Research Article| Volume 172, ISSUE 5, P518-522, November 1996

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Tracheal gas insufflation is a useful adjunct in permissive hypercapnic management of acute respiratory distress syndrome1

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      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.


      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.


      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).


      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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