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

Pellicano, Anastasia; Tingay, David G.; Mills, John F.; Fasulakis, Stephen; Morley, Colin J; Dargaville, Peter A.

doi:10.1007/s00134-009-1628-8

Cited by 51 publications

(36 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Initial aeration was achieved using only 0.4-s tidal inspiratory times, suggesting that the benefits were related to both the prevention of fluid efflux during early respiratory transition and optimization of volume history during subsequent tidal ventilation. The OLV PEEP strategy was applied over a longer period than just the single 30-s SI, illustrating the importance of recruitment as a function of pressure and time dependence (35). This supports the argument that PEEP, and how it is used, Articles maybe more important than the first inflation at birth.…”

Section: Discussionsupporting

confidence: 69%

“…Finally, although pneumothoraces were not found in our study population, reports in similar preterm lamb studies (6,17), and some human studies of SI (18,19), illustrate that the interaction between applied pressure and air leak in the preterm lung is not well understood. Interesting, in the already-aerated lung, air leak has not been a feature of OLV strategies in human (31,33) and animal studies (32,34,35).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The interrelationship of recruitment maneuver at birth, antenatal steroids, and exogenous surfactant on compliance and oxygenation in preterm lambs

et al. 2016

Self Cite

View full text Add to dashboard Cite

Background:To describe the interrelationship between antenatal steroids, exogenous surfactant, and two approaches to lung recruitment at birth on oxygenation and respiratory system compliance (C dyn ) in preterm lambs. Methods: Lambs (n = 63; gestational age 127 ± 1 d) received either surfactant at 10-min life (Surfactant), antenatal corticosteroids (Steroid), or neither (Control). Within each epoch lambs were randomly assigned to a 30-s 40 cmH 2 O sustained inflation (SI) or an initial stepwise positive end-expiratory pressure (PEEP) open lung ventilation (OLV) maneuver at birth. All lambs then received the same management for 60-min with alveolar-arterial oxygen difference (AaDO 2 ) and C dyn measured at regular time points. results: Overall, the OLV strategy improved C dyn and AaDO 2 (all epochs except Surfactant) compared to SI (all P < 0.05; twoway ANOVA). Irrespective of strategy, C dyn was better in the Steroid group in the first 10 min (all P < 0.05). Thereafter, C dyn was similar to Steroid epoch in the OLV + Surfactant, but not SI + Surfactant group. OLV influenced the effect of steroid and surfactant (P = 0.005) on AaDO 2 more than SI (P = 0.235). conclusions: The antenatal state of the lung influences the type and impact of a recruitment maneuver at birth. The effectiveness of surfactant maybe enhanced using PEEPbased time-dependent recruitment strategies rather than approaches solely aimed at initial lung liquid clearance.i t is widely agreed that the optimal support of the preterm lung involves the combination of antenatal corticosteroid exposure, exogenous surfactant therapy, and early application of lung protective respiratory support strategies (1). Together, these therapies reduce the potential of assisted ventilation to injure the developmentally immature, surfactant-deficient preterm lung. The roles of early exogenous surfactant therapy (2) and antenatal corticosteroids (3) in improving lung mechanics, functional residual capacity, and reducing respiratory support are well established. The optimal respiratory support strategies are still debated (4-7).Ideally, lung protective respiratory support should commence during transition to ex utero life (1,8). During this period, the infant must rapidly clear lung liquid, aerate the lung, establish a functional residual capacity, and commence tidal ventilation, processes influenced by the intrinsic mechanical properties of the lung as well as the applied respiratory strategy (5,6,9-13). The optimal approach in preterm infants remains unclear but broadly requires an inflating pressure to drive fetal lung fluid into the alveoli and allow lung aeration, and positive end-expiratory pressure (PEEP) to maintain aeration and prevent fluid efflux back into the airways (14-17). In preterm animals, using an initial stepwise PEEP or open lung ventilation (OLV) approach during tidal ventilation from birth improves aeration and short-term respiratory outcomes in preterm animals via utilizing hysteresis and time dependency (6,11). However, clinical trials at birth...

