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Tracheal gas insufflation improves ventilatory efficiency during methacholine-induced bronchospasm

Miro, AM and Hoffman, LA and Tasota, FJ and Sigler, DW and Gowski, DT and Lutz, J and Zullo, T and Pinsky, MR (1997) Tracheal gas insufflation improves ventilatory efficiency during methacholine-induced bronchospasm. Journal of Critical Care, 12 (1). 13 - 21. ISSN 0883-9441

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Introduction: Barotrauma and cardiovascular insufficiency are frequently encountered problems in patients with acute bronchospastic disease who require mechanical ventilation. Permissive hypercapnia is a recognized strategy for minimizing these adverse effects; however, it has potential risks. Tracheal gas insufflation (TGI) has been shown to increase carbon dioxide elimination efficiency and thus could permit mechanical ventilation at lower peak airway pressures without inducing hypercapnia. However, caution exists as to the impact of TGI on lung volumes, given that expiratory flow limitation is a hallmark of bronchospastic disease. Purpose: To examine these issues, we studied ventilatory and hemodynamic effects of continuous TGI as an adjunct to mechanical ventilation before and after methacholine-induced bronchospasm. Materials and Methods: Ten anesthetized, paralyzed dogs were ventilated on volume-controlled mechanical ventilation during administration of continuous TGI (0, 2, 6, and 10 L/min) while total inspired minute ventilation (ventilator-derived minute ventilation plus TGI) was kept constant. In an additional step, with TGI flow of 10 L/min, total inspired minute ventilation was decreased by 30%. Results: Paco 2 decreased (44 ± 7 mm Hg at zero flow to 34 ± 7 mm Hg at 6 L/min and 31 ± 6 mm Hg at 10 L/min, respectively, P < .05), as did the dead space to tidal volume ratio at TGI of 6 and 10 L/min compared with zero flow. There were no significant changes in end-expiratory transpulmonary pressure, mean arterial pressure, or cardiac output. During the highest TGI flow (10 L/min), with a 30% reduction of total inspired minute ventilation, both Paco 2 and peak airway pressure remained less than during zero flow conditions. Conclusion: We conclude that TGI increases carbon dioxide elimination efficiency during constant and decreased minute ventilation conditions without any evidence of hyperinflation or hemodynamic instability during methacholine-induced bronchospasm.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Miro, AM
Hoffman, LAlhof@pitt.eduLHOF
Tasota, FJ
Sigler, DW
Gowski, DT
Lutz, J
Zullo, T
Pinsky, MRpinsky@pitt.eduPINSKY
Date: 1 January 1997
Date Type: Publication
Journal or Publication Title: Journal of Critical Care
Volume: 12
Number: 1
Page Range: 13 - 21
DOI or Unique Handle: 10.1016/s0883-9441(97)90021-6
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0883-9441
PubMed ID: 9075060
Date Deposited: 05 Mar 2012 20:38
Last Modified: 29 Oct 2017 11:55


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