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PubMed1998

Simultaneous LV and RV volumes by conductance catheter: effects of lung insufflation on parallel conductance.

One aspect in the measurement of ventricular volume using the conductance catheter technique is the assessment of parallel electrical conductivity of structures extrinsic to the ventricular blood pool. Because it is sometimes necessary to make volume measurements during ventilation or spontaneous respiration, the extent to which parallel conductance may vary with lung insufflation was investigated. Anesthetized pigs (11-15 kg) were ventilated and instrumented with both left (LV) and right ventricular (RV) conductance and pressure-tip catheters and end-hole catheters for injection of hypertonic saline into the inferior vena cava and pulmonary artery. Data were recorded during ventilation with tidal volumes of 10 and 20 ml/kg, and the associated fluctuations to LV and RV end-diastolic (EDV) and stroke (SV) volumes were measured. With the use of a saline dilution technique, parallel conductance (Vc) was determined for each ventricle with the ventilator off and lungs insufflated to 0, 10, and 20 ml/kg. Whereas ventilation caused marked oscillations in LV and RV EDV and SV, these variations could not be attributed to Vc, which remained statistically unchanged from their baseline values of 34.1 +/- 3.1 in the LV and 31.1 +/- 4.4 in the RV. These results indicate that the fluctuations that occur in conductance catheter-derived LV and RV volume signals with ventilation are not caused by any significant changes to parallel conductance.

Animals↗
PubMed1999

Efficacy of tracheal gas insufflation in spontaneously breathing sheep with lung injury.

Tracheal gas insufflation (TGI) decreases dead space (V D) and can be combined with continuous positive airway pressure (CPAP) to decrease minute volume (VE) and effort of breathing. In 11 anesthetized sheep, we induced acute lung injury (ALI) through oleic acid (OA) infusion and studied the effects of TGI combined with CPAP (CPAP-TGI) at different TGI flows and with catheters of different designs. Sheep were randomized to two groups: Group A (n = 7) was placed on CPAP and CPAP-TGI at 10 and 15 L/min of insufflation flow delivered through a reverse thrust catheter (RTC). Group B (n = 4) was placed on CPAP and CPAP-TGI at a flow of 10 L/min delivered through a RTC, and through a straight flow catheter (SFC). Compared with CPAP alone, CPAP-TGI resulted in significantly lower VD, VE, pressure time product, and work of breathing. We found no additional benefit from TGI flow of 15 L/min, compared with 10 L/min, and no statistically significant difference between the SFC and the RTC. In conclusion, TGI can be combined with CPAP in this model of ALI to reduce ventilation and effort of breathing.

Animals↗
PubMed2000

High-flow transtracheal insufflation treats obstructive sleep apnea. A pilot study.

To determine the effect of transtracheal insufflation (TTI) on obstructive sleep apnea (OSA), we examined breathing patterns in five tracheostomized patients with OSA at varying TTI flow rates when breathing with a closed tracheostomy. The breathing patterns and polysomnographic responses to air insufflation were studied as TTI was increased from 0 to 15 L/min for brief periods of non-rapid eye movement (NREM) sleep (Experiment 1). The frequency of sleep-disordered breathing episodes remained high at 0 and 5 L/min (87.0 +/- 33.7 and 79.4 +/- 24.4 episodes per hour NREM) and decreased significantly to 41.3 +/- 31.5 and 43.4 +/- 31.4 episodes/h NREM sleep at rates of 10 and 15 L/min, respectively (p = 0.003). At high levels of TTI (10 and 15 L/min), obstructive apneas and hypopneas decreased but periodic laryngeal obstructions were induced during stage 1 NREM sleep. To prevent laryngeal obstructions, a servo-control system was used to briefly interrupt TTI during these events. When this system was implemented for more prolonged periods of sleep (Experiment 2, total sleep time 176.6 +/- 12.5 min), high-flow TTI (hf-TTI, 15 L/min) led to an overall reduction in the combined frequency of obstructive apneas and laryngeal obstructions from 63.8 +/- 21.8 to 10.7 +/- 9.1 (p < 0.03) and was associated with a marked reduction in arousal frequency from 60.0 +/- 26.0 to 8. 3 +/- 5.4/h in NREM sleep, and from 67.5 +/- 3.5 to 0 +/- 0/h in rapid eye movement (REM) sleep. Our findings demonstrate that hf-TTI stabilized breathing patterns in apneic patients, and was safe and efficacious for prolonged periods of sleep.

