Skip to main content
Download PDF

An experimental randomized study of five different ventilatory modes in a piglet model of severe respiratory distress

Intensive Care Medicine volume 18, pages 339–347 (1992)Cite this article

Abstract

Objectives: To characterize different modes of pressure- or volume-controlled mechanical ventilation with respect to their short-term effects on oxygen delivery (DO2). Furthermore to investigate whether such differences are caused by differences in pulmonary gas exchange or by airway-pressure-mediated effects on the central hemodynamics.Design: After inducing severe respiratory distress in piglets by removing surfactant, 5 ventilatory modes were randomly and sequentially applied to each animal.Setting: Experimental laboratory of a university department of Anesthesiology and Intensive Care.Animals: 15 piglets after repeated bronchoalveolar lavage.Interventions: Volume-controlled intermittent positive-pressure ventilation (IPPV) with either 8 or 15 cmH2O PEEP; pressure-controlled inverse ratio ventilation (IRV); pressure-controlled high-frequency positive-pressure ventilation (HFPPV) and pressure-controlled high frequency ventilation with inspiratory pulses superimposed (combined high frequency ventilation, CHFV). The prefix (L) indicates that lavage has been performed.Measurements and results: Measurements of gas exchange, airway pressures, hemodynamics, functional residual capacity (using the SF6 method), intrathoracic fluid volumes (using a double-indicator dilution technique) and metabolism were performed during ventilatory and hemodynamic steady state. The peak inspiratory pressures (PIP) were significantly higher in the volume-controlled low frequency modes (43 cmH2O for L-IPPV-8 and L-IPPV-15) than in the pressure-controlled modes (39 cmH2O for L-IRV, 35 cmH2O for L-HFPPV and 33 cmH2O for L-CHFV, with PIP in the high-frequency modes being significantly lower than in inverse ratio ventilation). The mean airway pressure (MPAW) after lavage was highest with L-IRV (26 cmH2O). In the ventilatory modes with a PEEP>8 cmH2O PaO2 did not differ significantly and beyond this “opening threshold” MPAW did not further improve PaO2. Central hemodynamics were depressed by increasing airway pressures. This is especially true for L-IRV in which we found the highest MAPW and at the same time the lowest stroke index (74% of IPPV).Conclusions: In this model, as far as oxygenation is concerned, it does not matter in which specific way the airway pressures are produced. As far as oxygen transport is concerned, i.e. aiming at increasing DO2, we conclude that optimizing the circulatory status must take into account the circulatory influence of different modes of positive pressure ventilation.

References

  1. Nielsen JB, Sjöstrand UH, Edgren EL, Lichtwarck-Aschoff M, Svensson BA (1991) An experimental study of different ventilatory modes in piglets in severe respiratory distress induced by surfactant depletion. Intensive Care Med 17:225–233

    PubMed  Google Scholar 

  2. Nielsen JB, Sjöstrand UH, Henneberg SW (1991) An experimental randomized study of six different ventilatory modes in a piglet model with normal lungs. Intensive Care Med 17:169–174

    PubMed  Google Scholar 

  3. Sjöstrand UH (1977) A review of the physiological rationale for and development of high-frequency positive-pressure ventilation-HFPPV. Acta Anaesth Scand [Suppl] 64:7–27

    Google Scholar 

  4. Sjöstrand UH (1989) In what respect does high frequency positive pressure ventilation differ from conventional ventilation? Acta Anaesth Scand 33 [Suppl] 90:5–12

    Google Scholar 

  5. Sjöstrand UH (1989) High frequency positive pressure ventilation. Problems Respir Care 2:1

    Google Scholar 

  6. Reynolds EOR (1971) Effect of alterations in mechanical ventilator setting on pulmonary gas exchange in hyaline membrane disease. Arch Dis Child 46:152–159

    PubMed  Google Scholar 

  7. Lachmann B, Danzmann E, Haendly B, Jonson B (1982): Ventilatory settings and gas exchange in respiratory distress syndrome. In: Prakash O (ed) Applied physiology in clinical respiratory care. Nijhoff, The Hague Boston London, p 141

    Google Scholar 

  8. Baum M, Benzer H, Mutz M, Pauser G, Tonczar L (1980) Inverse ratio ventilation (IRV): Die Rolle des Atemzeitverhältnisses in der Beatmung beim ARDS. Anaesthesist 29:592–596

    PubMed  Google Scholar 

  9. El-Baz N, Faber LP, Doolas A (1983) Combined high frequency ventilation formanagement of terminal respiratory failure: a new technique. Anaesth Analg 62:39–49

