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Exhaled tidal volume overestimation in mechanically ventilated patients with large cardiogenic oscillation.

Abstract：

OBJECTIVES:In postcardiac surgery patients, we often noticed that monitored tidal volumes exceeded the ventilator settings. We investigated whether cardiogenic oscillation causes overestimation of tidal volume. DESIGN:Prospective, observational, clinical study. SETTING:Surgical intensive care unit in a national heart institute. PATIENTS:Eight postcardiac surgery patients (age 13-70). INTERVENTIONS:Patients were paralyzed and received flow-triggered volume-controlled ventilation with a tidal volume of 10 mL/kg. In random order, two types of ventilator (Bird 8400 STi and Servo-300) and two respiratory rates (5 and 10 breaths/min) were applied to each patient via a disposal ventilatory circuit and heat-and-moisture exchanger. For each ventilator, we adjusted the flow-triggering sensitivity to prevent autotriggering due to cardiogenic oscillation: 10 L/min for the Bird 8400 STi and green zone for the Servo-300. MEASUREMENTS AND MAIN RESULTS:The magnitude of cardiogenic oscillation during mechanical ventilation was defined as peak expiratory flow fluctuation at end-expiration. We recorded tidal volume using the monitoring devices on the ventilators and calculated the discrepancy from the set tidal volume. Cardiogenic oscillation was significantly greater with the Bird 8400STi (4.0 +/- 1.8 L/min) than with the Servo-300 (1.7 +/- 0.8 L/min). With the Bird 8400 STi, the discrepancy between monitored tidal volume and set tidal volume ranged from 15 to 260 mL when the respiratory rate was 5 breaths/min and from -9 to 75 mL at 10 breaths/min; there was a linear correlation between the overestimation of tidal volume and the magnitude of cardiogenic oscillation. In contrast, with the Servo-300, the discrepancy was relatively small (-36 to 14 mL). CONCLUSIONS:In mechanically ventilated patients with large cardiogenic oscillation, exhaled tidal volume is overestimated on at least one model of ventilator.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Imanaka H,Takeuchi M,Tachibana K,Nishimura M

doi

10.1097/01.ccm.0000129487.25203.1f

subject

Has Abstract

pub_date

2004-07-01 00:00:00

pages

1546-9

issue

eissn

0090-3493

issn

1530-0293

pii

00003246-200407000-00013

journal_volume

pub_type

临床试验,杂志文章,随机对照试验

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Exhaled tidal volume overestimation in mechanically ventilated patients with large cardiogenic oscillation.