Dynamics of spontaneous breathing during patient-triggered partial liquid ventilation.

Abstract

This study evaluates different ventilator strategies during gas (GV) and partial liquid ventilation (PLV) in spontaneously breathing animals. We hypothesized that during PLV, spontaneously breathing animals would self-regulate respiratory parameters by increasing respiratory rate (RR) and minute ventilation (V'E) when compared to animals mechanically ventilated with gas, and further that full synchronization of each animal's effort to the ventilator cycle would decrease RR at stable tidal volumes (V(T)). We studied 12 newborn piglets (1.54 +/- 0.24 kg) undergoing GV and PLV in 3 different modes: intermittent mandatory ventilation (IMV), synchronized IMV (SIMV), and assist control ventilation (AC). Modes occurred sequentially in random order during GV first, with the same order then repeated during PLV. Animals initially received continuous positive airway pressure (CPAP) and returned to CPAP during PLV at the end of the experiment. Pressure-limited, volume-targeted ventilation was used with a tidal volume goal of 13 cc/kg. Rate was set at 10/min during IMV and SIMV, with a back-up rate of 10/min during AC. RR, V'E, mechanical (V(T)) and spontaneous tidal volumes (sV(T)) were measured breath-to-breath using a computer-assisted lung mechanics analyzer; mean values were determined over 30-min periods. Data analysis used paired t-tests with Bonferroni correction as needed (P < 0.05). Blood gases were stable in all modes during GV and PLV. RR (min(-1)) and V'E (L x min(-1)/kg) increased in all modes from GV to PLV (RR: CPAP 71 vs. 128; IMV 69 vs. 112; SIMV 65 vs. 107; AC 33 vs. 47. V'E: CPAP 0.47 vs. 0.72; IMV 0.46 vs. 0.61; SIMV 0.45 vs. 0.61; AC 0.38 vs. 0.53; P < 0.05). Intermode comparisons during PLV showed a lower RR with AC (P < 0.02), and a higher V'E with CPAP (P < 0.05). V(T) and dynamic respiratory system compliance decreased from GV to PLV (V(T) P < 0.05; C(rs,dyn) P < 0.01); sV(T) remained unchanged. V(T) and sV(T) did not differ in intermode comparisons. We conclude that during PLV, spontaneously breathing piglets with normal lungs maintain physiologic blood gases by increasing V'E through increased RR. AC produced the most efficient respiratory pattern during PLV, with increased V'E achieved by a modest increase in RR.