Sustained Inflation and Incremental Mean Airway Pressure Trial During Conventional and High-frequency Oscillatory Ventilation in a Large Porcine Model of Acute Respiratory Distress Syndrome

Overview

Journal BMC Anesthesiol

Publisher Biomed Central

Specialty Anesthesiology

Date 2006 Jun 24

PMID 16792808

Citations 5

Authors

Ralf M Muellenbach

Markus Kredel

Bernd Zollhoefer

Christian Wunder

Norbert Roewer

Joerg Brederlau

Affiliations

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Abstract

Background: To compare the effect of a sustained inflation followed by an incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation on oxygenation and hemodynamics in a large porcine model of early acute respiratory distress syndrome.

Methods: Severe lung injury (Ali) was induced in 18 healthy pigs (55.3 +/- 3.9 kg, mean +/- SD) by repeated saline lung lavage until PaO2 decreased to less than 60 mmHg. After a stabilisation period of 60 minutes, the animals were randomly assigned to two groups: Group 1 (Pressure controlled ventilation; PCV): FIO2 = 1.0, PEEP = 5 cmH2O, V(T) = 6 ml/kg, respiratory rate = 30/min, I:E = 1:1; group 2 (High-frequency oscillatory ventilation; HFOV): FIO2 = 1.0, Bias flow = 30 l/min, Amplitude = 60 cmH2O, Frequency = 6 Hz, I:E = 1:1. A sustained inflation (SI; 50 cmH2O for 60s) followed by an incremental mean airway pressure (mPaw) trial (steps of 3 cmH2O every 15 minutes) were performed in both groups until PaO2 no longer increased. This was regarded as full lung inflation. The mPaw was decreased by 3 cmH2O and the animals reached the end of the study protocol. Gas exchange and hemodynamic data were collected at each step.

Results: The SI led to a significant improvement of the PaO2/FiO2-Index (HFOV: 200 +/- 100 vs. PCV: 58 +/- 15 and T(Ali): 57 +/- 12; p < 0.001) and PaCO2-reduction (HFOV: 42 +/- 5 vs. PCV: 62 +/- 13 and T(Ali): 55 +/- 9; p < 0.001) during HFOV compared to lung injury and PCV. Augmentation of mPaw improved gas exchange and pulmonary shunt fraction in both groups, but at a significant lower mPaw in the HFOV treated animals. Cardiac output was continuously deteriorating during the recruitment manoeuvre in both study groups (HFOV: T(Ali): 6.1 +/- 1 vs. T(75): 3.4 +/- 0.4; PCV: T(Ali): 6.7 +/- 2.4 vs. T(75): 4 +/- 0.5; p < 0.001).

Conclusion: A sustained inflation followed by an incremental mean airway pressure trial in HFOV improved oxygenation at a lower mPaw than during conventional lung protective ventilation. HFOV but not PCV resulted in normocapnia, suggesting that during HFOV there are alternatives to tidal ventilation to achieve CO2-elimination in an "open lung" approach.

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References

Ware L, Matthay M . The acute respiratory distress syndrome. N Engl J Med. 2000; 342(18):1334-49. DOI: 10.1056/NEJM200005043421806. View

Brower R, Matthay M, Morris A, Schoenfeld D, Thompson B, Wheeler A . Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000; 342(18):1301-8. DOI: 10.1056/NEJM200005043421801. View

Foti G, Cereda M, Sparacino M, De Marchi L, Villa F, Pesenti A . Effects of periodic lung recruitment maneuvers on gas exchange and respiratory mechanics in mechanically ventilated acute respiratory distress syndrome (ARDS) patients. Intensive Care Med. 2000; 26(5):501-7. DOI: 10.1007/s001340051196. View

Richard J, Maggiore S, Jonson B, Mancebo J, Lemaire F, Brochard L . Influence of tidal volume on alveolar recruitment. Respective role of PEEP and a recruitment maneuver. Am J Respir Crit Care Med. 2001; 163(7):1609-13. DOI: 10.1164/ajrccm.163.7.2004215. View

