Pneumatic systems facilitating treatment of respiratory insufficiency with alternative use of IPPV/PEEP, HFPPV/PEEP, CPPB or CPAP

An experimental randomized study of six different ventilatory modes in a piglet model with normal lungs

A randomized study of 6 ventilatory modes was made in 7 piglets with normal lungs. Using a Servo HFV 970 (prototype system) and a Servo ventilator 900 C the ventilatory modes examined were as follows: SV-20V, i.e. volume-controlled intermittent positive-pressure ventilation (IPPV); SV-20VIosc, i.e. volume-controlled ventilation (IPPV) with superimposed inspiratory oscillations; and SV-20VEf, i.e. volume-controlled ventilation (IPPV) with expiratory flush of fresh gas; HFV-60 denotes low-compressive high-frequency positive-pressure ventilation (HFPPV) and HVF-20 denotes low-compressive volume-controlled intermittent positive-pressure ventilation; and SV-20P denotes pressure-controlled intermittent positive-pressure ventilation. With all modes of ventilation a PEEP of 7.5 cm H2O was used. In the abbreviations used, the number denotes the ventilatory frequency in breaths per minute (bpm). HFV indicates that all gas was delivered via the HFV 970 unit. The ventilatory modes described above were applied randomly for at least 30 min, aiming for a normoventilatory steady state. The HFV-60 and the HFV-20 modes gave lower peak airway pressures, 12-13 cm H2O compared to approximately 17 cm H2O for the other ventilatory modes. Also the mean airway pressures were lower with the HFV modes 8-9 cm H2O compared to 11-14 cm H2O for the other modes. The gas distribution was evaluated by N2 wash-out and a modified lung clearance index. All modes showed N2 wash-out according to a two-compartment model. The SV-20P mode had the fastest wash-out, but the HFV-60 and HFV-20 ventilatory modes also showed a faster N2 wash-out than the others.(ABSTRACT TRUNCATED AT 250 WORDS)

A new ventilator for physiologic studies during high-frequency ventilation

Research in the field of high frequency ventilation (HFV) has been hampered by the difficulty of collecting and analyzing expired gas, uncontaminated by gas of inspiratory composition, at ventilatory frequencies in the relevant range. A new mechanical ventilator is described, which has been designed to facilitate studies on the respiratory physiology of small animals during HFV. Ventilation is controlled by a single rotary valve, which alternately switches the airway to an approximately constant-flow gas source during inspiration, and to gas measurement and analysis apparatus during expiration, which takes place passively. Theoretical and experimental studies, using the techniques of mechanical and mathematical modelling, are used to measure the performance of the ventilator and to demonstrate that it allows the quantitative collection of expired gas during ventilation at rates up to at least 20 Hz. The advantages and limitations of this approach are discussed.

High-frequency positive-pressure ventilation (HFPPV) in neonates and infants during neuroleptal analgesia and routine plastic surgery, and in postoperative management

The low pulmonary compliance, the high airway resistance and the "rapid" breathing pattern of neonatal and paediatric patients make it necessary to design special ventilators to match the pulmonary physiology of infants. A ventilator system which also in small children has a negligible compression volume was evaluated in a lung model and during repair of cleft lip and palate in 16 patients under general anaesthesia and in two other infants during other operations. High-frequency positive-pressure ventilation (HFPPV) was given with an insufflation frequency (f) of 60 per min and a relative insufflation time (t%) of 32%. In addition, two neonates treated postoperatively with HFPPV are reported. Despite the "open" character of the ventilator system both intra- and postoperative ventilation were uneventful in all patients. The arterial oxygenation was good in all cases, as judged from clinical signs or blood gas analyses. Postoperative ventilation required conventional clinical observation and intermittent analyses of blood. HFPPV has been shown to depress, or abolish, spontaneous respiration via reflex mechanisms. In all patients in this investigation respiratory movements were absent at normo- or slight hyperventilation during HFPPV.

Phrenic and vagal nerve activities during spontaneous respiration and positive-pressure ventilation

Afferent vagal nerve activity from stretch-receptors in the lung and efferent phrenic nerve activity were recorded during spontaneous respiration and during positive-pressure ventilation with three different types of ventilators. During spontaneous respiration the efferent phrenic nerve activity slightly preceded the afferent vagal nerve activity. Volume-controlled ventilation did not alter the phrenic nerve activity when the ventilation was set at a rate equal to that during spontaneous respiration, but afferent vagal volleys increased in duration. At higher frequencies of insufflation spontaneous inspiration was inhibited. An increase in afferent vagal nerve activity and a concomitant slight decrease in efferent phrenic nerve activity were obtained during animal triggered pressure-controlled ventilation. High-frequency positive-pressure ventilation (HFPPV) gave rise to basal, non-grouped activity in vagal afferents, causing inhibition of inspiration. During HFPPV, spontaneous respiration can take place on activation of other afferents to the respiratory centre. Clinical aspects of respirator treatment from a neurophysiological standpoint are discussed.

Physiologic evaluation of the HFPPV pneumatic valve principle and PEEP. An experimental study

In experiments in dogs the ventilatory and circulatory conditions prevailing with the ventilatory pattern in high-frequency positive-pressure ventilation (HFPPV) were investigated with use of a pneumatic valve principle and a ventilator system of an "open" character. Keeping the gas input constant the importance of insufflation frequency and insufflation time and the reactions to various levels of positive end-expiratory pressure (PEEP) were investigated in terms of changes in arterial pH, Pco2 and Po2. With the volumes of delivered gas kept constant, an increasing insufflation frequency from 60 to 100 per min gave a parallel decrease in tidal volume accompanied by lower maximum intratracheal pressures and a significant decrease in alveolar ventilation. Also taking into account the possibilities of inducing a suppression of the spontaneous respiration, higher ventilatory frequencies than 60 per min do now seem to introduce any further advantages. Including the associated effects on cardiac output and venous admixture, the cardio-pulmonary and circulatory parameters studied did not show any substantial changes with PEEP levels below 7.5--10 cm H2O. Thus the level of PEEP, which often is part of the ventilatory pattern in HFPPV, does not seem to have any untoward influence on the circulation (stroke volume, cardiac output, total peripheral vascular resistance) and oxygen transport (arterial oxygen content and oxygen flux) in normovolaemic dogs.