Effect of expiratory resistance on gas-exchange and breathing pattern in chronic obstructive pulmonary disease (COPD) patients being weaned from the ventilator.
BACKGROUND
The majority of patients with severe chronic obstructive pulmonary disease (COPD) have flow limitation, which has deleterious side effects. If these patients are mechanically ventilated, this often results in difficult weaning. Spontaneously breathing COPD patients experience a beneficial effect of pursed lip breathing. We investigated whether in intubated COPD patients application of an external resistance could produce the same beneficial effects on breathing pattern and gas-exchange as pursed lip breathing.


METHODS
Ten COPD patients with flow limitation were studied during pressure support mechanical ventilation. Two types of expiratory resistances were applied: one fixed level of resistance and one with a resistive pressure decay. Each resistance was applied in 5 patients and the highest level was chosen that did not cause hyperinflation. Blood gas values and breathing pattern with and without resistance were compared.


RESULTS
With resistance 1, gas-exchange and breathing pattern did not change significantly; average PCO2 changed from 8.0 to 8.1 kPa, PO2 from 10.2 to 10.3 kPa, tidal volume from 0.380 to 0.420 l, respiratory rate from 25 to 23 bpm and inspiratory:expiratory ratio from 1:1.9 to 1:2.0. With resistance 2, gas-exchange and breathing pattern did not change significantly; average PCO2 changed from 5.8 to 6.0 kPa, PO2 from 11.1 to 12.1 kPa, tidal volume from 0.733 to 0.695 l, respiratory rate from 16 to 18 bpm and inspiratory:expiratory ratio from 1:2.3 to 1:2.9.


CONCLUSIONS
In intubated COPD patients being weaned from the ventilator, application of an external resistance did not have the same beneficial effects as pursed lip breathing.
Lourens
M S
MS
Department of Pulmonary and Intensive Care Medicine, Erasmus Medical Centre Rotterdam, The Netherlands. vandenberg@icbe.azr.nl
van den Berg
B
B
Hoogsteden
H C
HC
Bogaard
J M
JM
D000368:Aged; D000369:Aged, 80 and over; D000403:Airway Resistance / Q000502:physiology*; D001784:Blood Gas Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics / Q000502:physiology*; D015300:Ventilator Weaning