Combination of Arteriovenous Extracorporeal Lung Assist and High-Frequency Oscillatory Ventilation in a Porcine Model of Lavage-Induced Acute Lung Injury: A Randomized Controlled Trial

Brederlau, Joerg; Muellenbach, Ralf Michael; Kredel, Markus; Kuestermann, Julian; Anetseder, Martin; Greim, Clemens‐Alexander; Roewer, Norbert

doi:10.1097/01.ta.0000221667.32598.71

Cited by 9 publications

(6 citation statements)

References 42 publications

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“…Lung-protective ventilation focuses on minimizing end-inspiratory stretch (using low tidal volumes) and minimizing derecruitment of the lung (application of PEEP). [ 4 , 7 ] However, even with protective mechanical ventilation recent studies have shown that acute lung injury continues to occur, with a paucity of effective therapeutic modalities. [ 8 ] Furthermore, several recent studies have documented that failure to recognize ARDS and implement timely lung protective strategies remains a widespread problem in intensive care units.…”

Section: Introductionmentioning

confidence: 99%

Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model

et al. 2017

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BackgroundPositive-pressure mechanical ventilation is an essential therapeutic intervention, yet it causes the clinical syndrome known as ventilator-induced lung injury. Various lung protective mechanical ventilation strategies have attempted to reduce or prevent ventilator-induced lung injury but few modalities have proven effective. A model that isolates the contribution of mechanical ventilation on the development of acute lung injury is needed to better understand biologic mechanisms that lead to ventilator-induced lung injury.ObjectivesTo evaluate the effects of positive end-expiratory pressure and recruitment maneuvers in reducing lung injury in a ventilator-induced lung injury murine model in short- and longer-term ventilation.Methods5–12 week-old female BALB/c mice (n = 85) were anesthetized, placed on mechanical ventilation for either 2 hrs or 4 hrs with either low tidal volume (8 ml/kg) or high tidal volume (15 ml/kg) with or without positive end-expiratory pressure and recruitment maneuvers.ResultsAlteration of the alveolar-capillary barrier was noted at 2 hrs of high tidal volume ventilation. Standardized histology scores, influx of bronchoalveolar lavage albumin, proinflammatory cytokines, and absolute neutrophils were significantly higher in the high-tidal volume ventilation group at 4 hours of ventilation. Application of positive end-expiratory pressure resulted in significantly decreased standardized histology scores and bronchoalveolar absolute neutrophil counts at low- and high-tidal volume ventilation, respectively. Recruitment maneuvers were essential to maintain pulmonary compliance at both 2 and 4 hrs of ventilation.ConclusionsSigns of ventilator-induced lung injury are evident soon after high tidal volume ventilation (as early as 2 hours) and lung injury worsens with longer-term ventilation (4 hrs). Application of positive end-expiratory pressure and recruitment maneuvers are protective against worsening VILI across all time points. Dynamic compliance can be used guide the frequency of recruitment maneuvers to help ameloriate ventilator-induced lung injury.

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Section: Introductionmentioning

confidence: 99%

Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model

et al. 2017

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“…In some cases the extent of the lung injury is rather severe, with a PaO 2 ! 40-60 mm Hg [23,24] , or just moderate with a PaO 2 ! 300 mm Hg [11,20] .…”

Section: Lav Modelmentioning

confidence: 99%

Overview of the Pathology of Three Widely Used Animal Models of Acute Lung Injury

Wang

Bodenstein²,

Markstaller³

2008

Eur Surg Res

153

140

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Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are syndromes of acute diffuse damage to the pulmonary parenchyma by a variety of local or systemic insults. Increased alveolar capillary membrane permeability was recognized as the common end organ injury and a central feature in all forms of ALI/ARDS. Although great strides have been made in understanding the pathogenesis of ALI/ARDS and in intensive care medicine, the treatment approach to ARDS is still relying on ventilatory and cardiovascular support based on the recognition of the clinical picture. In the course of evaluating novel treatment approaches to ARDS, 3 models of ALI induced in different species, i.e. the surfactant washout lavage model, the oleic acid intravenous injection model and the endotoxin injection model, were widely used. This review gives an overview of the pathological characteristics of these models from studies in pigs, dogs or sheep. We believe that a good morphological description of these models, both spatially and temporally, will help us gain a better understanding of the real pathophysiological picture and apply these models more accurately and liberally in evaluating novel treatment approaches to ARDS.

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“…The use of animals in randomized trials has been effective in the study of endoscopic and surgical techniques. [18][19][20][21][22][23][24] There was focal necrosis detected at the margin of the transection in the ETDP group, without consequences in terms of clinical parameters and survival. The only pancreatic leak and postprocedure death occurred in a swine in the laparoscopic group.…”

Section: Discussionmentioning

confidence: 93%

Natural orifice versus conventional laparoscopic distal pancreatectomy in a porcine model: a randomized, controlled trial

Willingham

Gee

Sylla

et al. 2009

Gastrointestinal Endoscopy

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Combination of Arteriovenous Extracorporeal Lung Assist and High-Frequency Oscillatory Ventilation in a Porcine Model of Lavage-Induced Acute Lung Injury: A Randomized Controlled Trial

Abstract: The combination of AV-ECLA and HFOV resulted in normocapnia and comparable Pao2, although a smaller ventilator pressure amplitude was applied. Long-term animal studies are needed to assess whether this approach results in further lung protection.

Cited by 9 publications

References 42 publications

Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model

Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model

Overview of the Pathology of Three Widely Used Animal Models of Acute Lung Injury

Natural orifice versus conventional laparoscopic distal pancreatectomy in a porcine model: a randomized, controlled trial

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