Changes in Lung Volume and Ventilation during Lung Recruitment in High-Frequency Ventilated Preterm Infants with Respiratory Distress Syndrome

Miedema, Martijn; Jongh, Frans de; Frerichs, Inéz; Veenendaal, Mariëtte B. van; Kaam, Anton H. van

doi:10.1016/j.jpeds.2011.01.066

Cited by 79 publications

(91 citation statements)

References 23 publications

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“…Our study shows that the changes in Vosc during lung recruitment are evenly distributed across the ventral and dorsal lung regions, supporting previous findings that RDS is a relatively homogenous lung disease [21,22].…”

Section: Discussionsupporting

confidence: 92%

“…We did, however, find a significantly higher increase in Vosc in the right lung compared with the left lung. This right-sided predominance is probably best explained by the presence of the heart in the left hemithorax [21,26].…”

Section: Discussionmentioning

confidence: 99%

“…The first phase of the study consisted of an oxygenationguided, individualised lung recruitment procedure, aiming to place ventilation on the deflation limb of the pressure-volume curve [20,21]. All patients were ventilated with a Sensormedics 3100A oscillator (CareFusion, Yorba Linda, CA, USA), starting at a continuous distending pressure (CDPst) of 6-8 cmH 2 O and pressure amplitude resulting in visible oscillations of the chest, with a frequency of 10 Hz and an inspiration time of 33%.…”

Section: Ventilation Protocolmentioning

confidence: 99%

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The effect of airway pressure and oscillation amplitude on ventilation in pre-term infants

Miedema

Jongh

Frerichs³

et al. 2012

Eur Respir J

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We determined the effect of lung recruitment and oscillation amplitude on regional oscillation volume and functional residual capacity (FRC) in high-frequency oscillatory ventilation (HFOV) used in pre-term infants with respiratory distress syndrome (RDS).Changes in lung volume, oscillation volume and carbon dioxide levels were recorded in 10 infants during a stepwise recruitment procedure, and an increase in pressure amplitude of 5 cmH 2 O was measured using electrical impedance tomography and transcutaneous monitoring. The pressures at maximal respiratory system compliance, maximal oscillation volume and minimal carbon dioxide levels were determined. Impedance data were analysed for the chest cross-section and predefined regions of interest.Despite the fixed pressure amplitude, the oscillation volume changed during the incremental pressure steps following a parabolic pattern, with an inverse relationship to the carbon dioxide pressures. The pressures corresponding with maximal compliance, maximal oscillation volume and minimal carbon dioxide were similar and highly correlated. Regional analysis showed similar findings. The increase in pressure amplitude resulted in increased oscillation volumes and decreased carbon dioxide levels, while FRC remained unchanged.In HFV pre-term infants with RDS, oscillation volumes are closely related to the position of ventilation in the pressure-volume envelope and the applied pressure amplitude. Changes in pressure amplitude do not seem to affect FRC.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Ventilation Protocolmentioning

confidence: 99%

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The effect of airway pressure and oscillation amplitude on ventilation in pre-term infants

Miedema

Jongh

Frerichs³

et al. 2012

Eur Respir J

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“…Oxygenation is the most commonly used indicator of the volumetric response to P AW (4,6,7,30), but its sensitivity to detect subtle regional volume changes is poor, it is insensitive to tissue distension and unable to define a narrow optimal point of ventilation (7,26,31). Our study suggested that oxygenation requires significant heterogeneous derecruitment before appreciable change was observed.…”

Section: Optimizing Hfov By Lung Mechanicsmentioning

confidence: 76%

Optimal mean airway pressure during high-frequency oscillatory ventilation determined by measurement of respiratory system reactance