    Google Scholar 

  10. Borg UR, Belzberg H, Blevins S (1989) Combined high frequency ventilation (CHFV). Acta Anaesth Scand 33 [Suppl] 90:155–157

    Google Scholar 

  11. Froese AB, Bryan AC (1987) High frequency ventilation. Am Rev Respir Dis 135:1363–1374

    PubMed  Google Scholar 

  12. Carlon GC, Kahn RC, Howland WS, Ray C Jr, Turnbull AD (1981) Clinical experience with high frequency jet ventilation. Crit Care Med 9:1–6

    PubMed  Google Scholar 

  13. Lachmann B, Schairer W, Hafner M, Armbruster S, Jonson B (1989) Volume-controlled ventilation with superimposed high frequency ventilation during expiration in healthy and surfactant-depleted pig lungs. Acta Anaesth Scand 33 [Suppl] 90:117–119

    Google Scholar 

  14. Boynton BR, Mannino FL, Davis RF, Kopotic RJ, Friedrichsen G (1984) Combined high frequency oscillatory ventilation and intermittent mandatory ventilation in critically ill neonates. J Pediatr 105:297–302

    PubMed  Google Scholar 

  15. Suter PM, Laverrière MC, Pittet JF (1987) Combined high-frequency and conventional mechanical ventilation. In: Bergmann H, Steinbereithner K (eds) Beiträge zur Anästhesiologie und Intensivmedizin, vol. 21. Springer, Berlin Heidelberg New York, pp 254–258

    Google Scholar 

  16. Zeravik J, Eckart J, Zimmermann G, Blümel G, Pfeiffer UJ, Wellhöfer H (1989) Indications for combined high frequency ventilation in clinical use. Acta Anaesth Scand 33 [Suppl] 90:149–152

    Google Scholar 

  17. Mathay MA (1989) New modes of mechanical ventilation for ARDS. How should they be evaluated? Chest 95:1175

    PubMed  Google Scholar 

  18. Hedenstierna G, Strandberg A, Brismar B, Lundquist H, Svensson L, Tokics L (1985) Functional residual capacity, thoracoabdominal dimensions and central blood volume during general anesthesia with muscle paralysis and mechanical ventilation. Anesthesiology 62:247–254

    PubMed  Google Scholar 

  19. Gattinoni L, Pesenti A, Torresin A, Baglioni S, Rivolta M, Vesconi S, Fumagalli R, Rossli GP, Mascheroni D (1986) Morphological and functional response to PEEP in acute respiratory failure. In: Vincent JL (ed) Update in intensive care and emergency medicine. Springer, Berlin Heidelberg New York Tokyo, pp 108–111

    Google Scholar 

  20. Gattinoni L, Mascheroni D, Torresin A, Marcolin R, Fumagalli R, Vesconi S, Rossi GP, Rossi F, Baglioni S, Bassi F, Nastri G, Pesenti A (1986) Morphological response to positive endexpiratory pressure in acute respiratory failure. Computerized tomography study. Intensive Care Med 12:137–142

    PubMed  Google Scholar 

  21. Pfeiffer UJ, Birk M, Aschenbrenner G, Blümel G (1982) The system for quantification of thermal-dye extravascular lung water. In: Prakash O (ed) Computers in critical care and pulmonary medicine, vol 2. Plenum, London, pp 123–125

    Google Scholar 

  22. Pfeiffer UJ, Zimmermann G (1984) Fehlermöglichkeiten und Grenzen der Lungenwasserbestimmung mit der Thermo-Dye-Technik. Beitr Anaesthesiol Intensivmed 6:81–104

    Google Scholar 

  23. Pfeiffer U, Birk M, Aschenbrenner G, Petrowicz O, Blümel G (1980) Validity of the thermal-dye-technique for measurements of extravascular lung water. Eur Surg Res 12 [Suppl]:106–107

    Google Scholar 

  24. Lewis FR, Elings VB (1978) Microprocessor determination of lung water using thermal-green dye double indicator dilution. Surg Forum 29:182–184

    PubMed  Google Scholar 

  25. Newmann EV, Merell MM, Genecin A, Monge C, Milnor WR, McKeever WP (1951) The dye dilution method for describing the central circulation. An analysis of factors shaping the time-concentration curves. Circulation 6:735–746

    Google Scholar 

  26. Wickerts CJ, Jacobsson J, Frostell C, Hedenstierna G (1990) Measurement of extravascular lung water by thermal-dye dilution technique: mechanisms of cardiac output dependence. Intensive Care Med 16:115–120

