Chest
Clinical Investigations in Critical CareCardiorespiratory Effects of Pressure Controlled Inverse Ratio Ventilation in Severe Respiratory Failure
Section snippets
Patients
Nine patients (Table 1) with severe ARDS, as manifested by diffuse pulmonary infiltrates on chest roentgenograms, arterial hypoxemia with widened A-a gradients despite supplemental oxygen, pulmonary capillary wedge pressures (WP) less than 20 mm Hg, and decreased static and dynamic thoracic compliance were entered in the study. In each case, the patient was placed on PC-IRV at the request of the attending physician, who judged the patient to be failing conventional volume controlled ventilation
Results
Table 1 summarizes the characteristics of the patient population studied. Four men and five women were included. The average age was 46±4 years.
Arterial blood gas values, arterial oxygen saturation and peak inspiratory pressures before and after initiation of PC-IRV are presented in Table 2. All patients showed an increase in PaO2 after the institution of PC-IRV, with the range of improvement in PaO2 being 1 to 18 mm Hg. The PaCO2 decreased in seven patients and pH rose in six patients with
Discussion
In the present study, increases in PaO2 and decreases in PIP were found after the initiation of PC-IRV These results are similar to those found in previous investigations3, 4 of PC-IRV. The changes found in PaCO2 and pH were minimal and probably could have been eliminated had the end-expiratory pressure been decreased, as was made possible by the improvement in oxygenation accompanying the use of PC-IRV.
Because PC-IRV has been demonstrated to result in improved PaO2 and decreased PIP in
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Manuscript received March 31; revision accepted May 17.