Adult↗
PubMed1989

Airway insufflation: physiologic effects on acute and chronic gas exchange in humans.

Reduction in dead space through conventional tracheostomy has been used to treat patients with chronic CO2 retention. The insufflation of air directly into the trachea by transtracheal catheter (airway insufflation, AI) provides reductions in dead space as great or greater than those of tracheostomy. The physiologic effects of AI on gas exchange have not been adequately studied because instillation of gases into the trachea contaminates minute ventilation (VL), dead space volume (VD), tidal volume (VT), and other indices of gas exchange, as measured by usual technics. We overcame this problem by devising special methods of measuring inspired and expired ventilation, alveolar and dead space ventilation, and VT and VD by using pneumotachographic timing of inspiration and expiration so that true inspired and expired ventilation were calculated. We studied 5 patients with chronic CO2 retention from either COPD, scoliosis, or muscular dystrophy (annual average PaCO2 = 45 to 75 mm Hg) during 75 min of AI with serial gas exchange and arterial blood gas measurements. AI at about 5 L/min of room air through the trachea in 5 patients reduced VL by 18% (from 7.91 to 6.48 L/min), VT by 25% (from 450 to 338 ml), and VD by 37% (from 223 to 141 ml), while not affecting PaCO2 (from 51.8 to 48.2 mm Hg) or PaO2 (from 65.1 to 63.4 mm Hg). In 2 patients, AI administered continuously for 4 to 12 months (as 30 to 50% O2) maintained PaCO2 as well as or better than breathing enriched O2 from a tracheal collar via an open tracheostomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Tracheal gas insufflation augments CO2 clearance during mechanical ventilation.

A technique that improves the efficiency of alveolar ventilation should decrease the pressure required and reduce the potential for lung injury during mechanical ventilation. Alveolar ventilation may be improved by replacing a portion of the anatomic dead space with fresh gas via an intratracheal catheter. We studied the effect of intratracheal gas insufflation as an adjunct to volume cycled ventilation in eight sedated, paralyzed patients with a variety of lung disorders. Continuous flows of 2, 4, and 6 L/min were delivered through a catheter positioned 1 or 10 cm above the carina. Carbon dioxide production, inspiratory minute ventilation, and peak and mean airway pressures did not change over the range of flows tested. PaCO2 and dead space volume/tidal volume decreased significantly as joint functions of catheter flow and position (p < 0.001). The highest catheter flow (6 L/min) and most distal catheter position (1 cm above the carina) were the most effective combination tested, averaging a 15% reduction in PaCO2 (range 9 to 23%). Certain characteristics of the expiratory capnogram were helpful in predicting the observed reduction in PaCO2. Tracheal gas insufflation may eventually prove a useful adjunct to a pressure-targeted strategy of ventilatory management (in either volume-cycled or pressure controlled modes), particularly when the total dead space is heavily influenced by its anatomic component.

Adult↗
PubMed1993

Modes of tracheal gas insufflation. Comparison of continuous and phase-specific gas injection in normal dogs.

Tracheal gas insufflation (TGI) improves the efficiency of CO2 elimination accomplished by conventional mechanical ventilation, primarily by reducing the anatomic (series) dead space volume. Dead space proximal to the catheter tip can be reduced by two methods. Fresh gas introduced at the carinal level during inspiration may effectively "bypass" the upper airway. Alternatively, proximal dead space can be "washed out" with fresh gas during expiration to reduce CO2 rebreathing. We examined these two modes of TGI-aided dead space reduction in nine paralyzed normal dogs receiving conventional mechanical ventilation and compared these results to those obtained with a catheter that delivered fresh gas continuously at the same flow rate, thereby accomplishing both bypass and washout. Total inspired tidal volume and cycling frequency were held constant. Differences in CO2 elimination efficiency among the TGI modes were flow dependent. Continuous catheter flow at 5 or 10 L/min reduced PaCO2 and physiologic dead space fraction (VD/VT) more than either proximal bypass or end-expiratory washout (p < 0.001). At the same catheter flow settings expiratory washout tended to improve VD/VT more than did inspiratory bypass. Under the conditions tested, constant tracheal insufflation of fresh gas improves alveolar ventilation by mechanisms that include, but are not limited to, a functional reduction in the dead space proximal to the catheter tip.

