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Comparative effects of helium-oxygen and external positive end-expiratory pressure on respiratory mechanics, gas exchange, and ventilation-perfusion relationships in mechanically ventilated patients with chronic obstructive pulmonary disease

Jolliet, Philippe ; Watremez, Christine ; Roeseler, Jean ; Ngengiyumva, J. ; de Kock, Marc ; Clerbaux, Thierry ; Tassaux, Didier ; Reynaert, Marc ; Detry, Bruno ; Liistro, Giuseppe

In: Intensive Care Medicine, 2003, vol. 29, no. 9, p. 1442-1450

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    Titel
    • Comparative effects of helium-oxygen and external positive end-expiratory pressure on respiratory mechanics, gas exchange, and ventilation-perfusion relationships in mechanically ventilated patients with chronic obstructive pulmonary disease
    Autor
    • Jolliet, Philippe. Medical Intensive Care Division, University Hospital, 1211, Geneva 14, Switzerland
    • Watremez, Christine. Division of Anesthesiology, Clinique Universitaire St.-Luc, Brussels, Belgium
    • Roeseler, Jean. Departement of Emergency and Intensive Care, Clinique Universitaire St.-Luc, Brussels, Belgium
    • Ngengiyumva, J.. Division of Anesthesiology, Clinique Universitaire St.-Luc, Brussels, Belgium
    • de Kock, Marc. Division of Anesthesiology, Clinique Universitaire St.-Luc, Brussels, Belgium
    • Clerbaux, Thierry. Division of Pneumology, Clinique Universitaire St.-Luc, Brussels, Belgium
    • Tassaux, Didier. Medical Intensive Care Division, University Hospital, 1211, Geneva 14, Switzerland
    • Reynaert, Marc. Departement of Emergency and Intensive Care, Clinique Universitaire St.-Luc, Brussels, Belgium
    • Detry, Bruno. Division of Pneumology, Clinique Universitaire St.-Luc, Brussels, Belgium
    • Liistro, Giuseppe. Division of Pneumology, Clinique Universitaire St.-Luc, Brussels, Belgium
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • Intensive Care Medicine, 2003, vol. 29, no. 9, p. 1442-1450. Springer-Verlag
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:317529
    Summary
    Objective: To compare the effects of He/O2 and external PEEP (PEEPe) on intrinsic PEEP (PEEPi), respiratory mechanics, gas exchange, and ventilation/perfusion (V̇A/Q̇) in mechanically ventilated COPD patients. Design and setting: Prospective, interventional study in the intensive care unit of a university hospital. Interventions: Ten intubated, sedated, paralyzed, mechanically ventilated COPD patients studied in the following conditions: (a) baseline settings made by clinician in charge, air/O2, ZEEP; (b) He/O2, ZEEP; (c) air/O2, ZEEP; (d) air/O2, PEEPe 80% of PEEPi. Measurements at each condition included V̇A/Q̇ by the multiple inert gas elimination technique (MIGET). Results: PEEPi and trapped gas volume were comparably reduced by He/O2 (4.2±4 vs. 7.7±4cmH2O and 98±82 vs. 217±124ml, respectively) and PEEPe (4.4±1.3 vs. 7.8±3.6cmH2O and 120±107 vs. 216±115ml, respectively). He/O2 reduced inspiratory and expiratory respiratory system resistance (15.5±4.4 vs. 20.7±6.9 and 19±9 vs. 28.8±15cmH2Ol−1s−1, respectively) and plateau pressure (13±4 vs. 17±6cmH2O). PEEPe increased airway pressures, including total PEEP, and elastance. PaO2/FIO2 was slightly reduced by He/O2 (225±83 vs. 245±82) without significant V̇A/Q̇ change. Conclusions: He/O2 and PEEPe comparably reduced PEEPi and trapped gas volume. However, He/O2 decreased airway resistance and intrathoracic pressures, at a small cost in arterial oxygenation. He/O2 could offer an attractive option in COPD patients with PEEPi/dynamic hyperinflation