Haemodynamic variations during independent lung ventilation in paediatrics

• Autorzy: Marraro G. A. , Luchetti M. , Galassini E. M.
• Języki publikacji: EN

Abstrakty

EN

Independent lung ventilation (ILV) has been suggested in order to reduce volutrauma and barotrauma in the treatment of lung pathology with unilateral prevalence. The application of different PEEP levels to each lung can allow an increase in gas exange and reduce haemodynamic variations connected with high transpulmonary pressure. Application of synchronized ILV with ZEEP or 5 cm H2O PEEP did not in itself cause haemodynamic changes any different from those that occur with intermittent positive pressure ventilation (IPPV) and continuous positive pressure ventilation (CPPV) with 5 cm H2O of positive end-espiratory pressure (PEEP). Maintaining 5 cm H2O of PEEP in the less affected lung and increasing progressively PEEP from 5 to 15 cm H2O in the more pathologic lung, central venous pressure (CVP), cardiac rate and mean arterial pressure (MAP) remained stable. The application of progressive PEEP levels in the less damaged lung while maintaining a stable value in the more damaged lung showed an increase in CVP and cardiac rate and reduction in MAP: Applying synchronised ILV (sILV) an improvement in PaO2 was noted compared to volume controlled ventilation with 10 cm H2O of PEEP. The improvement in PaO2 appears more evident when the "best" PEEP for each lung has been applied.

Słowa kluczowe

EN

children; respiratory failure; unilateral lung pathology; inhomogenous lung pathology; artificial ventilation; independent lung ventilation; volutrauma; barotrauma; haemodynamic evaluations; gas exchange

PL

niewydolność oddechowa; płuca; wentylacja mechaniczna

• Wydawca: Nałęcz Institute of Biocybernetics and Biomedical Engineering of the Polish Academy of Sciences ; Elsevier
• Czasopismo: Biocybernetics and Biomedical Engineering
• Rocznik: 2003
• Tom: Vol. 23, no. 2
• Strony: 67--76
• Opis fizyczny: Bibliogr. 18 poz., rys., tab,. wykr.

Twórcy

autor

Marraro G. A.

• Anaesthesia and Intensive Care Departament, Paediatric Intensive Care Unit, Fatebenefratelli and Ophthalmiatric Hospital, Milan, Italy

autor

Luchetti M.

• Anaesthesia and Intensive Care Departament, Paediatric Intensive Care Unit, Fatebenefratelli and Ophthalmiatric Hospital, Milan, Italy

autor

Galassini E. M.

• Anaesthesia and Intensive Care Departament, Paediatric Intensive Care Unit, Fatebenefratelli and Ophthalmiatric Hospital, Milan, Italy

Bibliografia

• [1] Amato M. B., Barbas C.S, Medeiros D. M et al.: Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N. Engl. J. Med. 1998, 338, 347-354.
• [2] Dreyfuss D., Saumon G.: Ventilator-induced lung injury: lessons from experimental studies [State of the art]. Am. J. Respir. Crit. Care Med. 1998, 157, 294-330.
• [3] Brochard L., Roudot-Thoraval E., et al.: Tidal volume reduction for prevention of ventilator-induced lung injury in the acute respiratory distress syndrome. The Multicenter Trail Group on Tidal Volume reduction in ARDS. Am. J. Respir. Crit. Care Med. 1998, 158, 1831-1838.
• [4] Brower R., Shanholtz C., Fessler H. E., et al.: Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients. Crit Care Med. 1999, 27, 1492-1498.
• [5] Nilsson R., Grossmann G., Robertson B.: Pathogenesis of neonatal lung lesions induced by artificial ventilation: evidence against the role of barotrauma. Respiration 1980, 40, 218-225.
• [6] Marraro G.: Synchronized independent lung ventilation in pediatric age. ACP Applied Cardiopulm Pathophys 1987, 2, 283-288.
• [7] Marraro G., Marinari M., Rataggi M.: The clinical application of SILV in pulmonary disease with unilateral prevalence in pediatrics. Inter. J. Clinical Mornitoring and Computing 1987, 4, 123-129.
• [8] Marraro G.: Innovative practices on mechanical ventilation. Conference Proc. 3rd National Congress on Paedriatric Critical Care. Chennai 2001, 1-19.
• [9] Marraro G.: The present technical possibilities for synchronized independent lung ventilation in pediatric age. Intensive Care Med. 1986, 12 (suppl.), 273.
• [10] Marraro G.: Ventilation a pomons separes chez l'enfant au cours de la 1.ere annee de vie. Cahiers d'Anestesiologie 1990, 38. 377-380.
• [11] Marraro G.: Simultaneous independent lung ventilation in pediatric patients. Critical Care Clinics 1992, 8, 131-145.
• [12] Marraro G.: Selective endobronchial intubation in paediatrics: the Marraro Paediatric Bilumen Tube. Paediatric Anaesthesia 1994, 4, 255-258.
• [13] East T. P., Pace N. L., Westenskow D. R.: Synchronous versus asynchronous differential lung ventilation with PEEP after unilateral acid aspiration in the dog. Crit. Care Med. 1983, 11, 441.
• [14] Frostell C., Hedenstierna G., Cronestrand R.: Asynchronous ventilation in the dogs: effects on lung blood flow and gas exchange. Clin. Physiol. 1995, 5 (suppl. 3), 59-64.
• [15] Dreyfuss D., Saumon G.: Barotrauma is volutrauma, but which volume is the one responsible? Intensive care Med. 1992, 18, 139-141.
• [16] Marraro G.: New modes of pulmonary ventilation. In Dalens B., Murat I & Bush G. ed. Advances in Paediatric Anasthesia. ADARPEF, FEAPA Paris 1997, 57-88.
• [17] Marraro G.: Intraoperative ventilation in paediatrics. Paediatric Anasthesia 1998, 8, 372-382.
• [18] Marraro G.: Airway management. In. Bissonette B. and Dalens B. J. eds. "Principle and practice of Pediatric Anesthesia". McGraw-hill Comp. New York 2001, 778-814.