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CRITICAL CARE AND TRAUMA

Ventilation-Perfusion Distribution Related to Different Inspiratory Flow Patterns in Experimental Lung Injury

From the Department of Anesthesiology, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany

Address correspondence and reprint requests to Dr. Rolf Dembinski, Klinik fuer Anaesthesiologie, Universitaetsklinikum der RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany. Address email to Rolf.Dembinski{at}post.rwth-aachen.de

In acute lung injury (ALI), controlled mechanical ventilation with decelerating inspiratory flow (_dec) has been suggested to improve oxygenation when compared with constant flow (_con) by improving the distribution of ventilation and perfusion (_A/). We performed the present study to test this hypothesis in an animal model of ALI. Furthermore, the effects of combined decelerating and constant flow (_deco) were evaluated. Thus, 18 pigs with experimental ALI were randomized to receive mechanical ventilation with either _con, _dec or a fixed combination of both flow wave forms (_deco) at the same tidal volume and positive end-expiratory pressure level for 6 h. Hemodynamics, gas exchange, and _A/ distribution were determined. The results revealed an improvement of oxygenation resulting from a decrease of pulmonary shunt within each group (P < 0.05). However, blood flow to lung areas with a normal _A/ distribution increased only during ventilation with _con (P < 0.05). Accordingly, PaO₂ was higher with _con than with _dec and _deco (P < 0.05). We conclude that contrary to the hypothesis, _con provides a more favorable _A/ distribution, and hence better oxygenation, when compared with _dec and _deco in this model of ALI.

IMPLICATIONS: In acute lung injury, mechanical ventilation with decelerating flow has been suggested to improve ventilation-perfusion distribution when compared with constant flow. We tested this hypothesis in an animal model. Contrary to the hypothesis, we found a more favorable ventilation-perfusion distribution during constant flow when compared with decelerating flow.

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