Analysis of Variance↗
PubMed1992

Postoperative atelectasis reexpansion by selective insufflation through a balloon-tipped catheter.

Although treatment of refractory atelectasis has been improved by pulmonary insufflation through FOB with balloon cuff, low pulmonary compliance and high critical opening pressure of alveoli in the atelectatic areas require a more selective approach to prevent pressure dispersion to highly compliant zones. To achieve the highest insufflation selectivity and reduce patient discomfort, we have devised a small caliber balloon-tipped catheter to easily reach even the minor branches of the bronchial tree. This result was obtained by utilizing the performed curve of the catheter distal end after withdrawing the internal stylet. The catheter was introduced through the nostrils (16 patients) or through an endotracheal tube (two patients) and advanced under fluoroscopic guidance. Reexpansion of atelectatic areas was accomplished by repeated air injections through a 60-ml syringe. No complications were observed. Complete disappearance of x-ray film evidence of atelectasis was obtained in 15 patients and partial reexpansion in 3 patients.

Air↗
PubMed1997

Combination of tracheal gas insufflation and airway pressure release ventilation.

STUDY OBJECTIVE: We hypothesized that the continuous gas flow administration delivered through an insufflation catheter positioned above the carina during airway pressure release ventilation (APRV) would facilitate carbon dioxide (CO2) elimination, resulting in normocarbia with a substantially reduced peak airway pressure (Paw). To test this hypothesis, we compared intermittent positive pressure ventilation (IPPV), tracheal gas insufflation (TGI), APRV, and combined TGI and APRV (TGI + APRV). DESIGN: Animal study with random application of four ventilatory modes in a canine restrictive-thorax model with and without pulmonary edema. SETTING: Research laboratory at Kumamoto (Japan) University School of Medicine. SUBJECTS: Six mongrel dogs. INTERVENTIONS: Application of four ventilatory modes (IPPV, TGI, APRV, and TGI + APRV). MEASUREMENTS AND RESULTS: TGI + APRV facilitated CO2 elimination. The peak Paw was significantly lower during TGI + APRV than during IPPV (nonpulmonary edema model; 15 +/- 4 vs 28 +/- 9 cm H2O; p < 0.05; pulmonary edema model: 20 +/- 4 vs 34 +/- 10 cm H2O; p < 0.05). Normocarbia was observed in both models. Neither TGI nor APRV alone maintained normocarbia. CONCLUSION: The combined use of TGI and APRV is a more effective method of maintaining normocarbia with reduced peak Paw than either IPPV or APRV alone.

Animals↗
PubMed2004

Effects of mechanical insufflation-exsufflation on respiratory parameters for patients with chronic airway secretion encumbrance.

STUDY OBJECTIVES: To analyze the physiologic effects and tolerance of mechanical insufflation-exsufflation (MI-E) for patients with chronic ventilatory failure of various etiologies. DESIGN: Prospective clinical trial. SETTING: Rehabilitation unit of a university hospital. PATIENTS OR PARTICIPANTS: Thirteen patients with amyotrophic lateral sclerosis (ALS), 9 patients with severe COPD, and 7 patients with other neuromuscular disorders (oNMDs) with chronic airway secretion encumbrance and decreases in oxyhemoglobin saturation (Spo(2)). INTERVENTIONS: Pressures of MI-E of 15 cm H(2)O, 30 cm H(2)O, and 40 cm H(2)O were cycled to each patient, with 3 s for insufflation and 4 s for exsufflation. One application was six cycles at each pressure for a total of three applications. MEASUREMENTS AND RESULTS: We continuously evaluated respiratory inductance plethysmography (RIP) and Spo(2) during every application. Peak cough flow (PCF) and dyspnea (Borg Scale) were also measured before the first and after the last application. The technique was well tolerated in all patient groups. Median Spo(2) improved significantly (p < 0.005) in all patient groups. Median PCF improved significantly (p < 0.005) in the ALS and oNMD groups from 170 to 200 L/min and from 180 to 220 L/min, respectively, and dyspnea improved significantly in the patients with oNMDs and patients with COPD from 3 to 1 and from 2 to 0.75, respectively. Breathing pattern characteristics (RIP) did not deteriorate after MI-E in any patient groups. Inspiratory flow limitation significantly decreased at the highest MI-E pressures for the ALS group. CONCLUSIONS: Our results confirm good tolerance and physiologic improvement in patients with restrictive disease and in patients with obstructive disease, suggesting that MI-E may be a potential complement to noninvasive ventilation for a wide variety of patient groups.

