Abstract
Acute respiratory failure and anaesthesia impede ventilation of dependent lung units and perfusion of non-dependent ones, creating considerable ventilation-perfusion \((\dot V/\dot Q)\) mismatch. General PEEP can improve \(\dot V/\dot Q\) but it cannot restore it to normal. To improve matching, ventilation must be distributed in proportion to regional blood flow. This can be accomplished by (1) placing the subject in the lateral position, (2) ventilating each lung in proportion to its blood flow (differential ventilation), and (3) applying PEEP solely to the dependent lung to ensure even distribution of inspired gas within that lung (selective PEEP). Differential ventilation with equal distribution of the tidal volume between the lungs and a selective PEEP of 10 cm H2O to the dependent lung resulted in equal distribution of perfusion between the lungs in anaesthetized healthy subjects, suggesting “optimum” \(\dot V/\dot Q\) lung disease, arterial oxygen tension was improved by an average of 45% compared with that during general PEEP, with no reduction in cardiac output. It is concluded that differential ventilation with selective PEEP can offer considerable improvement in gas exchange in acute, bilateral lung disease. However, long-term studies are required before a final evaluation can be made.
Article PDF
Similar content being viewed by others
References
Ashbaugh DG, Petty TL, Bigelow DB, Harris TM (1969) Continuous positive pressure breathing in adult respiratory distress syndrom. J Thorac Cardiovasc Surg 57:31
Baehrendtz S, Bindslev L, Hedenstierna G, Santesson J (1983) Selective PEEP in acute bilateral lung disease. Acta Anaesth Scand 27:311
Baehrendtz S, Hedensterina G, Santesson J, Bindslev L, Klingstedt C, Dahlborn M, Söderborg B, Norlander P (1982) Perfusion of each lung during differential ventilation with selective PEEP. Anaesthesiology 57:A458
Bake B, Wood L, Murphy B, Macklem PT, Milic-Emili J (1974) Effect of inspiratory flow rate on regional distribution on inspired gas. J Appl Physiol 34:8
Benumof JL, Wahrenbrock EA (1976) Local effects of anesthetics on regional hypoxic pulmonary vasoconstriction. Anaesthesiology 43:525
Berggren SM (1942) The oxygen deficit of arterial blood caused by nonventilating parts of the lung. Acta Physiol Scand 4(Suppl XI):1
Bindslev L, Hedenstierna G, Santesson J, Norlander O, Gram I (1980) Airway closure during anaesthesia and its prevention by positive end-expiratory pressure. Acta Anaesth Scand 24:199
Bindslev L, Santesson J, Hedenstierna G (1981) Distribution of inspired gas to each lung in anaesthetized human subjects. Acta Anaesth Scand 25:297
Bindslev L, Hedenstierna G, Santesson J, Gottlieb I, Carvallhas A (1981) Ventilation-perfusion distribution during inhalation anaesthesia. Effects of spontaneous breathing, mechanical ventilation and positive end expiratory pressure. Acta Anaesth Scand 25:360
Colgan FJ, Marocco PP (1972) The cardiorespiratory effect of constant and intermittent positive pressure breathing. Anaesthesiology 36:444
Craig DB, Wahba WM, Don HF, Contare JG, Becklake MR (1971) “Closing volume” and its relationship to gas exchange in seated and supine positions. J Appl Physiol 31:717
Don HF, Wahba M, Cuadrado L, Kelkar K (1970) The effects of anesthesia and 100 per cent oxygen on the functional residual capacity of the lungs. Anesthesiology 32:521
Briscoe WA (1964) Lung volumes: Handbook of physiology, vol. III. Section 3: Respiration. American Physiological Society, Washington, p 1363
Dueck R, Young I, Clausen J, Wagner PD (1980) Altered distribution of pulmonary ventilation and blood flow following induction of inhalational anaesthesia. Anesthesiology 52:113
Frazier AR, Rehder K, Sessler AD, Rodarte JR, Hyatt RE (1976) Single-breath oxygen test for individual lungs in awake man. J Appl Physiol 40:305
Gilmour I, Burnham M, Craig DB (1976) Closing capacity measurement during general anesthesia. Anesthesiology 45:477
Hedenstierna G, Santesson J (1979) Airway closure during anesthesia: a comparison between resident-gas and argon-bolus techniques. J Appl Physiol 47:874
