Basics of Respiratory Mechanics and Artificial Ventilation

248 Pages·1999·5.36 MB·English

by  W. A. Zin (auth.)

Basics of Respiratory Mechanics
and Artificial Ventilation
Springer
Milano
Berlin
Heidelberg
New York
Barcelona
HongKong
London
Paris
Singapore
Tokyo
J. Milic-Emili
U. Lucangelo
A. Pesenti
W.A. Zin (Eds)
Basics of
Respiratory Mechanics
and Artificial Ventilation
Series edited by
Antonino Gullo
, Springer
J. MILIC-EMILI, MD
Meakins-Christie Laboratories
McGill University, Montreal, Canada
u.
LUCANGELO, MD
Department of Anaesthesia, Intensive Care and Pain Therapy,
University of Trieste, Cattinara Hospital, Italy
A. PESENTI, MD
Department of Anaesthesia and Intensive Care
New S. Gerardo Hospital, Monza, Italy
W.A.ZIN,MD
Department of Biophysic "Carios Chagas Filho"
Laboratory of Respiratory Physiology
Federal University of Rio de Janeiro, Brazil
Series 01 Topics in Anaesthesia and Critical Care edited by
A.GuLLo,MD
Department of Anaesthesia, Intensive Care and Pain Therapy
University of Trieste, Cattinara Hospital, Italy
© Springer-Verlag Italia, Milano 1999
ISBN 978-88-470-0046-9 ISBN 978-88-470-2273-7 (eBook)
DOI 10.1007/978-88-470-2273-7
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SPIN 10697841
Foreword
Management of the intensive care patient afflicted by respiratory dysfunction
requires knowledge of the pathophysiologieal basis for altered respiratory func
tions. The etiology and therapy of pulmonary diseases, such as acute respiratory
distress syndrome (ARDS) and chronie obstructive pulmonary disease (COPD),
are highly complex. While physiologists and pathophysiologists work prevalently
with theoretical models, clinicians employ sophistieated ventilation support
technologies in the attempt to understand the pathophysiologieal mechanisms of
these pulmonary diseases whieh can present with varying grades of severity
from mild to "poumon depasse". Despite the availability of advanced technolo
gies, it is a common practiee to personalize the treatment protocol according to
the patient's "physiologie" structure. Generally speaking, artificial ventilation
cannot fuHy replace the patient's own physiology, and in certain situations can
actually cause severe lung damage (Le. barotrauma).
Given the complexity and difficulties of treating respiratory diseases, a strong
cooperation between clinicians and physiologists is of fundamental importance.
Such interdisciplinary approaches are imperative in the study of the resistive and
viscoelastie properties of the respiratory system, and in the study of the diaphragm,
especially regarding the evaluations of muscle fatigue and work breathing in both
physiologieal conditions secondary to respiratory or systemic illness.
Beside monitoring of patients sustained by artificial respiration requires eval
uation of the intrinsie positive end-expiratory pressure (PEEP) and of the pul
monary gas exchange. Variations in respiratory mechanies during anaesthesia
represent an important study model. Clinieal guidelines are available to assist in
the implementation of artificial ventilation or alternative strategies such as high
frequency ventilation. Controversial techniques such as servocontrolled mechan
ieal ventilation and proportional assisted ventilation (PAV) supposedly adapt to
the actual physiological needs of the patient based upon sophistieated monitor
ing of respiratory parameters. These technologies represent the future directions
for clinieal research and applications in the treatment of patients with respirato
ry dysfunction due to ARDS or COPD.
November 1998 Antonino Gullo, MD
Contents
BASICS OF RESPIRATORY MECHANICS
Chapter 1 -Principles of measurement of respiratory mechanics
W.A. Zin ....................................................... 3
Chapter 2 -Statics of the respiratory system
E. D' Angelo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Chapter 3 -Respiratory mechanics during general anaesthesia in
healthy subjects
P. Pelosi, M. Resta, L. Brazzi ....................................... 21
Chapter 4 -Resistance measurements. Forced oscillations
and plethysmography
R. Peslin ....................................................... 37
Chapter 5 -Oscillatory mechanics: principles and clinical applications
U. Lucangelo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Chapter 6 -Resistance measurement in ventilator-dependent patients
A. Rossi ........................................................ 81
Chapter 7 -Mechanical models of the respiratory system: linear models
W.A. Zin, R.F.M. Gomes .......................................... 87
Chapter 8 -Mechanical models of the respiratory system:
non-linear and inhomogeneous models
Z. Hantos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Chapter 9 -Mechanical implications of viscoelasticity
J. Milic-Emili, E. D' Angelo ........................................ 109
Chapter 10 -Alveolar micromechanics
