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The Use of Ventilatory Modes allowing Spontaneous Breathing during Mechanical Ventilation

  • R. Kuhlen
  • C. Putensen
  • R. Rossaint

Abstract

The primary goal of mechanical ventilation is to restore gas exchange and to limit patients with acute respiratory failure from an elevated breathing workload. To achieve these goals a variety of different ventilatory modalities are already in clinical use. The development of microprocessor-driven mechanical ventilators has facilitated enormous progress in the implementation of different new modes of ventilatory support into standard ventilators. Most of the newer ventilatory modes are designed for partial ventilatory support reflecting that different technical approaches might be used for patient/ventilator interaction during assisted mechanical ventilation. However, the increasing use of partial support modalities is not only due to technological improvements but also to data showing that avoiding controlled mechanical ventilation by preserving some spontaneous breathing activity by the diaphragm might be beneficial for gas exchange, hemodynamics, and the clinical course of acute lung injury (ALI). In this chapter, we will review the role of preserved spontaneous breathing activity during mechanical ventilation in patients with acute respiratory failure.

Keywords

Continuous Positive Airway Pressure Acute Lung Injury Acute Respiratory Failure Pressure Support Respir Crit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Downs JB, Douglas ME, Sanfelippo PM, Stanford W, Hodges MR (1977) Ventilatory pattern, intrapleural pressure, and cardiac output. Anesth Analg 56: 88–96PubMedCrossRefGoogle Scholar
  2. 2.
    Steinhoff H, Falke K, Schwarzhoff W (1982) Enhanced renal function associated with intermittend mandatory ventilation in acute respiratory failure. Intensive Care Med 8: 69–74PubMedCrossRefGoogle Scholar
  3. 3.
    Steinhoff H, Kohlhoff R, Falke K (1984) Facilitation of renal function by intermittent mandatory ventilation. Intensive Care Med 10: 59–65PubMedCrossRefGoogle Scholar
  4. 4.
    Valentine DD, Hammond MD, Downs JB, Sears NJ, Sims WR (1991) Distribution of ventilation and perfusion with different modes of mechanical ventilation. Am Rev Respir Dis 143: 1262–1266PubMedCrossRefGoogle Scholar
  5. 5.
    Rasanen J, Downs JB, Stock MC (1988) Cardiovascular effects of conventional positive pressure ventilation and airway pressure release ventilation. Chest 93: 911–915PubMedCrossRefGoogle Scholar
  6. 6.
    Putensen C, Rasanen J, Lopez FA (1994) Ventilation-perfusion distributions during mechanical ventilation with superimposed spontaneous breathing in canine lung injury. Am J Respir Crit Care Med 150: 101–108PubMedCrossRefGoogle Scholar
  7. 7.
    Putensen C, Mutz NJ, Putensen-Himmer G, Zinserling J (1999) Spontaneous breathing during ventilatory support improves ventilation-perfusion distributions in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 159: 1241–1248PubMedCrossRefGoogle Scholar
  8. 8.
    Putensen C, Rasanen J, Lopez FA (1995) Interfacing between spontaneous breathing and mechanical ventilation affects ventilation-perfusion distributions in experimental bronchoconstriction. Am J Respir Crit Care Med 151: 993–999PubMedGoogle Scholar
  9. 9.
    Putensen C, Rasanen J, Lopez FA, Downs JB (1994) Effect of interfacing between spontaneous breathing and mechanical cycles on the ventilation-perfusion distribution in canine lung injury. Anesthesiology 81: 921–930PubMedCrossRefGoogle Scholar
  10. 10.
    Dries DJ, Kumar P, Mathru M, et al (1991) Hemodynamic effects of pressure support ventilation in cardiac surgery patients. Am Surg 57: 122–125PubMedGoogle Scholar
  11. 11.
    Cereda M, Foti G, Marcora B, et al (2000) Pressure support ventilation in patients with acute lung injury. Crit Care Med 28: 1269–1275PubMedCrossRefGoogle Scholar
  12. 12.
