Tracheal Gas Insufflation - a Suitable Supplement of Artificial Pulmonary Ventilation of Pae-diatric Patients with Severe Respiratory Failure
M. Fedora; M. Šeda; M. Klimovič; R. Nekvasil; P. Dominik
ARO a ECMO centrum Fakultní dětské nemocnice, Brno, přednosta ARO prim. MUDr. M. Klimovičvedoucí ECMO centra doc. MUDr. R. Nekvasil, CSc.
Čes-slov Pediat 1999; (10): 539-543.
To test the effect of tracheal gas insufflation - TGI - on exchange of blood gases (in particular PaCO2)in children with severe respiratory failure.Type of study: Prospective observational study.Site: ARO and ECMO centre of Paediatric Faculty Hospital Brno.Patients: Eight children with acute hypoxaemic respiratory failure and marked hypercapnia.Methods: The patients were connected to a PCV or PRVC regime, oxygenation was optimalised by increasingthe mean airway pressure (Paw) by increasing PEEP with a limited peak pressure (PIP) and the lowest necessaryFiO2. They were ventilated by tidal volumes < 10 ml/kg, the minute ventilation was increased by the respiratoryrate (RR). When PaCO2 < 10.0 kPa and/or pH < 7.20 was achieved, the authors introduced continuous trachealgas insufflation, the gas flow through the catheter was between 150 and 200 ml/kg/min. Values of pH, PaO2, PaCO2,PaO2 /FiO2, the oxygenation index and ventilation index were recorded. Using the paired t-test, the mean values ofparameters at time 0 and during the third hour of TGI were evaluated.Results: Within 3 hours of TGI the pH rose from 7.25 to 7.42 (p = 0.0002), PaCO2 dropped from 10.58 to 4.79kPa (p < 0.0001) and the ventilation index from 76.3 to 33.9 (p < 0.002). Changes of PaO 2, PaO2 /FiO2 and OI arenot statistically significant.Conclusion: TGI eliminates effectively CO2, improves alveolar ventilation and has no effect on oxygenation. Itis a suitable therapeutic supplement of conventional mechanical ventilation of patients with severe respiratoryfailure with hypercapnia.
tracheal gas insufflation, respiratory failure, CO2 elimination, children
Full text is not available online.
If interested in a scan of this journal, contact NTO ČLS JEP
General practitioner for children and adolescents