Webster P, Menon A S, Slutsky A S
J Appl Physiol (1985). 1986 Dec;61(6):2238-42. doi: 10.1152/jappl.1986.61.6.2238.
Constant-flow ventilation (CFV) is a ventilatory technique in which physiological blood gases can be maintained in dogs by a constant flow of fresh gas introduced via two catheters placed in the main-stem bronchi (J. Appl. Physiol. 53: 483-489, 1982). High-velocity gas exiting from the catheters can create uneven pressure differences in adjacent lung segments, and these pressure differences could lead to gas flow through collateral channels. To examine this hypothesis, we studied CFV in pigs, animals known to have a high resistance to collateral ventilation. In three pigs we examined steady-state gas exchange, and in six others we studied unsteady gas exchange at three flow rates (20, 35, and 50 l/min) and three catheter positions (0.5, 1.5, and 2.5 cm distal to the tracheal carina). During steady-state runs we were unable to attain normocapnia; the arterial CO2 partial pressure (PaCO2) was approximately 300 Torr at all flow rates and all catheter positions, compared with 20-50 Torr at similar flows and positions in dogs studied previously. The initial unsteady gas-exchange experiments indicated no consistent effect of catheter position or flow rate on the rate of rise of PaCO2. In three other pigs, the rates of rise of PaCO2 were compared with the rates observed with apneic oxygenation (AO). At the maximum flow and deepest position, the rate of rise of PaCO2 was lower during CFV than during AO. These data suggest that flow through collateral channels might be important in producing adequate gas transport during CFV; however, other factors such as airway morphometry and the effects of cardiogenic oscillations may explain the differences between the results in pigs and dogs.
恒流通气(CFV)是一种通气技术,通过经置于主支气管的两根导管引入恒定流量的新鲜气体,可使犬的生理血气维持在正常水平(《应用生理学杂志》53: 483 - 489, 1982)。从导管中高速流出的气体可在相邻肺段产生不均匀的压力差,这些压力差可能导致气体通过侧支通道流动。为验证这一假说,我们在猪身上研究了CFV,猪是已知对侧支通气具有高抗性的动物。我们对三头猪进行了稳态气体交换研究,对另外六头猪在三种流速(20、35和50升/分钟)和三个导管位置(气管隆突远端0.5、1.5和2.5厘米处)研究了非稳态气体交换。在稳态实验中,我们无法实现正常碳酸血症;在所有流速和所有导管位置,动脉二氧化碳分压(PaCO2)约为300托,而在先前研究的处于相似流速和位置的犬中,该值为20 - 50托。最初的非稳态气体交换实验表明,导管位置或流速对PaCO2上升速率没有一致的影响。在另外三头猪中,将PaCO2的上升速率与窒息氧合(AO)时观察到的速率进行了比较。在最大流速和最深位置,CFV期间PaCO2的上升速率低于AO期间。这些数据表明,在CFV期间,通过侧支通道的气流可能对产生足够的气体传输很重要;然而,其他因素,如气道形态学和心源性振荡的影响,可能解释了猪和犬实验结果之间的差异。