Chest
Clinical Investigations in Critical CareEvaluation of Carbon Dioxide Rebreathing During Pressure Support Ventilation With Airway Management System (BiPAP) Devices
Section snippets
METHODS
This study comprised two parts, an experimental and a clinical study.
Experimental in Vitro Study
Table 2 shows the results obtained using the lung model, and Figure 2 depicts the pressure-volume loops recorded with the BiPAP-uc and the BiPAP-NRV. With the BiPAP-uc, the RVEA was 400 mL, ie, up to 55% of the VT. Use of the Sanders NRV-2 nonrebreathing valve fully eliminated rebreathing.
When the usual connector was replaced by a nonrebreathing valve, there was an increase in PEEP (2.4 vs 1.3 cm H2O) as a result of a rise in the time constant required to reach the equilibrium of the relaxed
DISCUSSION
Both our in vitro experiment (lung model) and our clinical randomized crossover study demonstrate that use of a standard BiPAP system to deliver inspiratory pressure support to ICU patients can result in a substantial amount of CO2 rebreathing with a marked increase in the WOB. Two simple factors were required to produce these adverse effects: (1) use of a standard tubing system with the widely used Whisper Swivel connector, and (2) a level of expiratory pressure set at the minimal value, ie,
REFERENCES (23)
- et al.
Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure.
Chest
(1991) - et al.
Noninvasive nasal mask ventilation for acute respiratory failure.
Chest
(1994) - et al.
Pressure support ventilation with a simplified ventilatory support system administered with a nasal mask in patients with respiratory failure.
Chest
(1991) - et al.
Non invasive pressure support ventilation in patients with acute respiratory failure.
Chest
(1993) - et al.
Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressure via nasal mask.
Chest
(1990) - et al.
Respiratory muscle rest using nasal BiPAP ventilation in patients with stable severe COPD.
Chest
(1994) - et al.
Comparison of BiPAP nasal ventilation and ventilation via iron lung in severe stable COPD.
Chest
(1993) - et al.
Ventilatory muscle support in respiratory failure with nasal positive pressure ventilation.
Chest
(1990) - et al.
Enhancement of the ventilatory response to carbon dioxide by tube breathing.
Respiration Physiology
(1968) - et al.
Noninvasive modalities of positive pressure ventilation improve the outcome of acute exacerbations in COLD patients.
Intens Care Med
(1993)
Reversal of acute exacerbation of chronic obstructive lung disease by inspiratory assistance with a face mask.
N Engl J Med
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The experimental part of this study was supported by a grant from the Caisse Nationale d'Assurance Maladie (CNAMTS); the clinical part by the Assistance Publique de Hopitaux de Paris.