Suppression of spontaneous breathing during high-frequency jet ventilation. Influence of dynamic changes and static levels of lung stretch

Alveolar pressure during high-frequency jet ventilation

We studied the influence of ventilatory frequency (1-5 Hz), tidal volume, lung volume and body position on the end-expiratory alveolar-to-tracheal pressure difference during high-frequency jet ventilation (HFJV) in Yorkshire piglets. The animals were anesthetized and paralysed. Alveolar pressure was estimated with the clamp off method, which was performed by a computer controlled ventilator and which had been extensively tested on its feasibility. The alveolar-to-tracheal pressure difference increased with increasing frequency and with increasing tidal volume, the common determinant appearing to be the mean expiratory flow. The effects in prone and in supine position were similar. Increasing thoracic volume decreased the alveolar-to-tracheal pressure difference indicating a dependence of this pressure difference on airway resistance. We concluded that the main factors determining the alveolar-to-tracheal pressure difference (delta P) during HFJV are expiratory flow (V'E) and airway resistance (R), delta P congruent to V'E x R.

Ventilation and ventilators--an update

In the five years which have passed since the previous review, the literature has been concerned more with the ways in which ventilators may be applied to patients and the effects of differing patterns of ventilation than with the design philosophy of the ventilators themselves. This account should be read in conjunction with that of 1982 [1].

Suppression of spontaneous breathing during high-frequency jet ventilation. Separate effects of lung volume and jet frequency

The effect of ventilatory frequency of high-frequency jet ventilation (HFJV) from 1 to 5 Hz, apart from changes in thoracic volume, on spontaneous breathing activity was studied in Yorkshire piglets under pentobarbital anesthesia. The highest PaCO2 at which the animals did not breathe against the ventilator (apnea point) was established either by changing minute volume of ventilation or by adding CO2 to the respiratory gas. The higher the apnea point, the higher the suppression of spontaneous breathing activity was assumed to be. If the apnea point was searched for by changing minute volume a progressive increase of suppression of spontaneous respiratory activity was found at ventilatory rates of 3 Hz or more, concomitantly with a rise in end-expiratory pressure (PEE). In case the tidal volume was kept constant, increase of ventilatory rate resulted in a tremendous increase of lung volume, together with considerably higher levels of PEE. When under these conditions the apnea point was searched for by adding CO2 to the respiratory gas a much higher CO2-drive was needed for spontaneous breathing and therefore a much stronger inhibition of spontaneous breathing was concluded. By placing the animals in a body box in which pressure could be varied, thoracic volume could be kept constant during HFJV. When thoracic volume was kept constant in this way a constant tidal volume at increasing jet frequencies resulted in only a slight increase in suppression of spontaneous breathing. We conclude that the increase in lung volume is a major factor in suppressing central respiratory activity during HFJV. Jet frequency by itself might be an additional suppressive factor.(ABSTRACT TRUNCATED AT 250 WORDS)