Effects of breathing patterns on mechanically ventilated patients with chronic obstructive pulmonary disease and dynamic hyperinflation.
OBJECTIVE
To examine the circulatory and respiratory effects of breathing pattern in patients with chronic obstructive pulmonary disease (COPD) and dynamic hyperinflation (DH) during controlled mechanical ventilation.


METHODS
Prospective, controlled, randomized, non-blinded study.


METHODS
Respiratory intensive care unit of a university hospital.


METHODS
Nine patients with acute respiratory failure and DH due to acute exacerbations of COPD.


METHODS
Keeping tidal volume and total breath duration (TTOT) constant, patients were ventilated at six different values of expiratory time (TE). TE changes were randomly induced by alterations of constant inspiratory flow (VI) and/or end-inspiratory pause (EIP). Patients were studied at three levels of VI(0.93 +/- 0.08, 0.72 +/- 0.06 and 0.55 +/- 0.04 l/s, mean +/- SE), with and without EIP (10% of TTOT).


RESULTS
Lung volumes, airflows, airways pressures, oxygenation indices and dead space were measured. Alveolar pressure and airway resistance (Rmin), as well as the additional resistance (delta R) due to viscoelastic pressure dissipation and time-constant inequalities, were estimated by rapid airway occlusion during inflation. In seven out of nine patients, right-heart catheterization was performed and hemodynamic parameters were obtained at each value of TE. A significant decrease of intrinsic positive end-expiratory pressure (PEEPi), end-inspiratory static and mean (mPaw) airway pressures, end-expiratory lung volume above passive FRC (Vtrap), delta R and venous admixture and a significant increase of peak airway pressure, Rmin, stroke volume index and mixed venous PO2 (PvO2) were observed when VI increased. At each VI, the addition of EIP significantly decreased iso-volume expiratory flows and PvO2 and increased Vtrap and mPaw.


CONCLUSIONS
We conclude that in mechanically ventilated patients with COPD, the pattern of lung inflation and TE alteration have a significant impact on respiratory system mechanics, gas exchange and hemodynamics. Addition of EIP in patients with COPD may be detrimental.
Georgopoulos
D
D
Respiratory Failure Unit, G. Papanicolaou Hospital, University of Thessaloniki, Exohi, Greece.
Mitrouska
I
I
Markopoulou
K
K
Patakas
D
D
Anthonisen
N R
NR
D000208:Acute Disease; D000368:Aged; D001784:Blood Gas Analysis; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications*; D008297:Male; D008875:Middle Aged; D018467:Positive-Pressure Respiration, Intrinsic / Q000209:etiology*; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D015656:Respiratory Mechanics