Update in Intensive Care and Emergency Medicine. Edited by J. L. Vincent

Transcription

1 13 Update in Intensive Care and Emergency Medicine Edited by J. L. Vincent

2 Pulmonary Function in Mechanically Ventilated Patients Edited by S.Benito and A. Net With 138 Figures and 25 Tables Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong Barcelona

3 Series Editor Prof. Dr. Jean Louis Vincent Clinical Director, Department of Intensive Care, Erasme Hospital Free University of Brussels, Route de Lennik Brussels, Belgium Volume Editors Prof. Dr. Salvador Benito, Prof. Dr. Alvar Net Servei de Medicina Intensiva Hospital de la Santa Creu i Sant Pau Universitat Autonoma de Barcelona Barcelona, Spain Library of Congress Cataloging-in-Publication Data Pulmonary function in mechanically ventilated patients/edited by S. Benito and A. Net. (Update in intensive care and emergency medicine; 13) Includes index. ISBN-13: e-isbn-13: DOl: / I. Artificial respiration. 2. Pulmonary function tests. [I. Lung physiopathology. 2. Respiration, Artificial. 3. Ventilators. Mechanical.] I. Net, A. (Alvar) II. Benito, S. (Salvador) III. Series. [DNLM: WI UP66H v. 13/WF 102 P9825] RC87.9.P '36- dc20 DNLM/DLC This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9, 1965, in its current version, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. Springer-Verlag Berlin Heidelberg 1991 The use of registered names, trademarks, etc. in the publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Typeset by Macmillan India Ltd., Bangalore, India Printed on acid-free paper

4 Foreword This welcome addition to the series Update in Intensive Care and Emergency Medicine emerges from the most recent of a series of meetings organized by Alvar Net and Salvador Benito of Barcelona. This gathering provided a forum for European intensive care specialists to exchange ideas, knowledge and experience on, the measurements feasible in mechanically ventilated patients. The scope was ambitious, ranging from basics like the measurement of airway pressure and blood gases to topics such as CT, MRI and the multiple inert gas elimination technique. The success of the meeting made publication a logical consequence. The book is unique in its breadth. The contributors, from numerous centers in Europe and North America, cover all techniques employed in intensive care units, describing indications, contraindications, procedures, biases and complications. This volume will be an invaluable source for intensive care specialists and other clinicians. Alongside practical descriptions of procedures they employ routinely (spirometry, measurement of systemic vascular oxygen pressure, Swan-Ganz catheterization, BOPA etc.), they will find accounts of such sophisticated techniques as online measurement offunctional residual capacity, isotope determination of ventilation/perfusion ratios, diaphragmatic metabolism and peripheral oxygen exchange. I am especially happy to see the book published by Springer-Verlag, which has distinguished itself in the field of intensive care medicine. Creteil, France, December 1990 F. Lemaire

5 Contents Introduction with Special Reference to Ventilator-associated Barotrauma (J. Milic-Emili, C. Tantucci, M. Chasse, and C. Corbeil) Pneumotachographic Recording of Ventilatory Pattern (J. Sanchis, J. L. Diez-Betoret, J. Canet, and P. Casan) Spirometry (P. Casan and J. Sanchis) Inspiratory Occluded Airway Pressure (R. Fernandez) Transdiaphragmatic Pressure (L. Brochard) 52 Assessment of the Breathing Workload During Mechanical Ventilation (J. J. Marini) Assessment of Diaphragmatic Function (M. Aubier) Pulmonary Compliance (S. Benito) Respiratory Impedance (D. Navajas, R. Farre, and M. Rotger) Elastance and Resistance of Respiratory System (J. Milic-Emili) Respiratory Inductive Plethysmography (J. Dall'Ava-Santucci and A. Armanganidis) Closing Volume (J. Ibanez and J. M. Raurich) Functional Residual Capacity in Acute Respiratory Failure. Methods of Measurement in the Ventilated Patients and Their Clinical Utility (J. Mancebo) FRC and Efficiency of Gas Mixing in the Lung. SF 6 (B. Jonson)

