Ee. Muller et al., HOW TO VENTILATE LUNGS AS SMALL AS 12.5-PERCENT OF NORMAL - THE NEW TECHNIQUE OF INTRATRACHEAL PULMONARY VENTILATION, Pediatric research, 34(5), 1993, pp. 606-610
We wished to determine in a laboratory animal model how much residual
lung was needed to sustain total gas exchange. In a series of young, h
ealthy lambs weighing approximately 10 kg that were sedated and paraly
zed, we progressively excluded from gas exchange all the left lung (a
total of 43%), plus the right lower and cardiac lobes (81%), plus the
right middle lobe (87.5%). In some studies, the respective lobes were
surgically removed; in others, the bronchi and the pulmonary arteries
to the respective lobes were ligated. We provided pulmonary ventilatio
n using the pressure control mode (Servo 900 C) at a tidal volume of 2
0 mL/kg multiplied by the fraction of the remaining lungs, a respirato
ry rate up to 120/min, a peak inspiratory pressure of 12-15 cm H2O, an
d a positive end-expiratory pressure of 3 cm H2O. Those lambs with at
least both the right upper lobe (RUL) and right middle lobe remaining
(19% of total lungs) were weaned to room air on mechanical ventilation
within 48 h. Ventilating RUL (12.5% of remaining lung) with the same
ventilator required a substantially higher tidal volume and peak inspi
ratory pressure to result in adequate alveolar ventilation but led to
respiratory failure and death within 8 h. We then applied a newly deve
loped system of intratracheal pulmonary ventilation to ventilate the R
UL (12.5% of remaining lung) alone. A continuous flow of humidified mi
xture of air and oxygen was directly passed into the trachea at the le
vel of the carina through a diffuser at a tidal volume of 2.5 mL/kg. A
single valve controlled expiration and respiratory rate. Lambs with o
nly RUL remaining were weaned to room air within 2 h, at a respiratory
rate of 60-120/min and peak inspiratory pressure of 14-9 cm H2O, insp
iration to expiration ratio of 1:1, and positive end-expiratory pressu
re of 3 cm H2O. Initial mean pulmonary artery pressure progressively d
ecreased from 40 +/- 5 to 25 +/- 7 mm Hg within 6 h after surgery.