2 elimination when used in conjunction with high-frequency oscillatory ventilation. Design: A nonrandomized before and after trial. Each animal served as his own control. Subjects: Ten mongrel dogs weighing 20.9 ± 1.9 kg. Four animals were assigned to a normal lung group and six animals underwent lung injury by large volume saline lavage. Intervention: Permissive hypercapnia was allowed to occur by selecting oscillator settings that would lead to alveolar hypoventilation. Proximal mean airway pressure was kept constant. Tracheal gas was insufflated at 1 cm above the carina for 30-min periods at gas flows of 5 to 15 L/min. Measurements and Main Results: Carinal pressure, hemodynamic parameters (cardiac output, mean arterial pressure, pulmonary arterial pressure, pulmonary artery occlusion pressure), and gas exchange parameters (PaCO2, PaO2, PaO2/FiO2, shunt fraction, DO2) were measured. For the normal dogs, st catheter flow of 15 L/min, the forward thrust catheter increased carinal pressure and PaO2/FiO2 by 30% (p < .003) and 105% (p < .005), respectively. The forward thrust catheter reduced PaCO2 by 40% (p < .04). The reverse thrust catheter increased PaO2/FiO2 by 102% (p < .001) and decreased carinal pressure and PaCO2 by 44% (p < .001) and 34% (p < .003), respectively. For the injured dogs, at catheter flow rate of 15 L/min, the forward thrust catheter increased carinal pressure, PaO2, and PaO2/FiO2 by 6% (p < .001), 23% (p < .001) and 24% (p < .02), respectively. The forward thrust catheter reduced PaCO2 by 29% (p < .002). The reverse thrust catheter increased PaO2 and PaO2/FiO2 both by 11% (p < .02) and reduced carinal pressure and PaCO2 by 23% (p < .001) and 18% (p < .002), respectively. Conclusions: Tracheal gas insufflation is capable of improving oxygenation and ventilation in acute lung injury when combined with high-frequency oscillatory ventilation. The addition of this second gas flow at the level of the carina raises or lowers distal airway pressure, the magnitude of which is dependent on the direction and rate of gas flow. The beneficial effects of tracheal gas insufflation may be tempered by the long- term effects of altering distal airway pressure; lowering distal airway pressure may lead to atelectasis, whereas raising distal airway pressure may lead to an auto-positive end-expiratory pressure (auto-PEEP) effect.

Original languageEnglish (US)
Pages (from-to)458-465
Number of pages8
JournalCritical Care Medicine
Volume24
Issue number3
DOIs
StatePublished - Mar 1996
Externally publishedYes

Fingerprint

High-Frequency Ventilation
Insufflation
Gases
Pressure
Catheters
Dogs
Arterial Pressure
Hypoventilation
Lung
Pulmonary Atelectasis
Positive-Pressure Respiration
Hypercapnia
Acute Lung Injury
Therapeutic Irrigation
Lung Injury
Cardiac Output
Pulmonary Artery
Ventilation
Hemodynamics

Keywords

  • adult respiratory distress syndrome
  • atelectasis
  • barotrauma
  • high-frequency oscillatory ventilation
  • hypercapnia
  • lung injury
  • mechanical ventilation
  • positive end-expiratory pressure

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Dolan, S., Derdak, S., Solomon, D., Farmer, C., Johanningman, J., Gelineau, J., & Smith, R. B. (1996). Tracheal gas insufflation combined with high-frequency oscillatory ventilation. Critical Care Medicine, 24(3), 458-465. https://doi.org/10.1097/00003246-199603000-00016

Tracheal gas insufflation combined with high-frequency oscillatory ventilation. / Dolan, Stephen; Derdak, Stephen; Solomon, Dale; Farmer, Christopher; Johanningman, Jay; Gelineau, Jerry; Smith, R. B.

In: Critical Care Medicine, Vol. 24, No. 3, 03.1996, p. 458-465.

Research output: Contribution to journalArticle

Dolan, S, Derdak, S, Solomon, D, Farmer, C, Johanningman, J, Gelineau, J & Smith, RB 1996, 'Tracheal gas insufflation combined with high-frequency oscillatory ventilation', Critical Care Medicine, vol. 24, no. 3, pp. 458-465. https://doi.org/10.1097/00003246-199603000-00016
Dolan S, Derdak S, Solomon D, Farmer C, Johanningman J, Gelineau J et al. Tracheal gas insufflation combined with high-frequency oscillatory ventilation. Critical Care Medicine. 1996 Mar;24(3):458-465. https://doi.org/10.1097/00003246-199603000-00016
Dolan, Stephen ; Derdak, Stephen ; Solomon, Dale ; Farmer, Christopher ; Johanningman, Jay ; Gelineau, Jerry ; Smith, R. B. / Tracheal gas insufflation combined with high-frequency oscillatory ventilation. In: Critical Care Medicine. 1996 ; Vol. 24, No. 3. pp. 458-465.
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AU - Derdak, Stephen

AU - Solomon, Dale

AU - Farmer, Christopher

AU - Johanningman, Jay

AU - Gelineau, Jerry

AU - Smith, R. B.

