Mechanical ventilation. Part I: Physiology and pathophysiology

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Published: Nov 13, 2017
DOI: https://doi.org/10.12681/jhvms.14878
Keywords:
mechanical ventilation physiology pathophysiology
Ch. NIKOLAOU (Χ. ΝΙΚΟΛΑΟΥ)
Unit of Surgery and Obstetrics, Companion Animal Clinic, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki
I. SAVVAS (Ι. ΣΑΒΒΑΣ)
Unit of Anaesthesiology and Intensive Care, Companion Animal Clinic, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki
A. PAPASTEFANOU (Α. ΠΑΠΑΣΤΕΦΑΝΟΥ)
Unit ofAnaesthesiology and Intensive Care, Companion Animal Clinic, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki
Abstract

Despite the fact that mechanical ventilation is an integral part of anaesthesia practice, its widespread use in veterinary medicine has yet to be established. The increasing needs and advances in animal pain management, being associated with anaesthetic protocols that can cause hypoventilation, make the use of mechanical ventilation more necessary than ever. Although mechanically ventilating the patient is not pivotal in a substantial number of surgical techniques, inability to do so precludes certain anaesthetic protocols from being used, making the choice of the drugs to be employed troubleshooting. Successful mechanical ventilation requires a thorough understanding of the physiology and pathophysiology of respiration, as well as the way mechanical ventilation affects them. Before any attempt to describe mechanical ventilation, a glossary of technical terms has to be accepted, as long as consensus between the authors has not been found in the literature. Lung elasticity, resistance to flow, inspiration time and the ratio of inspiration to expiration time interact during mechanical ventilation affecting the final result on the patient. Volutrauma, barotrauma, ventilation-perfusion mismatch and cardiac output decrease are some of the adverse effects of mechanical ventilation. The choice of whether or not to use automatic ventilators, the choice of the right equipment and setting the variables correctly on the control panel need a thorough understanding of patient pathology. This article reviews respiration under normal and pathologic conditions and the effects mechanical ventilation exerts on different organ systems. Guidelines for the application of mechanical ventilation under various pathologic conditions are provided.

