• D A Rodeberg, T A Housinger, D G Greenhalgh, N E Maschinot, and G D Warden.
• Shriners Burns Institute, Cincinnati, OH 45229-3095.
• J. Am. Coll. Surg. 1994 Nov 1;179(5):518-22.

BackgroundVolumetric diffusive respiration (VDR) offers theoretical advantages over conventional mechanical ventilation (CV) by using lower airway pressures, recruiting alveoli, and mobilizing secretions.Study DesignForty-eight thermally injured pediatric patients with failing respiratory status were changed from CV to VDR. Data were obtained just before transition for CV and after stabilization on VDR, within six hours of transition.ResultsBoth ventilation and oxygenation were significantly improved with PaCO2 decreasing from 47 +/- 3 to 39 +/- 11 mm Hg and PaO2 increasing from 105 +/- 8 to 171 +/- 12 mm Hg after transition to VDR. Treatment with the VDR ventilator also resulted in a significant decrease in peak inspiratory pressures (PIP) from 52 +/- 2 to 38 +/- 2 cm H2O. The PaO2 to FiO2 ratio increased from 189 +/- 16 using CV, to 329 +/- 21 using VDR, suggesting an improvement in the ventilation and perfusion matching. Ventilatory efficiency, measured by the PaO2/FiO2/PIP ratio, greatly improved after transition from CV to VDR with fraction of inspired oxygen increasing from 3.9 +/- 0.4 to 10.3 +/- 1.0. Hemodynamic function (blood pressure and pulse rate) were not adversely affected by VDR.ConclusionsThe VDR ventilator is more effective than conventional ventilation for maintaining optimal gas exchange at lower airway pressures in thermally injured pediatric patients.

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