Pattern of lung emptying and expiratory resistance in mechanically ventilated patients with chronic obstructive pulmonary disease

Kondili, Eumorfia; Alexopoulou, Christina; Prinianakis, George; Xirouchaki, Nectaria; Georgopoulos, Dimitris

doi:10.1007/s00134-004-2255-z

Cited by 32 publications

(19 citation statements)

References 32 publications

(59 reference statements)

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“…In these circumstances, increasing external PEEP increases Vt for a given inspiratory pressure, will reduce pCO 2 and improve oxygenation. In obstructive disease, PEEP improves expiratory airflow, limits dynamic hyperinflation and improves alveolar ventilation 108 109. Dynamic hyperinflation may be suspected by a progressive fall in tidal volume with constant ventilator pressure settings (or, with volume control, an increase in inflation pressure) and by signs of increasing patient distress such as tachycardia and hypotension.…”

Section: Principles Of Mechanical Ventilationmentioning

confidence: 99%

BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults

Davidson

Banham

Elliott

et al. 2016

Thorax

313

303

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Section: Principles Of Mechanical Ventilationmentioning

confidence: 99%

BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults

Davidson

Banham

Elliott

et al. 2016

Thorax

313

303

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“…Guttmann et al [10] reported an average Ƭ E of 0.60 seconds and Kondili et al [14] reported Ƭ E to be in the range of 0.70 seconds. In another study of COPD patients, Ƭ E varied inversely with PEEP; at end exhalation Ƭ E ranged up to 3.75 seconds on zero PEEP and up to 1.58 seconds on 10 cm H 2 0 PEEP [15]. …”

Section: Discussionmentioning

confidence: 99%

Expiratory time constant for determinations of plateau pressure, respiratory system compliance, and total resistance

et al. 2013

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IntroductionWe hypothesized the expiratory time constant (ƬE) may be used to provide real time determinations of inspiratory plateau pressure (Pplt), respiratory system compliance (Crs), and total resistance (respiratory system resistance plus series resistance of endotracheal tube) (Rtot) of patients with respiratory failure using various modes of ventilatory support.MethodsAdults (n = 92) with acute respiratory failure were categorized into four groups depending on the mode of ventilatory support ordered by attending physicians, i.e., volume controlled-continuous mandatory ventilation (VC-CMV), volume controlled-synchronized intermittent mandatory ventilation (VC-SIMV), volume control plus (VC+), and pressure support ventilation (PSV). Positive end expiratory pressure as ordered was combined with all aforementioned modes. Pplt, determined by the traditional end inspiratory pause (EIP) method, was combined in equations to determine Crs and Rtot. Following that, the ƬE method was employed, ƬE was estimated from point-by-point measurements of exhaled tidal volume and flow rate, it was then combined in equations to determine Pplt, Crs, and Rtot. Both methods were compared using regression analysis.ResultsƬE, ranging from mean values of 0.54 sec to 0.66 sec, was not significantly different among ventilatory modes. The ƬE method was an excellent predictor of Pplt, Crs, and Rtot for various ventilatory modes; r2 values for the relationships of ƬE and EIP methods ranged from 0.94 to 0.99 for Pplt, 0.90 to 0.99 for Crs, and 0.88 to 0.94 for Rtot (P <0.001). Bias and precision values were negligible.ConclusionsWe found the ƬE method was just as good as the EIP method for determining Pplt, Crs, and Rtot for various modes of ventilatory support for patients with acute respiratory failure. It is unclear if the ƬE method can be generalized to patients with chronic obstructive lung disease. ƬE is determined during passive deflation of the lungs without the need for changing the ventilatory mode and disrupting a patient's breathing. The ƬE method obviates the need to apply an EIP, allows for continuous and automatic surveillance of inspiratory Pplt so it can be maintained ≤ 30 cm H2O for lung protection and patient safety, and permits real time assessments of pulmonary mechanics.

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“…23 A vicious circle is created, and if the latter is not resolved, the patient gradually becomes exhausted until cardiovascular and respiratory collapse occurs in a way similar to that produced by tension pneumothorax. The only measure that has been shown to predict the complications of hyperinsufflation is the determination of end-inspiratory volume (V ei ) over functional residual capacity, calculating the total volume of gas exhaled in a patient with muscle paralysis after 60 s of apnea.…”

Section: Dynamic Hyperinsufflation and Auto-peepmentioning

confidence: 99%

Invasive Mechanical Ventilation in COPD and Asthma

Vicente¹,

Almengor²,

Caballero³

et al. 2011

Medicina Intensiva (English Edition)

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Pattern of lung emptying and expiratory resistance in mechanically ventilated patients with chronic obstructive pulmonary disease

Abstract: Patients with COPD exhibit a decrease in the rate of lung emptying toward the end of expiration due to an increase in Rrs. PEEP decreases Rrs, resulting in a faster and uniform rate of lung emptying.

Cited by 32 publications

References 32 publications

BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults

BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults

Expiratory time constant for determinations of plateau pressure, respiratory system compliance, and total resistance

Invasive Mechanical Ventilation in COPD and Asthma

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