Influence of respiratory rate on gas trapping during low volume ventilation of patients with acute lung injury.
OBJECTIVE
Reduction in tidal volume (Vt) associated with increase in respiratory rate to limit hypercapnia is now proposed in patients with acute lung injury (ALI). The aim of this study was to test whether a high respiratory rate induces significant intrinsic positive end-expiratory pressure (PEEPi) in these patients.


METHODS
Prospective crossover study.


METHODS
A medical intensive care unit.


METHODS
Ten consecutive patients fulfilling criteria for severe ALI were ventilated with a 6 ml/kg Vt, a total PEEP level at 13+/-3 cmH(2)O and a plateau pressure kept at 23+/-4 cmH(2)O. The respiratory rate was randomly set below 20 breaths/min (17+/-3 breaths/min) and increased to 30 breaths/min (30+/-3 breaths/min) to compensate for hypercapnia. External PEEP was adjusted to keep the total PEEP and the plateau pressure constant. PEEPi was computed as the difference between total PEEP and external PEEP. The lung volume retained by PEEPi was then measured.


RESULTS
Increase in respiratory rate resulted in significantly higher PEEPi (1.3+/-0.4 versus 3.9+/-1.1 cmH(2)O, p<0.01) and trapped volume (70+/-43 versus 244+/-127 ml, p<0.01). External PEEP needed to be reduced from 11.9+/-3.4 to 9.7+/-2.9 cmH(2)O ( p<0.01). PaO(2) was not affected but the alveolar-arterial oxygen tension difference slightly worsened with the high respiratory rate (p<0.05).


CONCLUSIONS
An increase in respiratory rate used to avoid Vt reduction-induced hypercapnia may induce substantial gas trapping and PEEPi in patients with ALI.
Richard
Jean-Christophe
JC
Medical Intensive Care Unit, University Hospital-Charles Nicolle, 1 rue de Germont, 76031 Rouen, France. jrichard@invivo.edu
Brochard
Laurent
L
Breton
Lucie
L
Aboab
Jérôme
J
Vandelet
Philippe
P
Tamion
Fabienne
F
Maggiore
Salvatore M
SM
Mercat
Alain
A
Bonmarchand
Guy
G
D000328:Adult; D000368:Aged; D005060:Europe; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000209:etiology / Q000517:prevention & control; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D018467:Positive-Pressure Respiration, Intrinsic / Q000209:etiology / Q000517:prevention & control; D012119:Respiration; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D013990:Tidal Volume