Adult↗
PubMed1993

Augmented arterial to end-tidal PCO2 difference during laparoscopic CO2 insufflation in man.

Acid-base status of the blood and tissue fluids and pulmonary gas exchange were continuously observed during intra-abdominal CO2 insufflation for 2 h in 8 paralyzed and artificially ventilated patients who underwent laparoscopic cholecystectomy or resection of the sigmoid colon. Carbon dioxide pressure in the arterial and mixed venous blood as well as in end-tidal air started to increase already at 5 min CO2 insufflation. On the other hand, appreciable elevation in VCO2 and tissue PCO2 (PTCO2) was noted only after 15 min. In vivo buffer value (beta) was well within the normal physiological range at 5 min and gradually declined up to 2 h. These observations indicated that chemical buffering to CO2 and redistribution of buffer base among the blood and tissue fluids were slowly developed during entire period of observation. In reflecting these experimental findings, arterial to end-tidal PCO2 difference (a-ADCO2) and respiratory gas exchange ratio (R) were promptly and significantly increased at 5 min and maintained slow increment up to 2 h. We conclude that these profiles of a-ADCO2 and R can be explained by initially rapid and subsequently slow augmentation in ventilation-perfusion ratio (VA/Q) during the specific type of respiratory acidosis elicited in this study.

Acid-Base Equilibrium↗
PubMed2006

Patient-controlled room air insufflation versus automated carbon dioxide delivery for CT colonography.

OBJECTIVE: Our objective was to prospectively compare colonic distention and patient comfort at screening CT colonography (CTC) with patient-controlled room air (RA) insufflation versus automated carbon dioxide (CO2) delivery. SUBJECTS AND METHODS: Two hundred eight adults undergoing CTC were randomized to RA or CO2 (104 per method). Colonic distention was prospectively assessed by segment using a 4-point scale (1 = optimal, 2 = adequate, 3 = inadequate, 4 = collapsed). Adequacy of combined supine/prone segmental evaluation was also recorded. Patients provided discomfort ratings on a 0-10 scale (0-1 = none/insignificant, 2-3 = minimal, 4-6 = intermediate, 7-10 = significant) before, during, and after the procedure. RESULTS: No significant differences in segmental distention were observed in the prone position between techniques. In the supine position, CO2 resulted in significantly greater distention in the sigmoid, descending, and transverse segments (p < 0.01). After combined supine/prone assessment, two/104 (1.9%) and three/104 (2.9%) patients were judged to have an inadequately evaluated segment on RA and CO2, respectively (four sigmoid, one transverse). Mean discomfort scores for RA and CO2 were 3.97 and 5.08 during the examination (p < 0.01); 0.91 and 0.42 immediately after (p < 0.01); 0.51 and 0.25 15 min later (p < 0.05); and 0.15 and 0.04 2 hours later (p < 0.01), respectively. During active distention, 19 (18.3%) and 33 (31.7%) patients reported significant transient discomfort with RA and CO2, respectively (p < 0.05). Beyond 15 min, only two (1.9%) patients with RA and no patients with CO2 had a discomfort level higher than 3. CONCLUSION: Although patient-controlled RA insufflation and automated CO2 delivery each resulted in negligible postprocedure discomfort and reliable colonic distention, CO2 was better for both categories.

