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The effect of tracheal gas insufflation on gas exchange efficiency

Pinsky, MR and Delgado, E and Hete, B (2006) The effect of tracheal gas insufflation on gas exchange efficiency. Anesthesia and Analgesia, 103 (5). 1213 - 1218. ISSN 0003-2999

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Abstract

Transtracheal gas insufflation (TGI) improves gas exchange efficiency, but is associated with hyperinflation, and usually requires ventilator adjustment to compensate for the increased gas flow. Although bidirectional TGI (Bi-TGI) minimizes hyperinflation, it does not preclude the need to reduce tidal volumes to prevent hyperinflation. A flow-compensation system was developed by Respironics (Murrysville, PA) to match TGI flows; however, neither that nor the efficacy of Bi-TGI have been tested in vivo. We tested the hypotheses that flow compensation allows for a constant minute ventilation; Bi-TGI produces less hyperinflation than does unidirectional TGI (Uni-TGI), and endotracheal tube size influences the degree of hyperinflation during TGI. Seven anesthetized intact dogs were studied during positive-pressure ventilation using the Respironics flow compensation system. Measurements were made during steady-state conditions at constant and measured levels of CO2 production. Gas exchange efficiency (assessed by expired gas analysis for dead space) and hyperinflation (measured as an increase in pleural pressure) were compared during Bi- and Uni-TGI and for endotracheal tube sizes varying from 7 to 10F. Bi- and Uni-TGI could be delivered at constant minute ventilation without adjusting ventilatory setting when the flow compensation circuit was present. Uni-TGI produced more hyperinflation than did Bi-TGI with all sizes of endotracheal tube, and hyperinflation was universally present as tube size decreased to 7.5F. We conclude that this new flow compensation system allows for the delivery of TGI without the need for adjustments to the ventilator settings, and that Bi-TGI produces less hyperinflation than does Uni-TGI, even with small diameter endotracheal tubes. © 2006 by International Anesthesia Research Society.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Pinsky, MRpinsky@pitt.eduPINSKY
Delgado, E
Hete, B
Date: 1 November 2006
Date Type: Publication
Journal or Publication Title: Anesthesia and Analgesia
Volume: 103
Number: 5
Page Range: 1213 - 1218
DOI or Unique Handle: 10.1213/01.ane.0000237400.29668.e6
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0003-2999
Other ID: 10.1213/01.ane.0000237400.29668.e6
PubMed ID: 17056957
Date Deposited: 05 Apr 2012 21:13
Last Modified: 01 Nov 2017 14:05
URI: http://d-scholarship.pitt.edu/id/eprint/11596

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