P.V. Romero .................................................... 119
VIII Contents
Chapter 11 -Partitioning of lung responses into airway and tissue
components
M.S. Ludwig .................................................... 133
THE WORK OF THE RESPIRATORY SYSTEM
Chapter 12 -How the diaphragm works in normal subjects
N.B. Pride ...................................................... 145
Chapter 13 -How the diaphragm works in respiratory disease
N.B. Pride ...................................................... 153
Chapter 14 -Evaluation of the inspiratory musde mechanical activity
during Pressure Support Ventilation
M.C. Olivei, C. Galbusera, M. Zanierato, G. lotti ...................... 161
Chapter 15 -Work of breathing
J. Milic-Emili, E. Rocca, E. D' Angelo 165
ARTIFICIAL VENTILATION - PRINCIPLES, TECHNIQUES, CLINICAL APPLICATIONS
Chapter 16 -Respiratory mechanics in ARDS
P. Pelosi, M. Resta, L. Gattinoni ...................................... 179
Chapter 17 -Altered elastic properties of the respiratory system
R. Brandolese, U. Andreose ....................................... 191
Chapter 18 -Intrinsic PEEP
A. Rossi .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 201
Chapter 19 -Gas-exchange in mechanicallyventilated patients
J. Roca ......................................................... 207
Chapter 20 -Effects of anaesthesia on respiratory mechanics
G. Hedenstierna ................................................. 223
Chapter 21 -Respiratory mechanics during the long-term artificial
ventilation
M. Cereda, A. Pesenti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 237
Chapter 22 -Closed-Ioop control mechanical ventilation
G. Iotti, M.C. Olivei, C. Galbusera, A. Braschi ........................ 241
Main symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 249
Subject index ................................................... 253
Contributors
AndreoseU.
Department of Anaesthesia, Conselve Rehabilitation Centre, Padova, Italy.
Brandolese R.
Department of Anaesthesia, Conselve Rehabilitation Centre, Padova, Italy.
BraschiA.
Department of Anaesthesia and Intensive Care, Laboratory of Biomedical Tech
niques,IRCCS S. Matteo Hospital, Pavia, Italy.
Brazzi L.
Department of Anaesthesia and Reanimation, University of Milan, IRCCS
Maggiore Hospital, Milan, Italy.
CeredaM.
Department of Anaesthesia and Intensive Care, New S. Gerardo Hospital, Monza,
Italy.
D'AngeloE.
Department of Human Physiology I, University of Milan, Milan, Italy.
Galbusera C.
Department of Anaesthesia and Intensive Care, Laboratory of Biomedical Tech
niques,IRCCS S. Matteo Hospital, Pavia, Italy.
Gattinoni L.
Department of Anaesthesia and Reanimation, University of Milan, IRCCS Maggiore
Hospital, Milan, Italy.
Gomes R.F.M.
Department of Biophysics "Carlos Chagas Filho", Laboratory of Respiratory
Physiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
X Contributors
HantosZ.
Department of Medical Informatics and Engineering, Albert Szent-Györgyi
Medical University, Szeged, Hungary
Hedenstierna G.
Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala,
Sweden.
IottiG.
Department of Anaesthesia and Intensive Care, Laboratory of Biomedical Tech
niques,IRCCS S. Matteo Hospital, Pavia, Haly.
Lucangelo U.
Department of Anaesthesia, Intensive Care and Pain Therapy, University of Trieste,
Cattinara Hospital, Italy.
LudwigM.S.
Meakins-Christie Laboratories, Royal Victoria Hospital, McGill University,
Montreal, Quebec, Canada.
Milic-Emili J.
Meakins-Christie Laboratories, McGill University, Montreal, Canada.
OliveiM.C.
Department of Anaesthesia and Intensive Care, Laboratory of Biomedical
Techniques, IRCCS S. Matteo Hospital, Pavia, Italy.
Pelosi P.
Department of Anaesthesia and Reanimation, University of Milan, IRCCS
Maggiore Hospital, Milan, Italy.
PesentiA.
Department of Anaesthesia and Intensive Care, New S. Gerardo Hospital,
Monza, Italy.
Peslin R.
Respiratory Physiopathology, Unit 14, National Institute of Health and Medical
Research, Vandoeuvre-Ies-Nancy, France.
PrideN.B.
Thoracic Medicine, NHLI, Imperial College School of Medicine, London, UK.
RestaM.
Department of Anaesthesia and Reanimation, University of Milan, IRCCS Maggiore
Hospital, Milan, Haly
Contributors XI
Roca].
Department of Pneumology, Clinical Hospital of Barcelona, Villanoel, Barcelona,
Spain.
RoccaE.
Department of Human Physiology I, University of Milan, Milan, Italy.
RomeroP.V.
Experimental Pneumology Unit, Pneumology Service, Ciutat Sanitaria i Universi
taria de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
RossiA.
Department of Respiratory Pathophysiology, Maggiore Hospital, Borgo Trento
(VR), Italy.
Zanierato M.
Department of Anaesthesia and Intensive Care, Laboratory of Biomedical Tech
niques, IRCCS S. Matteo Hospital, Pavia, Italy.
ZinW.A.
Department of Biophysics "Carlos Chagas Filho", Laboratory of Respiratory
Physiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.