Is tracheal gas insufflation an alternative to extrapulmonary gas exchangers in severe ARDS?

Tracheal gas insufflation (TGI) of pure oxygen combined with mechanical ventilation decreases dead space and increases CO2 clearance. In the present study, TGI was used in six patients with ARDS who met extracorporeal membrane oxygenation criteria and who were severely hypoxemic and hypercapnic despite optimal pressure-controlled ventilation. This open clinical study aimed to investigate the effects of 4 L/min continuous flow of oxygen given via an intratracheal catheter. PaCO2 decreased from 108 +/- 32 to 84 +/- 26 mm Hg (p < 0.05), and no significant change in PaO2 (68 +/- 18 vs 96 +/- 43, p = 0.06). There was no change in airway pressures and hemodynamic variables. A slight increase in end-expiratory and end-inspiratory volumes with TGI possibly occurred, as seen on tracings from respiratory inductive plethysmography (Respitrace). We conclude that TGI improves tolerance of limited pressure ventilation by removing CO2, but it may induce changes in lung volumes that are not detected by ventilator measurements.

[1]  J. Mira,et al.  Permissive hypercapnia and intravascular oxygenator in the treatment of patients with ARDS. , 1994, Artificial organs.

[2]  J. Dhainaut,et al.  Extracorporeal carbon dioxide removal technique improves oxygenation without causing overinflation. , 1994, American Journal of Respiratory and Critical Care Medicine.

[3]  G Saumon,et al.  Role of tidal volume, FRC, and end-inspiratory volume in the development of pulmonary edema following mechanical ventilation. , 1993, The American review of respiratory disease.

[4]  J. Dhainaut,et al.  Extracorporeal carbon dioxide removal and low-frequency positive-pressure ventilation. Improvement in arterial oxygenation with reduction of risk of pulmonary barotrauma in patients with adult respiratory distress syndrome. , 1993, Chest.

[5]  B. Celli,et al.  Transtracheal delivery of gas decreases the oxygen cost of breathing. , 1993, The American review of respiratory disease.

[6]  A. Nahum,et al.  Tracheal gas insufflation during pressure-control ventilation. Effect of catheter position, diameter, and flow rate. , 1992, The American review of respiratory disease.

[7]  E. Bergofsky,et al.  Airway insufflation. Increasing flow rates progressively reduce dead space in respiratory failure. , 1991, The American review of respiratory disease.

[8]  J. Venegas,et al.  Contributions of diffusion jet flow and cardiac activity to regional ventilation in CFV. , 1991, Journal of applied physiology.

[9]  A Armaganidis,et al.  Mechanical effects of PEEP in patients with adult respiratory distress syndrome. , 1990, Journal of applied physiology.

[10]  E. Bergofsky,et al.  Airway insufflation: physiologic effects on acute and chronic gas exchange in humans. , 1989, The American review of respiratory disease.

[11]  B. Make,et al.  Transtracheal oxygen decreases inspired minute ventilation. , 1989, The American review of respiratory disease.

[12]  Arthur S Slutsky,et al.  Constant oxygen insufflation (COI) in a ventilatory failure model. , 1988, The American review of respiratory disease.

[13]  S K Pingleton,et al.  Complications of acute respiratory failure. , 1988, The Medical clinics of North America.

[14]  G Saumon,et al.  High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. , 1988, The American review of respiratory disease.

[15]  Mortensen Jd,et al.  An intravenacaval blood gas exchange (IVCBGE) device. A preliminary report. , 1987 .

[16]  R. Fumagalli,et al.  Low-frequency positive-pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure. , 1986, JAMA.

[17]  T. Petty,et al.  Transtracheal Oxygen Therapy for Refractory Hypoxemia , 1986 .

[18]  Arthur S Slutsky,et al.  Effect of flow rate on blood gases during constant flow ventilation in dogs. , 1986, The American review of respiratory disease.

[19]  R Brown,et al.  Tracheal Insufflation of O2 (TRIO) at Low Flow Rates Sustains Life for Several Hours , 1985, Anesthesiology.

[20]  A S Slutsky,et al.  Gas mixing by cardiogenic oscillations: a theoretical quantitative analysis. , 1981, Journal of applied physiology: respiratory, environmental and exercise physiology.

[21]  Rupert G. Miller,et al.  Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. , 1979, JAMA.

[22]  A. Nahum,et al.  Tracheal gas insufflation augments CO2 clearance during mechanical ventilation. , 1993, The American review of respiratory disease.

[23]  A. Nahum,et al.  Modes of tracheal gas insufflation. Comparison of continuous and phase-specific gas injection in normal dogs. , 1993, The American review of respiratory disease.

[24]  M. Takeya,et al.  Histopathologic pulmonary changes from mechanical ventilation at high peak airway pressures. , 1991, The American review of respiratory disease.