Biomaterial Database

Continuous positive pressure breathing without and with inspiratory pressure support in acute respiratory failure when mean airway pressure is constant. 1991

H Langenstein

Department of Anaesthesiology and Intensive Care Medicine, Ruhr University Bochum, Knappschaftskrankenhaus Bochum-Langendreer, FRG.

OBJECTIVE Mean airway pressure (Pawm) may be a major factor for PaO2, functional residual capacity, and cardiac output in acute respiratory failure (ARF). To clarify effects of inspiratory pressure support (IPS) as a ventilatory mode in ARF, we studied patients in ARF either using IPS or continuous positive pressure breathing (CPAP) at the same level of Pawm, measuring respiratory and circulatory parameters. METHODS After consent, 10 patients in ARF of moderate severity (PaO2:FiO2 205 +/- 108 at positive end expiratory pressure (PEEP) 8.7 +/- 3.1 cmH2O; mean +/- SD) were investigated. Measurements were on day 7.4 +/- 8.4 after onset of ARF. IPS was 13.5 +/- 3.9 cmH2O above PEEP. To result in constant Pawm, PEEP was reduced for IPS (Pawm IPS 11.1 +/- 3.6 vs. Pawm CPAP 9.9 +/- 3.3 cmH2O, ns; PEEP IPS 8.7 +/- 3.1 vs. PEEP CPAP 10.6 +/- 4.3 cmH2O, p = 0.04). Inspired concentration of oxygen (FiO2) and the ventilator (Siemens 900 C) were not changed for the individual patient. RESULTS For IPS, tidal volume (VT) increased by +31% and respiratory frequency (RF) decreased by -19% (VT IPS 608 +/- 179 vs. VT CPAP 465 +/- 141 ml, p = 0.01; RF IPS 21.6 +/- 7.6 vs. RF CPAP 26.7 +/- 8.3 breaths per minute, p = 0.02). Also, PaCO2 showed a tendency to be lower for IPS, not reaching significance (PaCO2 IPS 44.3 +/- 5 vs. PaCO2 CPAP 47.4 +/- 4.9 mmHg, p = 0.1). All other parameters were unchanged (expiratory minute volume, PaO2, pH, intravascular pressures, cardiac index, stroke volume index (n = 6), systemic and pulmonary vascular resistances, venous admixture, deadspace (n = 3), oxygen consumption and oxygen delivery). WE CONCLUDE: When Pawm remained constant, IPS added to CPAP improved VT and RF without improving oxygenation or deteriorating circulation in patients with ARF of moderate severity. IPS mainly supports the ability to breathe spontaneously in ARF.

UI	MeSH Term	Description	Entries
D007384	Intermittent Positive-Pressure Breathing	Application of positive pressure to the inspiratory phase of spontaneous respiration.	IPPB,Inspiratory Positive-Pressure Breathing,Intermittent Positive Pressure Breathing (IPPB),Breathing, Inspiratory Positive-Pressure,Breathing, Intermittent Positive-Pressure,Inspiratory Positive Pressure Breathing,Intermittent Positive Pressure Breathing,Positive-Pressure Breathing, Inspiratory,Positive-Pressure Breathing, Intermittent
D008297	Male		Males
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D011175	Positive-Pressure Respiration	A method of mechanical ventilation in which pressure is maintained to increase the volume of gas remaining in the lungs at the end of expiration, thus reducing the shunting of blood through the lungs and improving gas exchange.	Positive End-Expiratory Pressure,Positive-Pressure Ventilation,End-Expiratory Pressure, Positive,End-Expiratory Pressures, Positive,Positive End Expiratory Pressure,Positive End-Expiratory Pressures,Positive Pressure Respiration,Positive Pressure Ventilation,Positive-Pressure Respirations,Positive-Pressure Ventilations,Pressure, Positive End-Expiratory,Pressures, Positive End-Expiratory,Respiration, Positive-Pressure,Respirations, Positive-Pressure,Ventilation, Positive-Pressure,Ventilations, Positive-Pressure
D012131	Respiratory Insufficiency	Failure to adequately provide oxygen to cells of the body and to remove excess carbon dioxide from them. (Stedman, 25th ed)	Acute Hypercapnic Respiratory Failure,Acute Hypoxemic Respiratory Failure,Hypercapnic Acute Respiratory Failure,Hypercapnic Respiratory Failure,Hypoxemic Acute Respiratory Failure,Hypoxemic Respiratory Failure,Respiratory Depression,Respiratory Failure,Ventilatory Depression,Depressions, Ventilatory,Failure, Hypercapnic Respiratory,Failure, Hypoxemic Respiratory,Failure, Respiratory,Hypercapnic Respiratory Failures,Hypoxemic Respiratory Failures,Respiratory Failure, Hypercapnic,Respiratory Failure, Hypoxemic,Respiratory Failures
D005260	Female		Females
D006439	Hemodynamics	The movement and the forces involved in the movement of the blood through the CARDIOVASCULAR SYSTEM.	Hemodynamic
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000208	Acute Disease	Disease having a short and relatively severe course.	Acute Diseases,Disease, Acute,Diseases, Acute
D000293	Adolescent	A person 13 to 18 years of age.	Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths