[Continuous flow ventilatory support with multijet insufflation catheter. Initial clinical experience].
BACKGROUND
Clinical application of continuous flow ventilatory support with multijet insufflation catheter is not mentioned in the literature until now. Despite the use of various forms of ventilatory support, in 10-30% of patients disweaning from mechanical ventilation is unsuccessful even if they fulfil clinical and biochemical criteria.


OBJECTIVE
To evaluate the efficiency of a new ventilatory support continuous flow ventilatory support with multijet insufflation catheter--in clinical conditions.


METHODS
Continuous flow ventilatory support with original, patented multijet insufflation catheter with nasal installation into the trachea was used in a group of 14 patients. In a subgroup of 8 patients with chronic obstructive lung disease (COLD) was this method used for development of global respiratory insufficiency due to infectious complications and in a subgroup of 6 patients it was successfully used as a ventilatory model for weaning of patients from longterm mechanical ventilation in whom other ventilatory modes for weaning were unsuccessful.


RESULTS
No patient with COLD had to be intubated and 30 minutes after the start of ventilatory support with multijet insufflation catheter mean respiratory frequency decreased from 33 +/- 2.8 to 27 +/- 2.5 d/min, paCO2 from 11.9 +/- 1.7 to 10.8 +/- 1.6 kPa and paO2 increased from 5.7 to 6.8 +/- 1.3 kPa by FiO2 of 0.3. Up to 24 h after the start of ventilatory support blood gases were improved to values characteristic for partial respiratory insufficiency. Frequency of spontaneous ventilation decreased to 20 +/- 2.2, paCO2 decreased to 6.4 +/- 1.2 kPa and paO2 continually increased reaching the value of 8.9 +/- 1.4 (FiO2 = 0.3) in the 24th hour of ventilatory support. Ventilatory support lasted in average 5 days, than it could be removed. In the second group of patients continuous flow ventilatory support was used because of unsuccessful weaning following longterm mechanical ventilation. After extubation and 30 minutes after continuous flow ventilatory support start the breathing frequency decreased to 27 +/- 2.5 d/min, paCO2 showed further fall to the value of 3.9 +/- 0.9 due to hyperventilation caused evidently by continuing paO2 decrease to the value of 8.8 +/- 1.4 kPa. Only after 60 minutes following the start of ventilatory support, by equal breathing frequency, the values of blood gases increased (paO2 to 9.9 +/- 1.5 kPa, paCO2 to 5.2 +/- 1.1 kPa) and also Vt increased (0.38 +/- 0.3) which allowed to carry on with continuous flow ventilatory support, it could be interrupted after 48 hours.


CONCLUSIONS
On the basis of the obtained results it can be stated that continuous flow ventilatory support represents an efficient ventilatory mode in patients with chronic obstructive lung disease with global respiratory insufficiency and enables to bridge the period of management e.g. of infectious complications without intubation and mechanical ventilation. As a noninvasive ventilatory regime it can be also used of patients from longterm mechanical ventilation. Application in acute respiratory for weaning (ARF, ARDS) requires further prospective studies. (Tab. 5, Fig. 4, Ref. 28.)
Majek
M
M
Department of Anesthesiology and Resuscitation, General Hospital, Vranov nad Toplou, Slovakia.
Torok
P
P
Kolnik
J
J
D000368:Aged; D005260:Female; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods*; D015656:Respiratory Mechanics