regional lung aeration and ventilation during pressure support and biphasic positive airway pressure ventilation in experimental lung injury地区肺通气和换气在支持和双相气道正压通风实验肺损伤.pdfVIP

Gama de Abreu et al. Critical Care 2010, 14:R34 /content/14/2/R34 R E S E A R C H Open Access Research Regional lung aeration and ventilation during pressure support and biphasic positive airway pressure ventilation in experimental lung injury †2 1 1 3 Marcelo Gama de Abreu*†1, Maximiliano Cuevas , Peter M Spieth , Alysson R Carvalho , Volker Hietschold , 3 4 2 5 6 Christian Stroszczynski , Bärbel Wiedemann , Thea Koch , Paolo Pelosi and Edmund Koch Abstract Introduction: There is an increasing interest in biphasic positive airway pressure with spontaneous breathing (BIPAP+SBmean), which is a combination of time-cycled controlled breaths at two levels of continuous positive airway pressure (BIPAP+SBcontrolled) and non-assisted spontaneous breathing (BIPAP+SBspont), in the early phase of acute lung injury (ALI). However, pressure support ventilation (PSV) remains the most commonly used mode of assisted ventilation. To date, the effects of BIPAP+SBmean and PSV on regional lung aeration and ventilation during ALI are only poorly defined. Methods: In 10 anesthetized juvenile pigs, ALI was induced by surfactant depletion. BIPAP+SBmean and PSV were performed in a random sequence (1 h each) at comparable mean airway pressures and minute volumes. Gas exchange, hemodynamics, and inspiratory effort were determined and dynamic computed tomography scans obtained. Aeration and ventilation were calculated in four zones along the ventral-dorsal axis at lung apex, hilum and base. Results: Compared to PSV, BIPAP+SBmean resulted in: 1) lower mean tidal volume, comparable o