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Effect of Mechanical Ventilation with End-inspiratory Pause on Blood-Gas Exchange

SAMIR F. FULEIHAN, MD^*, ROGER S. WILSON, MD, and HENNING PONTOPPIDAN, MD

*Instructor in Anesthesia, Anesthesia Laboratories of the Harvard Medical School at the Massachusetts General Hospital, Boston, Massachusetts 02114. Assistant Professor of Anesthesia, Respiratory Intensive Care Unit and Anesthesia Laboratories of the Harvard Medical School at the Massachusetts General Hospital, Boston, Massachusetts 02114. Professor of Anesthesia, Respiratory Intensive Care Unit and Anesthesia Laboratories of the Harvard Medical School at the Massachusetts General Hospital, Boston, Massachusetts 02114.

Abstract

The effects of end-inspiratory pause (EIP) on gas exchange were measured in 10 adult patients with acute respiratory insufficiency while maintained on mechanical ventilation. Four inspiratory patterns were studied with a constant tidal volume (10 to 15 ml/kg body weight), respiratory rate (9 to 12 breaths/ min), FIO₂ (0.5) and end-expiratory pressure. Inspiratory flow rate (_insp) and EIP time were varied to produce a control pattern (_insp = 60 L/min, EIP = 0), 2 EIP patterns of 0.6 and 1.2 seconds with a similar _insp and a "slow" flow pattern (_insp = 30 L/min) without EIP. The control pattern was applied before and after each study period.

Arterial oxygenation was unchanged with both EIP and "slow" flow patterns when compared to control. Dead-space ventilation (V_D/V_T) and Paco₂ were significantly decreased (p<0.01) as EIP was increased from 0 to 1.2 seconds, but remained unchanged with slow inspiratory flow. Thus, EIP improved the efficiency of ventilation with no apparent improvement in oxygenation in patients with acute respiratory insufficiency.

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