Air↗
PubMed1986

Simultaneous recording of uterine and tubal motility during utero-tubal insufflation in monkeys.

One main cause of female infertility is the tubal factor, and interest in the role and function of the Fallopian tube has increased our knowledge about tubal infertility. In this study in monkeys, Cynomolgus (Macaca fascicularis), the tubal and uterine motility was recorded with a Millar microtransducer. The recordings were made during uterotubal, uterine as well as tubal insufflation with gas. Tubal activity patterns varied with the phase of the menstrual cycle. The kymograms made during gas insufflation did not reflect tubal or uterine activity, as registered by the Millar microtransducer, but rather the resistance to pressure of the intra-uterine part of the tube. An intra-uterine pressure up to 200 mmHg, has previously been regarded as being free from risk of uncontrolled escape of gas outside the uterus and the oviducts. This was not confirmed in the present study.

Animals↗
PubMed2003

[High-frequency insufflation of drug aerosol into abdominal cavity in combined treatment of acute general peritonitis].

Method of treatment of abdominal cavity in acute general peritonitis--high-frequency insufflation of drug aerosol into abdominal cavity--was developed, tested in animals and used in 126 patients. Results of treatment were compared with a standard method of surgical practice--peritoneal lavage. It is demonstrated that the method of high-frequency insufflation promotes a more favorable course of peritonitis, decreases in the number of purulent-septic complications and reduces time and cost of treatment.

Abdominal Cavity↗
PubMed2002

Echocardiographic findings in minimally invasive coronary artery bypass grafting: The role of intrathoracic CO2 - insufflation and single lung ventilation.

BACKGROUND: Current options for surgical treatment of coronary single vessel disease range from beating heart procedure without cardiopulmonary bypass via a mini thoracotomy (MIDCAB) to totally endoscopic robot-assisted techniques (TECAB) with cardiopulmonary bypass. Both procedures are associated with considerable stress even before revascularization such as single lung ventilation, temporary coronary occlusion, Luxatio cordis, intrathoracic CO2 insufflation and extended bypass and operating time. The aim of the this study was to document the extent of intraoperative segmental wall motion abnormalities (SWMA) by echocardiography, and to identify variables affecting SWMA. MATERIALS AND METHODS: Forty patients with coronary single vessel disease were included in the study. 16 patients were operated with the MIDCAB technique, and 24 patients underwent TECAB. In both groups of patients sequential transesophageal echocardiograms (2D-loops) were recorded and analyzed. Hemodynamic and electrocardiographic data as well as oxygenation parameters were acquired during echo exams. In both groups of patients mild, but significant perioperative SWMA were identified, which increased in the course of the operation. These SWMA were more pronounced in the TECAB as compared to the MIDCAB group. Independent of operating time these changes disappeared completely until the ends of surgery. Significant hemodynamic or elektrocardiographic modifications were not observed. CONCLUSION: The application of minimally invasive techniques for the surgical treatment of coronary single vessel disease is associated with significant perioperative SWMA. The more pronounced SWMA in the TECAB group may be a consequence of intrathoracic CO2-insufflation. Both techniques can be applied without significant myocardial ischemia, provided that appropriate intraoperative monitoring is performed, and intrathoracic CO2 pressure in TECAB patients is limited.

Blood Gas Analysis↗
PubMed1992

[Extraperitoneal endoscopic lymph node dissection with insufflation in the staging of bladder and prostate cancer].