    Froese AB, Bryan AC (1974) Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 41: 242–255PubMedCrossRefGoogle Scholar
  13. 13.
    Rehder K, Knopp TJ, Sessler AD, Didier EP (1979) Ventilation perfusion relationship in young healthy awake and anethsetized paralyzed man. J Appl Physiol 47: 745–753PubMedGoogle Scholar
  14. 14.
    Gea J, Roca J, Torres A, Agusti AG, Wagner PD, Rodriguez-Roisin R (1991) Mechanisms of abnormal gas exchange in patients with pneumonia. Anesthesiology 75: 782–789PubMedCrossRefGoogle Scholar
  15. 15.
    Reber A, Nylund U, Hedenstierna G (1998) Position and shape of the diaphragm: implications for atelectasis formation. Anaesthesia 53: 1054–1061PubMedCrossRefGoogle Scholar
  16. 16.
    Tokics L, Hedenstierna G, Svensson L, Brismar B, Cederlund T, Lundquist H (1996) V/Q distribution and correlation to gas atelectasis in anesthetized paralyzed humans. J Appl Physiol 81: 1822–1833PubMedGoogle Scholar
  17. 17.
    Neumann P, Rothen HU, Berglund JE, Valtysson J, Magnusson A, Hedenstierna G (1999) Positive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration. Acta Anaesthesiol Scand 43: 295–301PubMedCrossRefGoogle Scholar
  18. 18.
    Hedenstierna G, Tokics L, Lundquist H, Andersson T, Strandberg A, Brismar B (1994) Phrenic nerve stimulation during halothane anesthesia. Effects of atelectasis. Anesthesiology 80: 751–760Google Scholar
  19. 19.
    Gattinoni L, Pesenti A, Bombino M, et al (1988) Relationships between lung computed tomographic density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology 69: 824–832PubMedCrossRefGoogle Scholar
  20. 20.
    Gattinoni L, Bombino M, Pelosi P, et al (1994) Lung function and structure in different stages of severe adult respiratory distress syndrome. JAMA 271: 1772–1779PubMedCrossRefGoogle Scholar
  21. 21.
    Sydow M, Burchardi H, Ephraim E, Zielmann S, Crozier TA (1994) Long term effects of two different ventilatory modes on oxygenation in acute lung injury. Comparison of airway pressure release ventilation and volume controlled inverse ratio ventilation. Am J Respir Crit Care Med 149: 1550–1556Google Scholar
  22. 22.
    Hormann C, Baum M, Putensen C, Kleinsasser A, Benzer H (1997) Effects of spontaneous breathing with BIPAP on pulmonary gas exchange in patients with ARDS. Acta Anaesthesiol Scand Suppl 111: 152–155PubMedGoogle Scholar
  23. 23.
    Dembinski R, Kuhlen R, Max M, Bensberg R, Kißler J, Rossaint R (2000) Gas exchange and hemodynamics during controlled and mechanical ventilation (CMV) and pressure support (PS) in experimental lung injury. Am J Respir Crit Care Med 161: A391 (Abst)Google Scholar
  24. 24.
    Bensberg R, Kuhlen R, Max M, Dembinski R, Kißler J, Rossaint R (2000) Pressure support versus controlled mechanical ventilation in experimental lung injury. Intensive Care Med 26 (suppl 3 ): S273 (Abst)Google Scholar
  25. 25.
    Dembinski R, Kuhlen R, Lopez F, et al (2000) Ventilation-perfusion distribution during controlled mechanical ventilation (CMV) and pressure support (PS). Intensive Care Med 26 (suppl 3 ): S284 (Abst)Google Scholar
  26. 26.
    Putensen C, Zech S, Wrigge H, et al (2001) Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med 164: 43–49PubMedCrossRefGoogle Scholar
  27. 27.
    Dreyfuss D, Saumon G (1998) Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med 157: 294–323PubMedCrossRefGoogle Scholar
  28. 28.
    Slutsky AS, Tremblay L (1998) Multiple system organ failure: is mechanical ventilation a contributing factor? Am J Respir Crit Care Med 157: 1721–1725PubMedCrossRefGoogle Scholar
  29. 29.
    Chiumello D, Pristine G, Slutsky AS (1999) Mechanical ventilation affects local and systemic cytokines in an animal model of acute respiratory distress syndrome. Am J Respir Crit Care Med 160: 109–116PubMedCrossRefGoogle Scholar
  30. 30.
    Muscedere JG, Mullen JB, Gan K, Slutsky AS (1994) Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med 149: 1327–1334PubMedCrossRefGoogle Scholar
  31. 31.
