Adaptation of pressure support ventilation to increasing ventilatory demand during experimental airway obstruction and acute lung injury

Critical Care Medicine
J RäsänenR D Cane

Abstract

To estimate the changes in the relative amount of ventilatory assistance offered by inspiratory pressure support during changing ventilatory demand with external airway obstruction and with oleic acid-induced acute lung injury. Prospective, controlled, crossover study. Experimental laboratory in a university anesthesiology department. Eight dogs anesthetized with pentobarbital. An external resistor was placed in the breathing circuit to produce increased resistance to breathing. Acute lung injury was produced with oleic acid. Ventilatory demand was increased by increasing the CO2 concentration in inspired gas to produce an increase of 20 torr (2.7 kPa) in end-tidal CO2 tension. During airway obstruction, pressure support was adjusted to reduce the inspiratory decrease in intrathoracic pressure to the level present during unobstructed breathing. During acute lung injury, pressure support was applied to reduce the maximum negative deflection of intrathoracic pressure by 50%. The ventilator effort was estimated by calculating the pressure-time integral of proximal airway pressure; the spontaneous ventilatory effort was estimated in a similar manner from esophageal pressure. The pressure support averaged 10 +/- 3 cm H2O during airw...Continue Reading

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