In experimental lung injury, BIPAP with preserved spontaneous breathing was effective in increasing regional P TP, since pressure-controlled ventilation with the same P TP resulted in similar gas exchange effects. Tidal volume with PCV TP increased to 11.9☒.3 ml/kg, compared to 8.5☐.8 with BIPAP and 7.6☑.4 with PCV AW ( p<0.001) and cardiac output decreased to 3.5☐.6 l/min (BIPAP 4.9☐.8 and PCV AW 3.9☐.8, p<0.006). Oxygen delivery was significantly higher during BIPAP (530☑09 ml/min) versus 374☑13 ml/min during PCV AW and 353☙3 ml/min during PCV TP ( p<0.005). BIPAP resulted in higher PaO 2 than PCV AW (188☘3 versus 147☘2 mmHg, p<0.05), but not than PCV TP (187☑39 mmHg). Intrapulmonary shunt was 33☑1% during BIPAP, 36☑0% during PCV AW and 33☑5% during PCV TP ( p= n.s.). In 12 pigs with saline lavage-induced lung injury we compared the effects of BIPAP to pressure-controlled ventilation with equal airway pressure (PCV AW) or equal transpulmonary pressure (PCV TP) on V̇ A/Q̇ distribution assessed by the multiple inert gas elimination technique (MIGET). We investigated whether improvement in ventilation perfusion (V̇ A/Q̇) distribution during mechanical ventilation using biphasic positive airway pressure (BIPAP) with spontaneous breathing may be attributed to an effectively increased transpulmonary pressure (P TP) and can also be achieved by increasing P TP during controlled ventilation.
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