Effekte teilunterstützter Beatmungsmodi auf Hämodynamik, respiratorische Funktion und Gasaustausch beim experimentell induzierten akuten Lungenversagen im Schwein

Since the first description of ARDS (Acute Respiratory Distress Syndrome) in 1967 by Ashbaugh, the lethality remains high though the technical investigations in therapy. Aggressive ventilation, which aimed to recruit injured lung tissue, revealed to be harmful to the lung itself (VILI, ventilator induced lung injury). The ARDS-Network study showed that an additional lung injury can be avoided by the use of low tidal volume via low peak pressure, which significantly decreases the lethality. Moreover, ventilation allowing spontaneous breathing has shown to be lung protective, as the bad ventilated dorsobasal lungfields are recruited for the gas exchange by the contracting diaphragm. It is proved that assisted ventilation has less negative influence on hemodynamics than controlled ventilation as the abdominal pressure is not raised as much during assisted ventilation as during controlled; consequently, the venous backstream is less depressed during assisted ventilation. The aim of this study was to compare the effects of assisted (P-ACV (pressure-assist controlled ventilation), BIPAP (biphasic positive airway pressure) and PSV (pressure support ventilation)) and controlled ventilation (PCV (pressure controlled ventilation)) on hemodynamics, gas exchange and respiratory mechanics in a porcine model with severe acute hypoxemic lung injury applying the same sedation level during the assisted ventilation modes which differes in just one parameter and equal inspiratory pressure for all ventilation modalities. It was shown that adequate oxygenation and hemodynamics could be better granted by using partial ventilatory assistence than by using PCV. The effects of P-ACV, BIPAP and PSV on gas exchange and hemodynamics were comparable; however the reduction of shunt was biggest under BIPAP. WOB and respiratory drive were more reduced by P-ACV and PSV than by BIPAP. During PSV the dead space ventilation was more affected. P-ACV granted better oxygenation and hemodynamic function with lower resipiratory drive, WOB and lower sedation level. Thus P-ACV could be the modality of choice. Clinical studies are needed to determiate the outcome in patients with respiratory failure.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2008

Author dc:creator

• Pielen, Veronica Maria

Contributors dc:contributor

• Rossaint, Rolf

• info:eu-repo/classification/ddc/610
• ARDS
• Atemarbeit
• Assistierte Beatmung
• Pressure support ventilation
• Gasaustausch
• Hämodynamik
• Medizin
• Ventilations-Perfusionsverhältnis
• assistierte Spontanatmung
• ventilation-perfusion ratio
• assisted spontaneous breathing

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-112684%22

OAI record oai:identifier

https://publications.rwth-aachen.de/oai2d?verb=GetRecord&metadataPrefix=oai_dc&identifier=oai%3Apublications.rwth-aachen.de%3A50128