title: Expiratory phase and volume-adjusted tracheal gas insufflation: a lung model study.
abstract: OBJECTIVE
  To evaluate in a lung model the effects of expiratory-phase tracheal gas insufflation (expiratory-phase TGI) with both volume and pressure control ventilation, and tidal volume-adjusted continuous flow TGI (volume-adjusted TGI) on system pressures and volumes.
  
  
  METHODS
  Single-compartment lung model.
  
  
  METHODS
  Research laboratory in a university medical center.
  
  
  METHODS
  Expiratory-phase TGI was established, using a solenoid valve activated by the ventilator. Volume-adjusted TGI was applied by reducing tidal volume (VT) by the product of TGI flow and inspiratory time. Ventilation was provided with pressure control of 20 cm H2O or volume control ventilation with VT similar to that with pressure control ventilation. A rate of 15 breaths/min and positive end-expiratory pressure (PEEP) of 10 cm H2O were used throughout. Inspiratory time periods of 1.0, 1.5, 2.0, and 2.5 secs were used with TGI flows of 0, 4, 8, and 12 L/min. Lung model compliance (mL/cm H2O) and resistance (cm H2O/L/sec) combinations of 20/20, 20/5, and 50/20 were used.
  
  
  RESULTS
  In expiratory-phase TGI with pressure control ventilation, peak alveolar pressure remained constant, PEEP increased (p < .01) and VT decreased (p < .01). In expiratory-phase TGI with volume control ventilation and volume-adjusted TGI, there were significant increases in peak alveolar pressure and PEEP (p < .01). Readjustment of VT in volume-adjusted TGI was impossible with longer inspiratory time (> or = 2 secs) and higher TGI flows (> or = 8 L/min).
  
  
  CONCLUSIONS
  The marked increases in system pressures and volumes observed with continuous-flow TGI can be avoided with expiratory-phase TGI and volume-adjusted TGI.
authors.affiliation: Department of Anesthesia, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
authors.forename: H
authors.initials: H
authors.lastname: Imanaka
authors.forename: R M
authors.initials: RM
authors.lastname: Kacmarek
authors.forename: V
authors.initials: V
authors.lastname: Riggi
authors.forename: R
authors.initials: R
authors.lastname: Ritz
authors.forename: D
authors.initials: D
authors.lastname: Hess
mesh_terms: D007327:Insufflation / Q000295:instrumentation* / Q000379:methods; D008168:Lung / Q000502:physiology*; D008954:Models, Biological; D011175:Positive-Pressure Respiration / Q000379:methods*; D013990:Tidal Volume; D014132:Trachea