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References
Bergman NA (1963) Distribution of inspired gas during anaesthesia and artificial ventilation. J Appi Physiol 18:1085-1089.
Bone RC (1983) Mechanical trauma in acute respiratory failure. Respir Care 28:618.
Bonnet F, Richard C, Glaser Ρ, Lafay M, Guesde R (1982) Changes in hepatic flow induced by continuous positive pressure ventilation in critically ill patients. Crit Care Med 10:703-705.
Cairo JM, Pilbeam S (2006) Effects of positive pressure ventilation on the cardiovascular, cerebral, renal and other organ systems In: Mechanical Ventilation Physiological and Clinical Applications 4th ed, Mosby Elsevier, Missouri pp:345-356.
Chatburn RL (1992) Classification of mechanical ventilators. Respir Care 37:1009-1025.
Clare M, Hopper Κ (2005) Mechanical ventilation: ventilator settings, patient management and nursing care. Comp Cont Educ Vet 27:256-269.
De Backer DD (2000) The effects of positive end-expiratory pressure on the splanchnic circulation. Intensive Care Med 26:361-363.
De Troyer (1995) Respiratory muscle function In: Respiratory medicine, London WB Saunders pp: 125-133.
Dodek K, Keenan S, Cook D, Heyland D, Jacka M, Hand L, Muscedere J, Foster D, Mehta N, Hall R, Brun-Buisson C; Canadian Critical Care Trials Group; Canadian Critical Care Society (2004)
Evidence-based clinical practice guideline for the prevention of ventilator associated pneumonia. Ann Intern Med 141:305-313.
Don HF, Wahba WM, Craig DB (1972) Airway closure, gas trapping and functional residual capacity during anaesthesia. Anaesthesiology 36:533-53.
Drellich S (2002) Principles of mechanical ventilation. Vet Clin Small Anim 32:1087-1100.
Dreyfuss D, Soler Ρ, Basset G, Saumon G (1988) High inflation pressure pulmonary edema: respective effects of high airway pressure, high tidal volume and positive end-expiratory pressure.
Am Rev Respir Pis 137:1159-1164.
Drummond GB (1989) Chest wall movements in anaesthesia. Eur J Anaesthesiol 6:161-196.
Drury DR, Henry JP, Goodman J (1947) The effects of continuous pressure breathing on kidney function. J clin Invest 26:945-951.
Froese AB (2006) Gravity, the belly and the diaphragm: you can't ignore physics. Anaesthesiology 104:193-196.
Hall SV, Johnson EE, Hedley-Whyte J (1974) Renal hemodynamics and function with continuous pressure ventilation in dogs. Anaesthesiology 41:452-461.
Hammond R (2007) Automatic ventilators In: BSAVA Manual of Canine and Feline Anaesthesia and Analgesia 2nd ed, BSAVA, Gloucester, pp: 49-61.
Hedenstierna G, Strandberg A, Brismar B, Lundquist H, Svensson L, Tokics L (1985) Functional residual capacity, thoracoabdominal dimensions and central blood volume during general anaesthesia with muscle paralysis and mechanical ventilation. Anaesthesiology 62:247-254.
Hess DR, Kacmarek RM (2002) Essentials of mechanical ventilation 2nd ed, McGraw-Hill, New York, pp 3-16.
Hopper Κ (2009) Basic Mechanical Ventilation In: Small Animal Critical Care Medicine 1st ed Saunders Elsevier, Missouri, pp: 900-904.
Jenkinson SG (1983) Nutritional problems during mechanical ventilation in acute respiratory failure. Respir Care 28:641.
Jones JG, Faithfull D, Jordan C, Minty Β (1979) Rib cage movement during halothane anaesthesia in man. Br J Anaesth 51:399-407.
Lumb AB (2000a) Pulmonary ventilation: mechanisms and work of breathing In: Nunn's Applied Respiratory Physiology 5th ed, Reed Educational and Professional Publishing, Oxford pp: 113-134.
Lumb AB (2000b) The pulmonary circulation In: Nunn's Applied Respiratory Physiology 5th ed, Reed Educational and Professional Publishing, Oxford pp: 138-162.
Lumb AB (2000c) Distribution of pulmonary ventilation and perfusion In: Nunn's Applied Respiratory Physiology 5th ed, Reed Educational and Professional Publishing, Oxford pp: 163-199.
Maclntyre NR (1996) Minimizing alveolar stretch injury during mechanical ventilation. Respir Care 41:318-326.
Marini JJ, Gattinoni L (2004) Ventilatory management of acute respiratory distress syndrome: a consensus of two. Crit Care Med 32:250-255.
Morgan GE, Mikhail MS, Murray MJ (2006a) Anaesthesia for thoracic surgery In: Clinical Anaesthesiology 4th ed, McGraw-Hill Companies, USA, pp:585-613.
Morgan GE, Mikhail MS, Murray MJ (2006b) Critical Care In: Clinical Anaesthesiology 4th ed, McGraw-Hill Companies, USA, pp: 1018-1064.
Morgan GE, Mikhail MS, Murray MJ (2006c) Neurophysiology and Anaesthesia In: Clinical Anaesthesiology 4th ed, McGraw-Hill Companies, USA, pp: 552-563.
Morgan GE, Mikhail MS, Murray MJ (2006d) Respiratory Physiology: The effects of Anaesthesia In: Clinical Anaesthesiology 4th ed, McGraw-Hill Companies, USA, pp: 537-570.
Muscedere JG, Mullen JBM, Gan K, Slutsky AS (1994) Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med 149:1327-1334.
Pepe ΡΕ, Lurie KG, Wigginton JG, Raedler C, Idris AH (2004) Detrimental hemodynamic effects of assisted ventilation in hemorrhagic states. Crit Care Med 32:414-420.
Pierson DJ, Hildebrandt J (1994) Pierson response to letter from F Piedaliue. Respir Care 39:670.
Pilbeam SP (2006a) Basic terms and concepts of mechanical ventilation In: Mechanical Ventilation Physiological and Clinical Applications 4th ed, Mosby Elsevier, Missouri, pp: 15-30.
Pilbeam SP (2006b) Effects of positive pressure ventilation on the pulmonary system In: Mechanical Ventilation Physiological and Clinical Applications 4th ed, Mosby Elsevier, Missouri, pp: 357-390.
Power I and Kam Ρ (2001) Respiratory Physiology In: Principles of Physiology for the Anaesthetist 1st ed, Arnold, London, pp: 63-97.
Qvist J, Pontoppidan H, Wilson RS, Lowenstein E, Laver MB (1975) Hemodynamic responses to mechanical ventilation with PEEP: the effect of hypervolemia. Anaesthesiology 42:45-55.
Raffe MR (2002) Principles of mechanical ventilation In: The Veterinary ICU Book 1st edition, Teton NewMedia, Jackson pp: 96-113.
Rutherford JS, Logan MR, Drummond GB (1994) Changes in endexpiratory lung volume on induction of anaesthesia with thiopentone or propofol. Br J Anaesth 73:579-582.
Slutsky AS, Tremblay LN (1998) Multiple organ failure. Is mechanical ventilation a contributing factor? Am J Respir Crit Care Med 157(6 ptl):1721-1725.
Steingrub JS, Tidswell M, Higgins TL (2003): Hemodynamic consequences of heart lung interactions. J Intensive Care Med 18:92-99.
Stock MC, Perei A (1997) Handbook of mechanical ventilator support, 2nd ed, Williams and Wilkins, Baltimore. Tyberg JV, Grant DA, Kingma I, Moore TD, Sun Y, Smith ER, Belenkie I (2000) Effects of positive intrathoracic pressure on pulmonary and systemic hemodynamics. Respir Physiol 119(2-3):171-9.
von Ungern-Sternberg BS, Frei FJ, Hammer J, Schibler A, Doerig R, Erb TO (2007) Impact of depth of propofol anaesthesia on functional residual capacity and ventilation distribution in healthy preschool children. Br J Anaesth 98:503-508.
Warner DO, Warner MA, Ritman EL (1995) Human chest wall function while awake and during halothane anaesthesia I. Quiet Breathing. Anaesthesiology 82:6-19.
West J (2007a) Mechanics of breathing - How the Lung is Supported and Moved In: Respiratory Physiology, The Essentials 7th ed, Lippincott Williams and Wilkins, Baltimore: pp 95-123.
West J (2007b) Blood flow and metabolism - How the pulmonary circulation removes gas from the lung and alters some metabolites In: Respiratory Physiology, The Essentials 7th ed, Lippincott
Williams and Wilkins, Baltimore: pp 35-55.
West JB, Dollery CT (1965) Distribution of blood flow and pressureflow relations of the whole lung. J Appi Physiol 20:175-183.
West JB, Dollery CT, Naimark (1964) A distribution of blood flow in isolated lung; relation to vascular and alveolar pressures. J Appi Physiol 19:713-724.
Waddell LS, King LG (2007) General approach to dyspnoea In: BSAVA Manual of Canine and Feline Emergency and Critical Care 2nd ed, British Small Animal Veterinary Association,
Gloucester, pp: 85-113.
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