Comparison of four methods of lung volume recruitment during high frequency oscillatory ventilation

Analysis of Variance Pulmonary Atelectasis Respiratory Distress Syndrome, Newborn Cross-Over Studies Time Factors Pulmonary Gas Exchange Swine Airway Resistance Infant, Newborn Oxygen Inhalation Therapy High-Frequency Ventilation Disease Models, Animal Random Allocation 03 medical and health sciences 0302 clinical medicine Animals, Newborn Tidal Volume Animals Humans Blood Gas Analysis Lung Volume Measurements Tomography, X-Ray Computed
DOI: 10.1007/s00134-009-1628-8 Publication Date: 2009-09-14T13:35:36Z
ABSTRACT
To compare four methods of volume recruitment upon initiation of high frequency oscillatory ventilation (HFOV).Anesthetized intubated neonatal piglets (n = 10) underwent repeated saline lavage, followed by conventional mechanical ventilation (CMV). After transition to HFOV at a mean airway pressure 8 cmH2O above CMV (P(basal)), four methods of lung volume recruitment were tested in each animal in random order: Escalating--step-wise pressure increments over 6 min to a peak mean airway pressure 12 cmH2O above P(basal); Sustained dynamic inflation (DI)--a 20 s inflation to the same peak pressure; DI repeated six times for 1 s; Standard--mean airway pressure set directly at P(basal). After each recruitment method, HFOV continued at P(basal) for 15 min. Thoracic gas volume and distribution of aeration were determined by single slice computed tomography, and oxygenation by arterial blood gas sampling.Escalating recruitment resulted in the greatest thoracic gas volume 15 min post recruitment [77 +/- 3.3% of total lung capacity vs. 70 +/- 4.2% (Sustained DI), 65 +/- 3.5% (Repeated DI),63 +/- 5.1% (Standard); mean +/- SEM; P = 0.042, ANOVA]. All methods resulted in a reduction in non-aerated lung, with the greatest redistribution to normally aerated lung being with Escalating recruitment. Oxygenation 15 min post recruitment was better with the Escalating method than with Repeated DI or Standard recruitment (pO2 307 +/- 41 vs. 159 +/- 36 vs. 134 +/- 39 mmHg, respectively; P = 0.016, ANOVA).Escalating recruitment produced the greatest increase in lung volume and resolution of atelectasis, and is recommended for lung volume recruitment upon initiation of HFOV.
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