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Anesth Analg 2001;92:950-958
© 2001 International Anesthesia Research Society

CRITICAL CARE AND TRAUMA

Ventilatory Support by Continuous Positive Airway Pressure Breathing Improves Gas Exchange as Compared with Partial Ventilatory Support with Airway Pressure Release Ventilation

Peter Neumann, MD, PhD, and Göran Hedenstierna, PhD

Department of Clinical Physiology, University of Uppsala, Uppsala, Sweden

Address correspondence and reprint requests to Goran Hedenstierna, MD, PhD, Department of Clinical Physiology, University of Uppsala, S - 75185 Sweden. Address e-mail to goran.hedenstierna{at}medsci.uu.se

In acute lung injury, airway pressure release ventilation (APRV) with superimposed spontaneous breathing improves gas exchange compared with controlled mechanical ventilation. However, the release of airway pressure below the continuous positive airway pressure (CPAP) level may provoke lung collapse. Therefore, we compared gas exchange and hemodynamics using a crossover design in nine pigs with oleic acid-induced lung injury during CPAP breathing and APRV with a release pressure level of 0 and 5 cm H2O. At an identical minute ventilation (E 8 L/min) spontaneous breathing averaged 55%, 67%, and 100% of E during the two APRV modes and CPAP, respectively. Because of the concept of APRV, mean airway pressure was highest during CPAP and lowest during APRV with a release pressure of 0 cm H2O. Shunt was reduced to almost half during CPAP (6.6% of t) compared with both APRV-modes (13.0% of t). Cardiac output and oxygen consumption, in contrast, were similar during all three ventilatory settings. Thus, in our lung injury model, CPAP was superior to partial ventilatory support using APRV with and without positive end-expiratory pressure. This may be attributable to beneficial effects of spontaneous breathing on gas exchange as well as to rapid lung collapse during the phases of airway pressure release below the CPAP level. These findings may suggest that the amount of mechanical ventilatory support using the APRV mode should be kept at the necessary minimum.

Implications: Oxygenation is better with continuous positive airway pressure breathing than with partial mechanical ventilatory support using airway pressure release ventilation. Therefore, mechanical ventilatory support achieved by a cyclic release of airway pressure during APRV should be kept at the minimum level that enables enough ventilatory support for patients to avoid respiratory muscle fatigue.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2001 by the International Anesthesia Research Society.