title: Tracheal gas insufflation during pressure-control ventilation: effect of using a pressure relief valve.
abstract: OBJECTIVE
  Pressure-control ventilation minimizes alveolar overdistention by limiting peak airway pressure, but a consequence of this pressure limitation may be a reduction in tidal volume with subsequent hypercarbia. Tracheal gas insufflation (TGI) can be used in combination with pressure-control ventilation to augment CO2 elimination. During pressure-control ventilation with continuous TGI, we observed that peak airway pressure increased above the set inspiratory pressure. Based on this observation, we investigated the ability of the pressure-control ventilator circuit to compensate for continuous TGI and the effect of insertion of a pressure relief valve to eliminate over-pressurization.
  
  
  METHODS
  University research laboratory.
  
  
  METHODS
  Using an artificial lung model, we studied the effects of continuous TGI with varying catheter flows (0, 2, 6, and 10 L/ min); ventilator frequencies (10 and 20 breaths/min); inspiratory duty cycles (0.33, 0.50, and 0.67); lung compliance (0.01, 0.02, and 0.04 L/cm H2O); and airway resistance (5, 20, and 50 cm H2O/L/sec) on: a) peak airway pressure; b) total inspiratory tidal volume; c) ventilator-derived tidal volume; and d) intrapulmonary pressure at end-exhalation (auto-PEEP). Tests were performed with and without a pressure relief valve whose threshold "pop-off" pressure was adjusted to match the set inspiratory pressure (35 cm H2O) for a total of 432 experimental conditions.
  
  
  RESULTS
  Our data demonstrate that pressure-control ventilation augmented with continuous TGI can increase peak airway pressure above set inspiratory pressure due to delivery of a higher than intended tidal volume. Predisposing conditions include catheter flow rates of 6 and 10 L/min, long inspiratory time, low compliance, and low resistance. With the pressure relief valve, peak airway pressure was maintained at the set inspiratory pressure and total inspiratory tidal volume remained constant.
  
  
  CONCLUSIONS
  A pressure relief valve is a necessary adjunct to maintain peak airway pressure at set inspiratory pressure and keep total inspiratory tidal volume constant when continuous TGI is administered in conjunction with pressure-control ventilation.
authors.affiliation: Department of Anesthesiology, School of Medicine, University of Pittsburgh, USA.
authors.forename: D T
authors.initials: DT
authors.lastname: Gowski
authors.forename: E
authors.initials: E
authors.lastname: Delgado
authors.forename: A M
authors.initials: AM
authors.lastname: Miro
authors.forename: F J
authors.initials: FJ
authors.lastname: Tasota
authors.forename: L A
authors.initials: LA
authors.lastname: Hoffman
authors.forename: M R
authors.initials: MR
authors.lastname: Pinsky
mesh_terms: D000403:Airway Resistance; D003131:Combined Modality Therapy; D007327:Insufflation / Q000379:methods; D008961:Models, Structural; D011175:Positive-Pressure Respiration / Q000295:instrumentation; D011312:Pressure; D012121:Respiration, Artificial / Q000295:instrumentation* / Q000379:methods*; D012129:Respiratory Function Tests; D014132:Trachea; D012122:Ventilators, Mechanical