Endoscopic pelvic lymph node dissection was performed in 30 patients as part of the staging of prostate (19) or bladder (11) cancers. The technique, using a procedure of detachment of the retroperitoneal space with CO2 insufflation, is described. Complete bilateral dissection of the ilio-obturator lymph nodes was performed in 24 patients (80%) using conventional laparoscopic surgical equipment. Only a unilateral dissection could be performed in 6 other patients because of technical difficulties. The mean operating time was 72 minutes. The intraoperative and postoperative complications consisted of 2 venous injuries and one infection. A prospective study of systemic diffusion of CO2 demonstrated that the blood Co2 level increased significantly during the procedure, but could be controlled by adaptation of the ventilation. Postoperative monitoring of blood CO2 levels using a capnograph is recommended. 4 out of 30 patients (13%), 2 with prostate cancer and 2 with bladder cancer, had lymph node metastases. Amongst the other 26 patients, 12 were treated by radiotherapy (bladder cancer), 12 patients underwent perineal prostatectomy and 12 others underwent retropubic prostatectomy (5) or prostatocystectomy (7]). No intraoperative and postoperative morbidity related to endoscopic lymph node dissection was observed in the patients subsequently undergoing a radical operation. Endoscopic retroperitoneal lymph node dissection with CO2 insufflation is a rapid, safe and effective technique for staging of malignant pelvic tumours and constitutes an alternative to open surgery and to endoscopic transperitoneal surgery.

Endoscopy↗
PubMed2004

[Endoscopic thyroid gland surgery without carbon dioxide neck insufflation].

OBJECTIVE: To evaluate endoscopic thyroid gland surgery without carbon dioxide neck insufflation. METHODS: Sixteen patients with thyroid gland benign tumor, aged from 23-62 years, were selected and treated with endoscopic surgery. Eight cases received whole thyroid lobectomy and the other eight cases received partial thyroid lobectomy, the procedure was through a wall method or a single 2.0-3.0 cm horizontal skin incision. Among the 16 cases, 6 were thyroid adenoma and 10 were nodular goiter. RESULTS: All patients received endoscopic surgery, 2 cases with sub-clavicle approach and 14 cases with a single 2.0-3.0 cm horizontal skin incision approach. The recurrent laryngeal nerve and parathyroid glands were easily identified and preserved during operation, the operating time lasted from 1.1 hours to 4.0 hours, no complication occurred, the postoperative cosmetic outcome was excellent. CONCLUSIONS: The results indicated that gasless technique is feasible and safe, so it suggested that the video-assisted thyroid surgery without carbon dioxide neck insufflation could be an alternative for thyroid gland surgery.

Adult↗
PubMed1991

[A method for the treatment of oviduct obstruction in cattle using CO2 insufflation into the uterus].

The investigations were carried out on 59 cows from Holstein half-breed, establishing that 8 cows suffered salpinx obstruction (5 cases with unilateral obstruction and 3 cases with bilateral obstruction). The authors are using an apparatus made by themselves, for insufflation of air in the obstructed uterus, and which is useful in desobstruction treatment, too. For diagnosis, CO2 was introduced inside of uterus. The authors used for treatment PBS (saline phosphate buffer) in addition with penicillin G, hydrocortisone and trypsin. Before air insufflation in uterus there will be infused 10-20 ml 2% Lidocaton. The cows must be examined in oestrus period, or 2 days after PGF2 alfa administration. The gas must be introduced under rectal palpation, and pressure must not be higher than 500 mm H2O column. If there is a permeable oviduct, after 15-20 sec. from gas introduction, ist is possible to palpate the filled oviduct. From ovary we can perceive a rustle produced by gas crossing in abdominal cavity. In case of salpinx obstruction, the treatment must be start as soon as possible. The utilized liquid for treatment will be introduce by gas pressure, inside of uterus and oviducts. Using this method, it managed the repermeability of oviducts at 3 from 8 treated cows. In each case, there were used 3 treatments at 48 h interval. After the second insemination (I.A.) 2 cows remained pregnant.

Animals↗
PubMed1995

[Fatal outcome after retrograde insufflation of the eustachian tube].

This case report describes a lethal complication of retrograde air insufflation through the Eustachian tube after myringotomy. A 35-year-old woman presented with otalgia and hearing loss in her left ear, which had occurred after an upper respiratory infection. Otoscopy showed a middle ear effusion. A myringotomy was performed under mask anesthesia in a private clinic. During subsequent retrograde Eustachian tube insufflation, the patient experienced sudden convulsions, followed by cardiac and respiratory arrest. The patient then died some hours later from generalized cardiac and circulation break-down in the intensive care unit of a nearby hospital. The cause of the cardiac and circulation collapse could not be defined completely, but it is believed than an anatomical variant of the tegmen tympani was responsible for the tragic outcome because of an air embolus.

Adult↗