6 VIII Contents Determination of Lung-Ventilation and Perfusion by Isotope Technique (G. Hedenstierna and L. Tokics) Multiple Inert Gas Elimination Technique (R. Rodriguez-Raisin) Pulmonary Diffusion Capacity (H. Burchardi and T. Stokke) Blood Gases (J. M. Raurich and J. Ibanez) Pulse Oximetry in the Intensive Therapy Unit (c. D. Hanning and D. M. Lassey) Transcutaneous Monitoring of Oxygen and Carbon Dioxide (F. Clergue and E. Barre) Mixed Venous Oxygen Saturation Monitoring in Mechanically Ventilated Patients (J. L. Vincent) Capnography (Ll. Blanch) Measurement of Oxygen Consumption and Carbon Dioxide Production in Artificially Ventilated Patients (G. Annat, J. P. Viale, O. Bertrand, B. Delafosse, Y. Bouffard, and J. Motin) Bronchoalveolar Lavage (M. Antonelli, M. Bufi, and A. Gasparetto) Measurement of Extrapulmonary Lung Water ( A. Net and C. Triginer) Interactions Between Convective and Diffusive Components of O 2 Transport to the Tissues (J. Roca, M. Hogan, and P. D. Wagner) Energy Metabolism and Diaphragmatic Function: Applications of Magnetic Resonance Spectroscopy (G. Gutierrez and F. Palizas) The Oxygen Consumption of the Respiratory Muscles (c. Roussos) Clinical Applications of Balloon Occlusion Pulmonary Angiography (BOPA) (G. Conti. J.-L. Tehoul. M. Rocco. and A. GasDaretto)

7 Contents IX Computerized Axial Tomography of the Lung During Acute Respiratory Failure (L. Gattinoni, M. Bambino, P. Pelosi, F. M eda, L. F agnoni, A. M areta, G. Avanzi, and A. Pesenti) Subject Index

8 List of Contributors Annat, G. H6pital Edouard-Herriot, Universite Lyon Cedex 3, France Antonelli, M. Istituto di Anestesiologia e Rianimazione, PolicIinico Umberto I, Universita "La Sapienza", Viale del PolicIinico, 155,00161 Roma, Italy Armanganidis, A. Laboratoire d'explorations FonctionelIes, H6pital Universitaire Cochin, 27, rue du Faubourg St. Jacques, Paris Cedex 14, France Aubier, M. Clinique Pneumologique, H6pital Bichat Claude Bernard, Universite de Paris VII, 46, rue Henri-Huchard, Paris Cede x 18, France Avanzi, G. Barre, E. Groupe Hospitalier Pitie-Salpetriere, 83, blvd de I'Hopital, Paris Cedex 13, France Benito, S. de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain Bertrand, o. Hopital Edouard-Herriot, Universite Lyon Cedex 3, France Blanch, Ll. de SabadelI, Parc Tauli, s/n., SabadelI, Spain Bombino, M. Bouffard, Y. H6pital Edouard-Herriot, Universite Lyon Cedex 3, France Brochard, L. Service de Reanimation Medicale, Hopital Henri Mondor, 51, ave du Marechal de Lattre de Tassigny, Creteil, France Bufi, M. Istituto di Anestesiologia e Rianimazione, PolicIinico Umberto I, Universita "La Sapienza", Viale del PolicIinico, 155, 00161, Roma, Italy Burchardi, H. Zentrum Anaesthesiologie, Georg August-Universitat, Robert-Koch-Strasse 40, 3400 Gottingen, West Germany

9 XII List of Contributors Canet, J. Servei d'anestesia i Reanimacii>, Hospital "Germans Trias i Pujol", Universitat Autonoma de Barcelona, Carr. de Can yet, sin., Badalona, Spain Casan, P. Unitat de Funcii> Pulmonar, HospItal de la Santa Creu i Sant Pau, Umversltat Autonoma de Barcelona, Av. St. Antoni M. Claret, 167,08025 Barcelona, Spain Chasse, M. Service de Pneumologie, Hopital Samt Luc, Universite de Montreal, Montreal, Quebec, Canada Clergue, F. Departement d' Anesthesie-Reammation, Groupe Hospitalier Pitie-Salpetru:re, 83, blvd de I'Hopital, Paris Cedex 13, France Conti, G. Istituto di Anestesiologia e Rianimazione, Policlinico Umberto I, Universita "La Sapienza",Viale del Policlinico, 155,00161 Roma, Italy Corbeil, C. Service de Pneumologle, Hopital Saint Luc, Universite de Montreal, Montreal, Quebec, Canada Dall'Ava-Santucci, J. Departement de Physiologie, Laboratoire d'explorations Fonctionelles, Hopital Universitaire Cochin, 27, rue du Faubourg St. Jacques, Paris Cedex 14, France Delafosse, B. Departement d' Anesthesle-Reanimation, Hopital Edouard-Herriot, Universite Lyon Cedex 3, France Diez-Betoret, J. L. Unitat de Funcii> Pulmonar, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Av. St. Antoni M. Claret, 167,08025 Barcelona, Spain Fagnoni, L. Farre, R. Laboratori de Biofisica i Bioenginyeria, Facultat de Medicina, Zona Universitaria de Pedralbes, Barcelona, Spain Fernandez, R. de Sabadell, Parc Tauli, sin., Sabadell, Spain Gasparetto, A. Istituto di Anestesiologia e Rianimazione, Policlinico Umberto I, Universita "La Sapienza", Viale del Policlinico, 155,00161 Roma, Italy Gattmoni, L. Gutierrez, G. Pulmonary Division, Intensive Care Division, University of Texas Health Science Center, 6431 Fannin, Suite , Houston, TX 77030, USA Hanning, C. D. Department of Anaesthesia, The General Hospital, University of Leicester, Leicester, LE 54 PW, United Kingdom Hedenstierna, G. Institutionen for Klinisk Fysiologi, Uppsala Universitet, Akademiska Sjukhuset, Uppsala, Sweden Hogan, M. Section of Physiology, University of California San Diego, La Jolla, CA 92093, USA Ibanez, J. Son Dureta, Andrea Doria, 55, Palma de Mallorca, Spain

