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Influence of SIMV plus inspiratory pressure support on VA/Q distributions during postoperative weaning.

Abstract：

:Since the introduction of synchronized intermittent mandatory ventilation (SIMV) several advantages have been attributed to this ventilatory mode, one of them being a more homogeneous distribution of ventilation and perfusion than during controlled mechanical ventilation (CMV). Up to now no data are available to confirm whether this is true when SIMV is used in combination with inspiratory pressure support (IPS). Therefore, we compared the influence of CMV and SIMV + IPS on the distributions of ventilation and perfusion in 9 patients undergoing weaning from postoperative mechanical ventilation. Continuous distributions of ventilation and perfusion were assessed using the multiple inert gas elimination technique (MIGET). SIMV + IPS did not induce any change in the hemodynamic or oxygenation parameters, in particular CI and PaO2 remained constant. Physiological dead space (VD/VT) increased, but PaCO2 remained unchanged due to increased minute ventilation (from 9.5 +/- 0.9 l.min-1 to 11.3 #/- 1.2 l.min-1). The perfusion distributions remained unaltered; there was no change in QS/QT nor in the perfusion of the low VA/Q lung regions. This result was underscored by the unchanged dispersion of the perfusion distribution (log SDQ). The increased VD/VT was caused by increased inert gas dead space (from 22.0 +/- 9.6 to 26.8 +/- 8.7%) which was accompanied by increased ventilation of lung regions with high VA/Q ratios (10 less than VA/Q less than 100) in 3 patients. These results show that in our group of patients partial removal of CMV together with pressure support assistance of spontaneous ventilation did not induce a clinically significant loss of the efficiency of the breathing pattern.(ABSTRACT TRUNCATED AT 250 WORDS)

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Santak B,Radermacher P,Sandmann W,Falke KJ

doi

10.1007/BF01704716

subject

Has Abstract

pub_date

1991-01-01 00:00:00

pages

136-40

issue

3

eissn

0342-4642

issn

1432-1238

journal_volume

17

pub_type

杂志文章

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