Gas exchange by intratracheal insufflation in a ventilatory failure dog model.

Gavriely, Noam; Eckmann, David M.; Grotberg, James B.

doi:10.1172/jci116128

Cited by 17 publications

(3 citation statements)

References 21 publications

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“…While the present, and previous, in vitro studies made use of idealized models of upper airway flow dynamics, the observed turbulent jet flow phenomena may nonetheless be generally applied to real airways. In this regard, in vivo studies by Gavriely et al were performed on intubated dogs with ventilatory failure receiving intratracheal insufflation (ITI) . In this study, a significant increase in carbon dioxide elimination, compared to no ITI, was demonstrated when an insufflation flow as low as 0.05 L/min/kg was injected either near the carina or in a mainstem bronchus.…”

Section: Discussionmentioning

confidence: 83%

Carbon dioxide washout during high flow nasal cannula versus nasal CPAP support: An in vitro study

Sivieri

Foglia

Abbasi

2017

Pediatric Pulmonology

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Section: Discussionmentioning

confidence: 83%

Carbon dioxide washout during high flow nasal cannula versus nasal CPAP support: An in vitro study

Sivieri

Foglia

Abbasi

2017

Pediatric Pulmonology

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“…However, ITPV and non-ITPV techniques for intratracheal ventilation differ in the direction of the intratracheal gas flow. In the non-ITPV studies, the bias flow of gas is administered into the trachea or in a bronchus (6)(7)(8), with the gas directed forward into the lungs and/or to the sides. ITPV is unique in its special way of clearing the upper dead space from CO,, i. e., the reversed flow of gas in the distal trachea is directed away from the lungs, thus flushing the proximal dead space from CO, and partially avoiding CO, rebreathing.…”

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confidence: 99%

Intratracheal Pulmonary Ventilation versus Conventional Mechanical Ventilation in a Rabbit Model of Surfactant Deficiency

et al. 1995

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Intratracheal pulmonary ventilation (ITPV) enhances the clearance of CO, from dead space and lungs by a bias flow of gas administered in the distal trachea. ITPV flow is continuously administered through a separate catheter placed within an endotracheal tube (ETT). After exiting from catheter's tip in the distal trachea, the flow of gas is redirected outward away from the lungs. We hypothesized that, compared with conventional mechanical ventilation (CMV), ITPV may increase minute CO, clearance (vco,), reduce the partial pressure of CO, dioxide in arterial gas (Paco,), and reduce distal tracheal peak inspiratory pressure (dPIP). We induced surfactant deficiency in 15 adult rabbits by lung lavage with 10 mL/kg normal saline. Animals were ventilated through a double-lumen 4.0 ETT, inserted through a tracheotomy incision. dPIP, distal positive end expiratory pressure, and distal mean airway pressure were monitored, and the mean exhaled CO, concentration was measured. For ventilator rates (respiratory rate) of 30, 45, and 70 breathslmin, the study included two phases: phase I compared CO, clearance and Paco, between ITPV and CMV using similar ventilatory pressures; phase I1 evaluated the effectiveness of ITPV in reducing dPIP and tidal volume (V,), compared with CMV, while maintaining eucapnea. When comparing ITPV and CMV, the following results (mean t SD) were achieved at respiratory rate of 30, 45, and 70 breathslmin, respectively. Phase I ITPV resulted in mean percent reduction of Paco, by 3 1.4 i lo%, 37.1 i 9.7% and 38.3 +-9%; mean percent increase in Vco, by 61.3 i 29%, 56 i 23%, and 98 t 40%, compared with CMV. Phase I1 ITPV resulted in mean percent reduction of dPIP by 35.5 t 14%, 38 i 10.8%, and 37.2 t 13.7%, and mean percent reduction in V, by 34.7 t 12.9%, 36.4 i 15%, and 52.7 t 10.7%, compared with CMV. The changes in Paco,, vco, (phase I), and dPIP and V, (phase 11) were all significantly more than 25% (p < 0.05). Oxygenation and pH were not significantly different between ITPV and CMV. We conclude that, in a surfactant deficiency rabbit model, ITPV is an efficient mode of assisted ventilation that increases CO, clearance and reduces ventilator pressures required for adequate ventilation. We speculate that ITPV can minimize lung barotrauma associated with mechanical ventilation. (Pediatr Res 38: 878-885, 1995) Abbreviations CMV, conventional mechanical ventilation dP,,, distal mean airway pressure dPEEP, distal positive end expiratory pressure dPIP, distal peak inspiratory pressure ETT, endotracheal tube ITPV, intratracheal pulmonary ventilation PFT, pulmonary function test RR, respiratory rate Vco,, minute CO, clearance V,, dead space volume V,, tidal volume Paco,, partial pressure of CO, in arterial gas Pao,, partial pressure of 0, in arterial gas Fio,, fraction of inspired 0, I:E ratio, inspiratory:expiratory ratio F,CO,, mean exiting CO, concentration v,, expiratory minute volume TI, inspiratory time T,, expiratory time ECMO, extracorporeal membrane oxygenation Intratracheal pulmonary ventilation is...