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N2 - Objectives: To determine the efficacy of tracheal gas insufflation delivered by two different catheter designs on CO2 elimination when used in conjunction with high-frequency oscillatory ventilation. Design: A nonrandomized before and after trial. Each animal served as his own control. Subjects: Ten mongrel dogs weighing 20.9 ± 1.9 kg. Four animals were assigned to a normal lung group and six animals underwent lung injury by large volume saline lavage. Intervention: Permissive hypercapnia was allowed to occur by selecting oscillator settings that would lead to alveolar hypoventilation. Proximal mean airway pressure was kept constant. Tracheal gas was insufflated at 1 cm above the carina for 30-min periods at gas flows of 5 to 15 L/min. Measurements and Main Results: Carinal pressure, hemodynamic parameters (cardiac output, mean arterial pressure, pulmonary arterial pressure, pulmonary artery occlusion pressure), and gas exchange parameters (PaCO2, PaO2, PaO2/FiO2, shunt fraction, DO2) were measured. For the normal dogs, st catheter flow of 15 L/min, the forward thrust catheter increased carinal pressure and PaO2/FiO2 by 30% (p < .003) and 105% (p < .005), respectively. The forward thrust catheter reduced PaCO2 by 40% (p < .04). The reverse thrust catheter increased PaO2/FiO2 by 102% (p < .001) and decreased carinal pressure and PaCO2 by 44% (p < .001) and 34% (p < .003), respectively. For the injured dogs, at catheter flow rate of 15 L/min, the forward thrust catheter increased carinal pressure, PaO2, and PaO2/FiO2 by 6% (p < .001), 23% (p < .001) and 24% (p < .02), respectively. The forward thrust catheter reduced PaCO2 by 29% (p < .002). The reverse thrust catheter increased PaO2 and PaO2/FiO2 both by 11% (p < .02) and reduced carinal pressure and PaCO2 by 23% (p < .001) and 18% (p < .002), respectively. Conclusions: Tracheal gas insufflation is capable of improving oxygenation and ventilation in acute lung injury when combined with high-frequency oscillatory ventilation. The addition of this second gas flow at the level of the carina raises or lowers distal airway pressure, the magnitude of which is dependent on the direction and rate of gas flow. The beneficial effects of tracheal gas insufflation may be tempered by the long- term effects of altering distal airway pressure; lowering distal airway pressure may lead to atelectasis, whereas raising distal airway pressure may lead to an auto-positive end-expiratory pressure (auto-PEEP) effect.

AB - Objectives: To determine the efficacy of tracheal gas insufflation delivered by two different catheter designs on CO2 elimination when used in conjunction with high-frequency oscillatory ventilation. Design: A nonrandomized before and after trial. Each animal served as his own control. Subjects: Ten mongrel dogs weighing 20.9 ± 1.9 kg. Four animals were assigned to a normal lung group and six animals underwent lung injury by large volume saline lavage. Intervention: Permissive hypercapnia was allowed to occur by selecting oscillator settings that would lead to alveolar hypoventilation. Proximal mean airway pressure was kept constant. Tracheal gas was insufflated at 1 cm above the carina for 30-min periods at gas flows of 5 to 15 L/min. Measurements and Main Results: Carinal pressure, hemodynamic parameters (cardiac output, mean arterial pressure, pulmonary arterial pressure, pulmonary artery occlusion pressure), and gas exchange parameters (PaCO2, PaO2, PaO2/FiO2, shunt fraction, DO2) were measured. For the normal dogs, st catheter flow of 15 L/min, the forward thrust catheter increased carinal pressure and PaO2/FiO2 by 30% (p < .003) and 105% (p < .005), respectively. The forward thrust catheter reduced PaCO2 by 40% (p < .04). The reverse thrust catheter increased PaO2/FiO2 by 102% (p < .001) and decreased carinal pressure and PaCO2 by 44% (p < .001) and 34% (p < .003), respectively. For the injured dogs, at catheter flow rate of 15 L/min, the forward thrust catheter increased carinal pressure, PaO2, and PaO2/FiO2 by 6% (p < .001), 23% (p < .001) and 24% (p < .02), respectively. The forward thrust catheter reduced PaCO2 by 29% (p < .002). The reverse thrust catheter increased PaO2 and PaO2/FiO2 both by 11% (p < .02) and reduced carinal pressure and PaCO2 by 23% (p < .001) and 18% (p < .002), respectively. Conclusions: Tracheal gas insufflation is capable of improving oxygenation and ventilation in acute lung injury when combined with high-frequency oscillatory ventilation. The addition of this second gas flow at the level of the carina raises or lowers distal airway pressure, the magnitude of which is dependent on the direction and rate of gas flow. The beneficial effects of tracheal gas insufflation may be tempered by the long- term effects of altering distal airway pressure; lowering distal airway pressure may lead to atelectasis, whereas raising distal airway pressure may lead to an auto-positive end-expiratory pressure (auto-PEEP) effect.

KW - adult respiratory distress syndrome

KW - atelectasis

KW - barotrauma

KW - high-frequency oscillatory ventilation

KW - hypercapnia

KW - lung injury

KW - mechanical ventilation

KW - positive end-expiratory pressure

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