10 List of Contributors XIII Jonson, B. Institutionen for Klinisk Fysiologi, Lund Universitet, Lund, Sweden Lassey, D. M. Department of Anaesthesia, Cleveland Hospital, Leicester, United Kingdom Mancebo, J. de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain Marini, J. J. Pulmonary Critical Care, St. Paul Ramsey Medical Center, 640 Jackson Street, St. Paul, MN , USA Meda, F. Milic-Emili, J. Meakins-Christie Laboratories, Department of Physiology, McGill University, 3626 St. Urbain Street, Montreal, Quebec H2X 2P2, Canada Moreto, A. Motin, J. H6pital Edouard-Herriot, Universite Lyon Cedex 3, France Navajas, D. Laboratori de Biofisica i Bioenginyeria, Facultat de Medicina, Zona Universitaria de Pedralbes, Barcelona, Spain Net, A. de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain Palizas. F. Division de Terapia Intensiva, Hospital de Clinicas, Universidad de Buenos Aires, Buenos Aires, Argentina Pelosi, P. DOlllzetti, 106, Monza (MI), Italy Pesenti, A. Raurich, J. M. Son Dureta, Andrea Doria, 55, Palma de Mallorca, Spain Roca, J. Servei de Pneumologia, Hospital Clinic i Provincial, VilJarroel, 170, Barcelona, Spain Rocco, M Istituto di Anestesiologia e Rianimazione, Polic1inico Umberto I, Universita "La Sapienza", Viale del Polic1inico, 155,00161 Roma, Italy Rodriguez-Roisin, R. Servei de Pneumologia, Hospital Clinic i Provincial, Villarroel, 170, Barcelona, Spain Rotger, M. Laboratori de Biofisica i Bioenginyeria, Facultat de Medicina, Zona Universitaria de Pedralbes, Barcelona, Spain Roussos, C. Critical Care Department, Evangelismos Hospital, Ipsilandou Str., Athens, Greece Sanchis, J. Unitat de Funcio Pulmonar, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Av. St. Antoni M. Claret, 167,08025 Barcelona, Spain

11 XIV List of Contributors Stokke, T. Ylliviei Hospital, University of Oslo, Oslo, Norway Tantucci, C. Service de Pneumologie, Hopltal Saint Luc, Universite de Montreal, Montreal, Quebec, Canada Teboul, J.-L. Service de Reanimation Medicale, Hopital Bicetre, Le Kremlin-Bicetre, France Tokics, L. Klinikt Fisiologiska Institutionen, Huddinge Sjukhus Karolinska Institutet, Huddinge, Sweden Triginer, C. Unitat de Vigilancia Intensiva, Hospital de Traumatologia de la Vall d'hebr6n, Universitat Autonoma de Barcelona, Barcelona, Spain Viale, J. P. Hospital Edouard-Herriot, Universite Lyon Cede x 3, France Vincent, J. L. Departement Soins Intensifs, Hopital Erasme, Universite Libre de Bruxelles, Route de Lennik 808, 1070 Bruxelles, Belgium Wagner, P. D. Section of Physiology, University of California San Diego, La Jolla, CA 92093, USA