Minimizing Barotrauma

Q: All of the following can decrease the chances of barotrauma and bronchopleural fistula in ventilated patients except?

A) Use of small tidal volumes
B) Allowing permissive hypercapnia
C) Lower PEEP
D) Higher inspiratory flow rate
E) Low-compressible-volume, low-compliance ventilator circuit


Answer: D

A, B and C are well-known choices to avoid barotrauma in ventilated patients as lower the volume and pressure via a ventilator, lower are chances of barotrauma. Permissive hypercapnia is (choice B) very well tolerated by a diseased lung and should not deter a clinician from utilizing this advantage as risks due to barotrauma are higher than risks of permissive hypercapnia.

Higher the inspiratory flow rate, higher would be the peak inspiratory pressure and consequently higher would be the risk of barotrauma (choice D).

Some emphasis should be put on the education of breathing circuits as the actual tidal volume get affected by the compliance of the breathing circuit. Low-compressible-volume, low-compliance ventilator circuit helps in keeping the actual tidal volume to lower limits (Choice E). 

#ventilators
#pulmonology



References:

1. Laffey JG, Engelberts D, Kavanagh BP. Buffering hypercapnic acidosis worsens acute lung injury. Am J Respir Crit Care Med 2000; 161:141.

2. Laffey JG, Tanaka M, Engelberts D, et al. Therapeutic hypercapnia reduces pulmonary and systemic injury following in vivo lung reperfusion. Am J Respir Crit Care Med 2000; 162:2287.

3. Yang SC, Yang SP. Effects of inspiratory flow waveforms on lung mechanics, gas exchange, and respiratory metabolism in COPD patients during mechanical ventilation. Chest 2002; 122:2096.

4. Masselli GM, Silvestri S, Sciuto SA, Cappa P. - Circuit compliance compensation in lung protective ventilation. Conf Proc IEEE Eng Med Biol Soc. 2006;1:5603-6.