    PubMed  Google Scholar 

  27. Lachmann B, Robertson B, Vogel J (1980) In vivo lung lavage as an experimental model of the respiratory distress syndrome Acta Anaesth Scand 24:231–236

    PubMed  Google Scholar 

  28. Jonmarker C, Castor R, Drefeldt B, Werner O (1985) An analyzer for in-line measurement of expiratory sulfur hexafluoride concentration. Anesthesiology 63:84–88

    PubMed  Google Scholar 

  29. Larsson A, Linnarsson D, Jonmarker C, Jonson B, Larsson H, Werner O (1987) Measurement of lung volume by sulfur hexafluoride washout during spontaneous and controlled ventilation. Further development of a method. Anesthesiology 67:543–550

    PubMed  Google Scholar 

  30. Larsson A, Jonmarker C, Werner O (1988) Ventilation inhomogeneity during controlled ventilation. Which index should be used? J Appl Physiol 65:2030–2039

    PubMed  Google Scholar 

  31. Gattinoni L, Pesenti A, Mascheroni D, Marcolin R, Fumagali R, Rossi F, Iapichino G, Romagnoli B, Uziel L, Agostoni A, Kolobow T, Damia G (1986) Low frequency positive pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure. JAMA 256:881–886

    PubMed  Google Scholar 

  32. Snyder JV, Froese AB (1987) The open lung approach: concept and application. In: Oxygen transport in the critically ill patient. Year Book Medical Publishers, Chicago London, pp 374–395

    Google Scholar 

  33. Hickling KG, Henderson S, Jackson R (1990) Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med 16:372–377

    PubMed  Google Scholar 

  34. Coalson JJ, deLemos RA (1989) Pathologic features of various ventilatory strategies. Acta Anaesth Scand 33 [Suppl] 90:108–116

    Google Scholar 

  35. Hickling KG (1990) Ventilatory management of ARDS: can it affect outcome? Intensive Care Med 16:219–226

    PubMed  Google Scholar 

  36. Pfeiffer UJ, Perker M, Zeravik J, Zimmermann G (1990) Sensitivity of central venous pressure, pulmonary capillary wedge pressure, and intrathoracic blood volume as indicators for acute and chronic hypovolemia. In: Lewis FR, Pfeiffer UJ (eds) Practical applications of fiberoptics in critical care monitoring. Springer, Berlin Heidelberg New York, pp 25–31

    Google Scholar 

  37. Shoemaker WC, Kram HB, Appel PL (1990) Therapy of shock based on pathophysiology, monitoring and outcome prediction. Crit Care Med 18:S19-S25

    PubMed  Google Scholar 

  38. Siggard-Andersen O (1980) Determination and presentation of acid-base data. Contr Nephrol 21/20:128–136

    Google Scholar 

  39. Fusciardi J, Rouby JJ, Benhamou D, Viars P (1984) Hemodynamic consequences of increasing mean airway pressures during high frequency jet ventilation. Chest 86:30–34

    PubMed  Google Scholar 

  40. Fusciardi J, Rouby JJ, Barakat T, Mal H, Godet G, Viars P (1986) Hemodynamic effects of high-frequency jet ventilation in patients with and without circulatory shock. Anesthesiology 65:485–491

    PubMed  Google Scholar 

Download references

Author information

Author notes

  1. E. L. Edgren

    Present address: Department of Anesthesiology, Bassett Hospital, One Atwell Road, 13326, Cooperstown, NY, USA

Affiliations

  1. Department of Anesthesiology and Intensive Care, University Hospital, S-75185, Uppsala, Sweden

    J. B. Nielsen & U. H. Sjöstrand MD, PhD

  2. Institute of Anesthesiology and Surgical Intensive Care Medicine, Zentralklinikum Augsburg, Augsburg, Germany

    M. Lichtwarck-Aschoff

Authors
  1. M. Lichtwarck-Aschoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. B. Nielsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. H. Sjöstrand MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. L. Edgren
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lichtwarck-Aschoff, M., Nielsen, J.B., Sjöstrand, U.H. et al. An experimental randomized study of five different ventilatory modes in a piglet model of severe respiratory distress. Intensive Care Med 18, 339–347 (1992). https://doi.org/10.1007/BF01694362

Download citation

  • Received:

  • Revised:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01694362

Key words

  • Respiratory failure
  • Lung lavage
  • Pressure-controlled ventilation
  • Inverse ratio ventilation
  • High frequency ventilation
  • Functional residual capacity
  • Extravascular lung water