Mehta S, Lapinsky S, Hallett D, Merker D, Groll R, Cooper A . Prospective trial of high-frequency oscillation in adults with acute respiratory distress syndrome. Crit Care Med. 2001; 29(7):1360-9. DOI: 10.1097/00003246-200107000-00011. View

Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart T . Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA. 2002; 287(3):345-55. DOI: 10.1001/jama.287.3.345. View

Ferguson N, Stewart T . The use of high-frequency oscillatory ventilation in adults with acute lung injury. Respir Care Clin N Am. 2002; 7(4):647-61. DOI: 10.1016/s1078-5337(05)70011-3. View

Hubmayr R . Perspective on lung injury and recruitment: a skeptical look at the opening and collapse story. Am J Respir Crit Care Med. 2002; 165(12):1647-53. DOI: 10.1164/rccm.2001080-01CP. View

Tremblay L, Miatto D, Hamid Q, Govindarajan A, Slutsky A . Injurious ventilation induces widespread pulmonary epithelial expression of tumor necrosis factor-alpha and interleukin-6 messenger RNA. Crit Care Med. 2002; 30(8):1693-700. DOI: 10.1097/00003246-200208000-00003. View

10.

Froese A . The incremental application of lung-protective high-frequency oscillatory ventilation. Am J Respir Crit Care Med. 2002; 166(6):786-7. DOI: 10.1164/rccm.2206005. View

11.

Derdak S, Mehta S, Stewart T, Smith T, Rogers M, Buchman T . High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. Am J Respir Crit Care Med. 2002; 166(6):801-8. DOI: 10.1164/rccm.2108052. View

12.

Pinhu L, Whitehead T, Evans T, Griffiths M . Ventilator-associated lung injury. Lancet. 2003; 361(9354):332-40. DOI: 10.1016/S0140-6736(03)12329-X. View

13.

Krishnan R, Meyers P, Worwa C, Goertz R, Schauer G, Mammel M . Standardized lung recruitment during high frequency and conventional ventilation: similar pathophysiologic and inflammatory responses in an animal model of respiratory distress syndrome. Intensive Care Med. 2004; 30(6):1195-203. DOI: 10.1007/s00134-004-2204-x. View

14.

Henzler D, Mahnken A, Dembinski R, Waskowiak B, Rossaint R, Kuhlen R . Repeated generation of the pulmonary pressure-volume curve may lead to derecruitment in experimental lung injury. Intensive Care Med. 2004; 31(2):302-10. DOI: 10.1007/s00134-004-2512-1. View

15.

Brederlau J, Muellenbach R, Kredel M, Greim C, Roewer N . High frequency oscillatory ventilation and prone positioning in a porcine model of lavage-induced acute lung injury. BMC Anesthesiol. 2006; 6:4. PMC: 1450271. DOI: 10.1186/1471-2253-6-4. View

16.

Corbridge T, Wood L, Crawford G, Chudoba M, Yanos J, Sznajder J . Adverse effects of large tidal volume and low PEEP in canine acid aspiration. Am Rev Respir Dis. 1990; 142(2):311-5. DOI: 10.1164/ajrccm/142.2.311. View

17.

McCulloch P, Forkert P, Froese A . Lung volume maintenance prevents lung injury during high frequency oscillatory ventilation in surfactant-deficient rabbits. Am Rev Respir Dis. 1988; 137(5):1185-92. DOI: 10.1164/ajrccm/137.5.1185. View

18.

Hallman M, Merritt T, Jarvenpaa A, BOYNTON B, Mannino F, Gluck L . Exogenous human surfactant for treatment of severe respiratory distress syndrome: a randomized prospective clinical trial. J Pediatr. 1985; 106(6):963-9. DOI: 10.1016/s0022-3476(85)80253-5. View

19.

Herman S, Reynolds E . Methods for improving oxygenation in infants mechanically ventilated for severe hyaline membrane disease. Arch Dis Child. 1973; 48(8):612-7. PMC: 1648592. DOI: 10.1136/adc.48.8.612. View

20.

CHENEY Jr F, Martin W . Effects of continuous positive-pressure ventilation on gas exchange in acute pulmonary edema. J Appl Physiol. 1971; 30(3):378-81. DOI: 10.1152/jappl.1971.30.3.378. View