Synchronized ventilatory support as a therapeutic means of reducing hypercarbia in a pediatrie burn unit

The most prominent therapeutic problem in providing ventilatory support for patients with inhalation injury becomes the inability to reduce excessive carbon dioxide levels. These patients continue to die of hypercarbia even though arterial oxygen saturations may be maintained. Investigation into extremely high flow respirators and jet ventilation has had limited success. Increased metabolic demands, along with altered pulmonary pathology secondaiy to inhalation injury, provide a challenge to current mechanical ventilators, which are often unable to provide the minute volume requirements necessary to alleviate hypercarbia. To achieve maximum minute volume, synchronized ventilatory support by means of two Siemens-Elema 900C ventilators with a bilateral ventilation cable has been used effectively in eight pediatrie burn patients for the removal of carbon dioxide levels above 50 mm Hg. This technique allowed a decrease in carbon dioxide levels by as much as 32%. Once the hypercarbia has been thera-peutically corrected and maintained, use of conventional ventilatory techniques can be resumed. The bilateral ventilation cable also will allow independent lung ventilation, if indicated.