et al. 2013

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Background:The aims of the present study were (i) to characterize the relationship between mean airway pressure (P AW ) and reactance measured at 5 Hz (reactance of the respiratory system (X RS ) , forced oscillation technique) and (ii) to compare optimal P AW (P opt ) defined by X RS , oxygenation, lung volume (V L ), and tidal volume (V T ) in preterm lambs receiving high-frequency oscillatory ventilation (HFOV). Methods: Nine 132-d gestation lambs were commenced on HFOV at P AW of 14 cmH 2 O (P start ). P AW was increased stepwise to a maximum pressure (P max ) and subsequently sequentially decreased to the closing pressure (P cl , oxygenation deteriorated) or a minimum of 6 cmH 2 O, using an oxygenation-based recruitment maneuver. X RS , regional V L (electrical impedance tomography), and V T were measured immediately after (t 0min ) and 2 min after (t 2min ) each P AW decrement. P opt defined by oxygenation, X RS , V L , and V T were determined. results: The P AW -X RS and P AW -V T relationships were dome shaped with a maximum at P cl +6 cmH 2 O, the same point as P opt defined by V L . Below P cl +6 cmH 2 O, X RS became unstable between t 0min and t 2min and was associated with derecruitment in the dependent lung. P opt , as defined by oxygenation, was lower than the P opt defined by X RS , V L , or V T . conclusion: X RS has the potential as a bedside tool for optimizing P AW during HFOV. h igh-frequency oscillatory ventilation (HFOV) is used to treat severe neonatal lung disease and has the potential to reduce ventilator-induced lung injury when applied optimally (1,2). HFOV optimally applied aims to recruit the lung and subsequently reduce mean airway pressure (P AW ) to an optimal pressure (P opt ) that achieves optimal lung recruitment at the lowest distending pressure (open lung strategy) (3,4). However, identification and maintenance of P opt remains challenging, particularly in the newly born, whose lungs are in a highly dynamic state because of fluid reabsorption and establishment of functional residual capacity (5). The lack of appropriate tools for the bedside assessment and continuous monitoring of lung function in infants makes targeting of P opt even more difficult.Oxygenation, evaluated by monitoring oxygen saturation (Sp O2 ), is most commonly used for targeting P opt during HFOV in clinical practice (6). However, Sp O2 is an imperfect guide for P AW titration as it is relatively uniform over a wide range of airway pressures and volumes (7). Beginning with the observations of Suter et al. (8), the notion that lung mechanics can guide pressure settings during mechanical ventilation has been examined carefully. For conventional ventilation, a relationship between end-expiratory lung volume (V L ), recruitment, and tidal breath mechanics has been demonstrated repeatedly (9,10). During HFOV, the same theoretical considerations apply (3), but the best means of assessing the mechanics of the oscillated lung remains unclear.A promising approach to noninvasive bedside assessment of lung mechanics ...

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“…Indeed, it has been found that end-expiratory lung volume (EELV) increases and stabilises in newborns treated with surfactant [48]. Finally, EIT enables monitoring of lung volume changes during oscillatory ventilation in preterm infants [49,50].…”

Section: Discussionmentioning

confidence: 99%

Tomografia impedancyjna w diagnostyce i monitorowaniu zaburzeń funkcji płuc na oddziale intensywnej terapii — opis przypadku i przegląd piśmiennictwa

Białka

Copik

Rybczyk

et al. 2017

Anaesthesiol Intensive Ther

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The aim of this paper is to describe the possibility of using Electrical Impedance Tomography (EIT) as a treatment monitoring tool in the ICU. It was based on case report and literature review. A 19-year-old female was admitted to ICU due to severe acute respiratory distress syndrome. Despite aggressive treatment there was no improvement. We decided to use EIT in the monitoring of treatment because of difficulties in transporting the patient to the radiology department in order to perform a control CT scan. After identifying the causing factor (Pneumocyctis jiroveci), EIT monitoring was maintained to assess the effectiveness of targeted microbial treatment. In the following days, we observed an improvement of regional ventilation of the upper and middle segments of the left lung that corresponded well with laboratory test results, especially arterial blood gas analysis. The use of Electrical Impedance Tomography enables non-invasive, bedside, continuous assessment of regional lung ventilation. It is possible to use it in both mechanically ventilated and spontaneously breathing patients. It allows efficient and dynamic monitoring of the course of the therapeutic process. Interpretation of the results is relatively easy to learn and does not require specialist knowledge. Moreover, it is possible to use EIT in those cases where other methods are of high risk or contraindicated.

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Changes in Lung Volume and Ventilation during Lung Recruitment in High-Frequency Ventilated Preterm Infants with Respiratory Distress Syndrome

Cited by 79 publications

References 23 publications

The effect of airway pressure and oscillation amplitude on ventilation in pre-term infants

The effect of airway pressure and oscillation amplitude on ventilation in pre-term infants

Optimal mean airway pressure during high-frequency oscillatory ventilation determined by measurement of respiratory system reactance

Tomografia impedancyjna w diagnostyce i monitorowaniu zaburzeń funkcji płuc na oddziale intensywnej terapii — opis przypadku i przegląd piśmiennictwa

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