Die Ventilation mit biphasic positive airway pressure (BIPAP) im experimentellen akuten Lungenschaden : der Einfluß des transpulmonalen Drucks auf Gasaustausch und Hämodynamik

OBJECTIVE: We investigated whether improvement in ventilation perfusion distribution during mechanical ventilation using biphasic positive airway pressure (BIPAP) with spontaneous breathing may be attributed to an effectively increased transpulmonary pressure (PTP) and can also be achieved by increasing PTP during controlled ventilation. DESIGN: In 12 pigs with saline lavage-induced lung injury we compared the effects of BIPAP to pressure-controlled ventilation with equal airway pressure (PCVAW) or equal transpulmonary pressure (PCVTP) on ventilation perfusion distribution assessed by the multiple inert gas elimination technique (MIGET).Measurements and results: Intrapulmonary shunt was 33±11% during BIPAP, 36±10% during PCVAW and 33±15% during PCVTP (p= n.s.). BIPAP resulted in higher PaO2 than PCVAW (188±83 versus 147±82 mmHg, p<0.05), but not than PCVTP (187±139 mmHg). Oxygen delivery was significantly higher during BIPAP (530±109 ml/min) versus 374±113 ml/min during PCVAW and 353±93 ml/min during PCVTP (p<0.005). Tidal volume with PCVTP increased to 11.9±2.3 ml/kg, compared to 8.5±0.8 with BIPAP and 7.6±1.4 with PCVAW (p<0.001) and cardiac output decreased to 3.5±0.6 l/min (BIPAP 4.9±0.8 and PCVAW 3.9±0.8, p<0.006). CONCLUSIONS: In experimental lung injury, BIPAP with preserved spontaneous breathing was effective in increasing regional PTP, since pressure-controlled ventilation with the same PTP resulted in similar gas exchange effects. However, PCVTP caused increased airway pressures and tidal volumes, whereby, with BIPAP, less depression of oxygen delivery and cardiac output were observed. BIPAP could be useful in maintaining pulmonary gas exchange and slightly improving oxygenation without interfering with circulation as strongly as PCV does.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2009

Author dc:creator

• Hatam, Nima

Contributors dc:contributor

• Autschbach, Rüdiger

• info:eu-repo/classification/ddc/610
• Lungenverletzung
• Ventilation
• Gasaustausch
• Hämodynamik
• Medizin
• BIPAP
• Transpulmonaler Druck
• biphasic positive airway pressure

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-113512%22

OAI record oai:identifier

https://publications.rwth-aachen.de/oai2d?verb=GetRecord&metadataPrefix=oai_dc&identifier=oai%3Apublications.rwth-aachen.de%3A51200