Hedenstierna G, McCarthy G, Bergström M (1976) Airway closure during mechanical ventilation. Anesthesiology 44:114
Hedenstierna G, Bindslev L, Santesson J (1981a) Pressurevolume and airway closure relationships in each lung in anaesthetized man. Clin Physiol 1:479
Hedenstierna G, Bindslev L, Santesson J, Norlander OP (1981b) Airway closure in each lung of anesthetized human subjects. J Appl Physiol 50:55
Hedenstierna G, Löfström B, Lundh R (1981c) Thoracic gas volume and chest-abdomen dimensions during anesthesia and muscle paralysis. Anesthesiology 55:499
Hewlett AM, Hulands GH, Nunn JF, Milledge JS (1974) Functional residual capacity during anaesthesia. III: Artificial ventilation. Br J Anaesthiol 46:495
Juno P, Marsh HM, Knopp TJ, Rehder K (1978) Closing capacity in awake and anesthetized-paralyzed man. J Appl Physiol 44:238
Katz JA, Ozanne GM, Zinn SE, Fairly HB (1981) Time course and mechanism of lung-volume increase with PEEP in acute pulmonary failure. Anesthesiology 54:9
Kumar A, Falke KJ, Geffin B, Aldredge CF, Laver MB, Löwenstein E, Pontoppidan H (1970) Continuous positivepressure ventilation in acute respiratory failure. New Engl J Med 238:1430
Kumar A, Pontoppidan H, Falke K, Wilson R, Laver MB (1973) Pulmonary barotrauma during mechanical ventilation. Crit Care Med 1:181
Laws AK (1968) Effects of induction of anesthesia and muscle paralysis on functional residual capacity of the lungs. Can Anaesth Soc J 15:325
LeBlanc P, Ruff F, Milic-Emili J (1970) Effects of age and body position on “airway closure” in man. J Appl Physiol 28:488
McCarthy GS, Hedenstierna G (1978) Arterial oxygenation during artificial ventilation. The effect of airway closure and of its prevention by positive end-expiratory pressure. Acta Anaesth Scand 22:563
Merin RG (1975) Effects of anesthetics on the heart. Surg Clin N Am 55:759
Milic-Emili J, Henderson JA, Colovich MB, Trop D, Kaneko K (1966) Regional distribution of inspired gas in the lung. J Appl Physiol 21:749
Nunn JF, Bergman NA, Coleman AJ (1965) Factors influencing the arterial oxygen tension during anaesthesia with artificial ventilation. Br J Anaesthiol 37:898
Pontoppidan H, Geffin B, Lowenstein E (1973) Acute respiratory failure in the adult. N Engl J Med, Medical Progress Series, Little, Brown and Company, Boston pp 9–16
Rehder K, Sessler AD, Rodarte JR (1977) Regional intrapulmonary gas distribution in awake and anaesthetized-paralyzed man. J Appl Physiol R 42:391
Rehder K, Knopp TJ, Sessler AD (1978) Regional intrapulmonary gas distribution in awake and anesthetized-paralyzed prone man. J Appl Physiol 45:528
Rehder K, Knopp TJ, Sessler AD, Didier EP (1979) Ventilation-perfusion relationship in young healthy awake and anesthetized man. J Appl Physiol 47:745
Sybrecht GW, Garret L, Anthonisen NR (1975) Effect of chest strapping on regional lung function. J Appl Physiol 39:707
Sykes MK, Loh L, Seed RF, Kafer ER, Cahkrabarti MK (1973) The effect of inhalation anaesthetics on hypoxic pulmonary vasoconstriction and pulmonary vascular resistance in the perfused lungs of the dog and cat. Br J Anaesth 44:776
Ueda H, Iio M, Kaihara S (1964) Determination of regional pulmonary blood flow in various cardiopulmonary disorders. Jpn Heart J 5:431
Wagner PD, Salzman HA, West JB (1974) Measurement of continuous distributions of ventilation-perfusion ratios: theory J Appl Physiol 36:588
Werkö L (1947) The influence of positive pressure breathing on the circulation in man. Acta Med Scand Suppl 193
West JB, Dollery CT, Naimark A (1964) Distribution of blood flow in isolated lung; relation to vascular and alveolar pressures. J Appl Physiol 19:713
West JB (1977) Regional differences in the lung. Academic Press, New York, pp 281
Westbrook PR, Stubbs SE, Sessler AD (1973) Effects of anaesthesia and muscle paralysis on respiratory mechanics in normal man. J Appl Physiol 34:81
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hedenstierna, G., Santesson, J. & Baehrendtz, S. Variations of regional lung function in acute respiratory failure and during anaesthesia. Intensive Care Med 10, 169–177 (1984). https://doi.org/10.1007/BF00259433
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00259433