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“…The addition of TGI techniques to mechanical ventilation allows the use of very small V T that, when combined with an appropriate respiratory rate, may reach the target of avoiding dangerous ventilatory settings while maintaining normocapnia. TGI techniques have been developed and investigated both in animal (5)(6)(7)(8) and human studies (9)(10)(11)(12)(13)(14)(15).…”

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confidence: 99%

Reverse-Thrust Ventilation in Hypercapnic Patients with Acute Respiratory Distress Syndrome

Rossi¹,

Musch²,

Sangalli³

et al. 2000

Am J Respir Crit Care Med

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Techniques of tracheal gas insufflation (TGI) have been shown to enhance CO(2) clearance efficiency in mechanically ventilated patients with acute respiratory distress syndrome (ARDS). Clinical studies have explored the effects of such techniques only at moderate intratracheal gas flow rates, with TGI superimposed to mechanical ventilation in a continuous fashion, or synchronized to the expiratory phase of the duty cycle. We examined the effects of intratracheal pulmonary ventilation (ITPV), delivering the entire tidal volume (VT) in the proximity of the tracheal carina, with all the gas flow supplied continuously through a reverse-thrust catheter (RTC). A potential limitation in the application of TGI is dynamic hyperinflation. Therefore, in a subgroup of patients, we also evaluated the effects of ITPV on end-expiratory lung volume (EELV) by respiratory inductive plethysmography (RIP). Eleven patients with ARDS under volume-cycled mechanical ventilation were subsequently switched to ITPV at the same baseline respiratory rate, I:E ratio, and VT. At the same minute volume, Pa(CO(2)) decreased from 70 +/- 12.3 to 59 +/- 9.5 mm Hg, with a percent reduction of 15 +/- 4% (range from 10 to 20%). The CO(2) decrease was greater in patients with higher baseline Pa(CO(2)) levels (DeltaPa(CO(2)) = 0.29 x Pa(CO(2)) - 9.48, r = 0.95). During transition from mechanical ventilation to ITPV, tracheal positive end-expiratory pressure (PEEP(tr)) decreased with a correspondent decrease in EELV. Both were restored by increasing the PEEP at the ventilator by 3.6 +/- 2.0 cm H(2)O. These data suggest that in patients with ARDS ITPV effectively reduces dead space ventilation and the employment of the RTC may limit or avoid dynamic hyperinflation.

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Gas exchange by intratracheal insufflation in a ventilatory failure dog model.

Abstract: Invest. 1992Invest. . 90:2376Invest. -2383

Cited by 17 publications

References 21 publications

Carbon dioxide washout during high flow nasal cannula versus nasal CPAP support: An in vitro study

Carbon dioxide washout during high flow nasal cannula versus nasal CPAP support: An in vitro study

Intratracheal Pulmonary Ventilation versus Conventional Mechanical Ventilation in a Rabbit Model of Surfactant Deficiency

Reverse-Thrust Ventilation in Hypercapnic Patients with Acute Respiratory Distress Syndrome

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