    The Acute Respiratory Distress Syndrome Network. (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342: 1301–1308Google Scholar
  32. 32.
    Amato MB, Barbas CS, Medeiros DM, et al (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338: 347–354PubMedCrossRefGoogle Scholar
  33. 33.
    Ranieri VM, Suter PM, Tortorella C, et al (1999) Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA 282: 54–61PubMedCrossRefGoogle Scholar
  34. 34.
    Leung P, Jubran A, Tobin MJ (1997) Comparison of assisted ventilator modes on triggering, patient effort, and dyspnea. Am J Respir Crit Care Med 155: 1940–1948PubMedCrossRefGoogle Scholar
  35. 35.
    Brochard L, Rauss A, Benito S, et al (1994) Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 150: 896–903PubMedCrossRefGoogle Scholar
  36. 36.
    Esteban A, Frutos F, Tobin MJ, et al (1995) A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med 332: 345–350Google Scholar
  37. 37.
    Brochard L, Harf A, Lorino H, Lemaire F (1989) Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation. Am Rev Respir Dis 139: 513–521PubMedCrossRefGoogle Scholar
  38. 38.
    Brochard L, Rua F, Lorini H, Lemaire F, Harf A (1991) Inspiratory pressure support compensates for the additional work of breathing caused by the endotracheal tube. Anesthesiology 75: 739–745PubMedCrossRefGoogle Scholar
  39. 39.
    Bersten AD, Rutten AJ, Vedig AE, Skowronski GA (1989) Additional work of breathing imposed by endotracheal tubes, breathing circuits, and intensive care ventilators. Crit Care Med 17: 671–677PubMedCrossRefGoogle Scholar
  40. 40.
    Bersten AD, Rutten AJ, Vedig AE (1993) Efficacy of pressure support in compensating for apparatus work. Anaesth Intensive Care 21: 67–71PubMedGoogle Scholar
  41. 41.
    Santak B, Radermacher P, Sandmann W, Falke KJ (1991) Influence of SIMV plus inspiratory pressure support on VA/Q distributions during postoperative weaning. Intensive Care Med 17: 136–140PubMedCrossRefGoogle Scholar
  42. 42.
    Baum M, Benzer H, Putensen C, Koller W, Putz G (1989) [Biphasic positive airway pressure ( BIPAP) - a new form of augmented ventilation]. Anaesthesist 38: 452–458Google Scholar
  43. 43.
    Stock MC, Downs JB, Frolicher DA (1987) Airway pressure release ventilation. Crit Care Med 15: 462–466PubMedCrossRefGoogle Scholar
  44. 44.
    Younes M (1992) Proportional assist ventilation, a new approach to ventilatory support. Theory. Am Rev Respir Dis 145: 114–120CrossRefGoogle Scholar
  45. 45.
    Younes M, Puddy A, Roberts D, et al (1992) Proportional assist ventilation. Results of an initial clinical trial. Am Rev Respir Dis 145: 121–129Google Scholar
  46. 46.
    Guttmann J, Eberhard L, Fabry B, Bertschmann W, Wolff G (1993) Continuous calculation of intratracheal pressure in tracheally intubated patients. Anesthesiology 73: 503–513CrossRefGoogle Scholar
  47. 47.
    Fabry B, Guttmann J, Eberhard L, Wolff G (1994) Automatic compensation of endotracheal tube resitance in spontaneously breathing patients. Technol Health Care 1: 281–291Google Scholar
  48. 48.
    Kuhlen R, Guttmann J, Nibbe L, et al (1997) Proportional pressure support and automatic tube compensation: new options for assisted spontaneous breathing. Acta Anaesthesiol Scand Suppl 111: 155–159PubMedGoogle Scholar
  49. 49.
    Fabry B, Haberthur C, Zappe D, Guttmann J, Kuhlen R, Stocker R (1997) Breathing pattern and additional work of breathing in spontaneously breathing patients with different ventilatory demands during inspiratory pressure support and automatic tube compensation. Intensive Care Med 23: 545–552PubMedCrossRefGoogle Scholar
  50. 50.
    Kuhlen R, Max M, Nibbe L, et al (1999) Atemmuster und Atemanstrengung bei Automatischer Tubuskompensation und inspiratorischer Druckunterstützung. Anaesthesist 48: 871875Google Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • R. Kuhlen
  • C. Putensen
  • R. Rossaint

There are no affiliations available

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