NDLI: Dead space and CO2 elimination related to pattern of inspiratory gas delivery in ARDS patients

Content Provider	Springer Nature : BioMed Central
Author	Aboab, Jerome Niklason, Lisbet Uttman, Leif Brochard, Laurent Jonson, Björn
Abstract	Introduction The inspiratory flow pattern influences CO2 elimination by affecting the time the tidal volume remains resident in alveoli. This time is expressed in terms of mean distribution time (MDT), which is the time available for distribution and diffusion of inspired tidal gas within resident alveolar gas. In healthy and sick pigs, abrupt cessation of inspiratory flow (that is, high end-inspiratory flow (EIF)), enhances CO2 elimination. The objective was to test the hypothesis that effects of inspiratory gas delivery pattern on CO2 exchange can be comprehensively described from the effects of MDT and EIF in patients with acute respiratory distress syndrome (ARDS). Methods In a medical intensive care unit of a university hospital, ARDS patients were studied during sequences of breaths with varying inspiratory flow patterns. Patients were ventilated with a computer-controlled ventilator allowing single breaths to be modified with respect to durations of inspiratory flow and postinspiratory pause (TP), as well as the shape of the inspiratory flow wave. From the single-breath test for CO2, the volume of CO2 eliminated by each tidal breath was derived. Results A long MDT, caused primarily by a long TP, led to importantly enhanced CO2 elimination. So did a high EIF. Effects of MDT and EIF were comprehensively described with a simple equation. Typically, an efficient and a less-efficient pattern of inspiration could result in ± 10% variation of CO2 elimination, and in individuals, up to 35%. Conclusions In ARDS, CO2 elimination is importantly enhanced by an inspiratory flow pattern with long MDT and high EIF. An optimal inspiratory pattern allows a reduction of tidal volume and may be part of lung-protective ventilation.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc11232.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc11232
Journal	Critical Care
Issue Number	2
Volume Number	16
Language	English
Publisher	BioMed Central
Publisher Date	2012-03-05
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Acute Respiratory Distress Syndrome Dead Space Inspiratory Flow Acute Respiratory Distress Syndrome Patient FCO2
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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