Inverse ratio ventilation compared with PEEP in adult respiratory failure

We have compared the cardiorespiratory effects of an inspiratory: expiratory (I:E) ratio of 4:1 with a ratio of 1:2 in 10 adult patients requiring intermittent positive pressure ventilation (IPPV) for acute respiratory insufficiency. Further comparisons were made with IPPV with positive end-expiratory pressure (PEEP) which was adjusted to achieve an equal external end-expiratory volume (EEEV) to that produced by the 4:1 ratio, as determined by respiratory inductive plethysmography, and with an I:E ratio that only changed the EEEV minimally (IRV-min). Percentage pulmonary shunt (Qs/Qt) was reduced equally with PEEP and with the 4:1 I:E ratio but both patterns reduced cardiac output and oxygen delivery. IRV-min also reduced Qs/Qt significantly but had no effect on cardiac output so that oxygen delivery was increased. The dead space to tidal volume ratio (V_D/V_T) during IPPV-4:1 and IRV-min was reduced significantly when compared with that during IPPV-1: 2. The clinical implications of the findings suggest that for some ITU patients, a modest increase in I:E ratio to between 1.1:1 and 1.7:1 may produce better gas exchange without significantly effecting the cardiac output.