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Background
Despite numerous advances in critical care, the mortality of postinjury acute respiratory
distress syndrome (ARDS) remains high. Recently, permissive hypercapnia (PHC) has
been shown to be a viable alternative to traditional ventilator management in patients
with ARDS. However, lowering tidal volume, as employed in PHC, below 5 cc/kg impinges
upon anatomic dead space and precipitates a significant rise in PaCO2 The purpose of this study was to determine if continuous tracheal gas insufflation
(cTGI) is a useful adjunct to PHC by lowering PaCO2, thus allowing adequate reduction in minute ventilation to achieve alveolar protection.
Methods
Over a 5-year period, 68 trauma patients with ARDS were placed on permissive hypercapnia.
Nine of these patients additionally received cTGI at 7 L/min. Arterial blood gas determinations
and ventilatory parameters were examined immediately prior to the implementation of
cTGI and after 6h.
Results
The cTGI produced significant improvement in pH (7.25 ± 0.03 to 7.33 ± 0.03), PaCO2 (72 ± 5 to 59 ± 5 torr), tidal volume (7.9 ± 0.6 to 7.2 ± 0.6 cc/kg), and minute
ventilation (13 ± 1 to 11 ± 1 L/min; P <0.05).
Conclusions
Continuous TGI is a useful adjunct to permissive hypercapnia, allowing maintenance
of an acceptable pH and PaCO2 while allowing further reduction in tidal volume and minute ventilation.
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Article info
Footnotes
**Presented at the 48th Annual Meeting of the Southwestern Surgical Congress, Scottsdale, Arizona, April 28–May 1, 1996.
1Supported in part by National Institutes of Health grants P50GM49222 and T32GM08315.
Identification
Copyright
© 1996 Excerpta Medica, Inc. All rights reserved. Published by Elsevier Inc.