show abstract

Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

The interrelationship of recruitment maneuver at birth, antenatal steroids, and exogenous surfactant on compliance and oxygenation in preterm lambs

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…Clinicians rely on monitoring chest expansion; however, this is a poor indicator of V T (14), and many infants can receive inappropriate V T within minutes of birth (15). Alternative strategies have been proposed for aerating lung volume, including sustained initial breaths (16) and a ramped increase in endexpiratory pressure (17). Although such strategies appear beneficial in establishing lung gas volumes and decreasing pulmonary compliance, they may be detrimental to the circulation and possibly the immature brain.…”

Section: Hemodynamic Consequences Of the Initiation Of Positive Pressmentioning

confidence: 99%

Respiratory support for premature neonates in the delivery room: effects on cardiovascular function and the development of brain injury

et al. 2014

View full text Add to dashboard Cite

“…52 This study showed that a step-wise pressure increase produced the greatest increase in lung volume and resolution of atelectasis. Thus, this study suggests that the stepwise increase pressure approach might be considered for optimizing lung volume during HFOV, as it incorporates not only pressure but also adequate duration of the RM.…”

Section: Best Hfov Approach and Oscillator Settings For Oxygenationmentioning

confidence: 74%

“…A positive effect of sustained inflations prior to the stepwise increase in CDP has not been demonstrated. 52,63 HFOV may also be considered in patients with refractory OAD. However, in these patients the purpose of the stepwise increase in CDP is to splint open and stent the airways to a certain point when the P aCO 2 starts to drop, in order to prevent relatively healthy alveoli being exposed to high pressures once the airways are open.…”

Section: Best Hfov Approach and Oscillator Settings For Oxygenationmentioning

confidence: 99%

Reflections on Pediatric High-Frequency Oscillatory Ventilation From a Physiologic Perspective

2012

View full text Add to dashboard Cite

Mechanical ventilation using low tidal volumes has become universally accepted to prevent ventilator-induced lung injury. High-frequency oscillatory ventilation (HFOV) allows pulmonary gas exchange using very small tidal volume (1-2 mL/kg) with concomitant decreased risk of atelectrauma. However, its use in pediatric critical care varies between only 3% and 30% of all ventilated children. This might be explained by the fact that the beneficial effect of HFOV on patient outcome has not been ascertained. Alternatively, in contrast with present recommendations, one can ask if HFOV has been employed in its most optimal fashion related especially to the indications for and timing of HFOV, as well as to using the best oscillator settings. The first was addressed in one small randomized study showing that early use of HFOV, instead of rescue use, was associated with improved survival. From a physiologic perspective, the oscillator settings could be refined. Lung volume is the main determinant of oxygenation in diffuse alveolar disease, suggesting using an open-lung strategy by recruitment maneuvers, although this is in practice not custom. Using such an approach, the patient can be oscillated on the deflation limb of the pressurevolume (P-V) curve, allowing less pressure required to maintain a certain amount of lung volume. Gas exchange is determined by the frequency and the oscillatory power setting, controlling the magnitude of the membrane displacement. Experimental work as well as preliminary human data have shown that it is possible to achieve the smallest tidal volume with concomitant adequate gas exchange when oscillating at high frequency and high fixed power setting. Future studies are needed to validate these novel approaches and to evaluate their effect on patient outcome.

show abstract

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

Abstract: Escalating recruitment produced the greatest increase in lung volume and resolution of atelectasis, and is recommended for lung volume recruitment upon initiation of HFOV.

Cited by 51 publications

References 41 publications

The interrelationship of recruitment maneuver at birth, antenatal steroids, and exogenous surfactant on compliance and oxygenation in preterm lambs

The interrelationship of recruitment maneuver at birth, antenatal steroids, and exogenous surfactant on compliance and oxygenation in preterm lambs

Respiratory support for premature neonates in the delivery room: effects on cardiovascular function and the development of brain injury

Reflections on Pediatric High-Frequency Oscillatory Ventilation From a Physiologic Perspective

Contact Info

Product

Resources

About