Effect of Alterations in Mechanical Ventilator Settings on Pulmonary Gas Exchange in Hyaline Membrane Disease

Reynolds, Eor

doi:10.1136/adc.46.246.152

Cited by 144 publications

(35 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…11,[17][18][19][20][21] Indeed, this recommendation makes sense when maintaining a relatively constant V T . 15,22 However, our study demonstrates that the MFV strategy allows the clinician to provide higher frequencies. More importantly, our data are in keeping with data generated from neonatal studies in which conventional ventilation applied at higher breathing frequencies with pressure control ventilation (similar to MFV) led to improved ventilation outcomes.…”

Section: Discussionmentioning

confidence: 60%

Application of Mid-Frequency Ventilation in an Animal Model of Lung Injury: A Pilot Study

et al. 2014

View full text Add to dashboard Cite

BACKGROUND: Mid-frequency ventilation (MFV) is a mode of pressure control ventilation based on an optimal targeting scheme that maximizes alveolar ventilation and minimizes tidal volume (V T ). This study was designed to compare the effects of conventional mechanical ventilation using a lung-protective strategy with MFV in a porcine model of lung injury. Our hypothesis was that MFV can maximize ventilation at higher frequencies without adverse consequences. We compared ventilation and hemodynamic outcomes between conventional ventilation and MFV. METHODS: This was a prospective study of 6 live Yorkshire pigs (10 ؎ 0.5 kg). The animals were subjected to lung injury induced by saline lavage and injurious conventional mechanical ventilation. Baseline conventional pressure control continuous mandatory ventilation was applied with V T ‫؍‬ 6 mL/kg and PEEP determined using a decremental PEEP trial. A manual decision support algorithm was used to implement MFV using the same conventional ventilator. We measured P aCO 2 , P aO 2 , end-tidal carbon dioxide, cardiac output, arterial and venous blood oxygen saturation, pulmonary and systemic vascular pressures, and lactic acid. RESULTS: The MFV algorithm produced the same minute ventilation as conventional ventilation but with lower V T (؊1 ؎ 0.7 mL/kg) and higher frequency (32.1 ؎ 6.8 vs 55.7 ؎ 15.8 breaths/min, P < .002). There were no differences between conventional ventilation and MFV for mean airway pressures (16.1 ؎ 1.3 vs 16.4 ؎ 2 cm H 2 O, P ‫؍‬ .75) even when auto-PEEP was higher (0.6 ؎ 0.9 vs 2.4 ؎ 1.1 cm H 2 O, P ‫؍‬ .02). There were no significant differences in any hemodynamic measurements, although heart rate was higher during MFV. CONCLUSIONS: In this pilot study, we demonstrate that MFV allows the use of higher breathing frequencies and lower V T than conventional ventilation to maximize alveolar ventilation. We describe the ventilatory or hemodynamic effects of MFV. We also demonstrate that the application of a decision support algorithm to manage MFV is feasible.

show abstract

Section: Discussionmentioning

confidence: 60%

Application of Mid-Frequency Ventilation in an Animal Model of Lung Injury: A Pilot Study

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Both these therapeutic measures have been applied separately in clinical trials on patients with severe RDS, with favorable results (18,21,32).…”

mentioning

confidence: 99%

Combined Effects of Surfactant Substitution and Prolongation of Inspiration Phase in Artificially Ventilated Premature Newborn Rabbits

et al. 1982

View full text Add to dashboard Cite

SummaryPremature newborn rabbits, delivered by hysterotomy on day 27 of gestation, were tracheotomized at birth, kept in body plethysmographs, and subjected to pressure-generated ventilation at a working pressure of 25 cm H 20, 100% O2, and frequency 40/min. Thirty-seven animals received 50 ttl of heterologous surfactant (phospholipid content 40 mg/ml) via the tracheal cannula before onset of artificial ventilation, eight were ventilated with a positive end-expiratory pressure (PEEP) of 6 cm H 20, and 44 served as controls. All animals were ventilated in a randomized sequence of 2-min periods with 20, 40, 60, or 80% inspiration time. After the experiment the trachea was clamped at end-inspiration and the lungs fixed by immersion in formalin. Plethysmograph recordings of tidal volume revealed that lung-thorax compliance was low in control animals, even at inspiration time 80% (mean ± S.E. = 0.17 ± 0.03 mIlcm H 20.kg). In animals treated with surfactant or PEEP, compliance was significantly improved at all ventilator settings. The highest mean compliance values, obtained at 60% inspiration time were 0.91 ± 0.07 and 0.73 ± 0.14 mIlcm H 20 .kg in surfactant-and PEEP-treated animals, respectively. Compliance of surfactant-treated animals was significantly higher than that of PEEP-treated animals at inspiration time 40% (0.85 ± 0.07 versus 0.52 ± 0.13 mIlcm H20. kg; P < 0.05). The relative volume of the alveolar compartment, determined morphometrically in histologic sections and expressed as the alveolar expansion index (la), was significantly higher in surfactant-treated animals than in controls (1.60 ± 0.12 versus 0.74 ± 0.06; P < 0.005), but not improved in animals ventilated with PEEP. In animals receiving surfactant, la increased with the duration of the inspiration phase, from 0.99 ± 0.10 at 20% to 1.95 ± 0.22 at 80% inspiration time. There was also histologic evidence of enhanced recruitment of aerated alveoli in surfactant-treated animals ventilated with prolonged inspiration time. SpeculationThe air expansion of the premature neonatal lung can be enhanced to a significant degree by treatment with surfactant in combination with appropriate prolongation of the inspiration phase. Such a therapeutic regimen might be useful in the management of newborn infants with severe respiratory distress syndrome, requiring artificial ventilation; however, because excessive prolongation of the inspiration phase could have adverse effects on pulmonary hemodynamics and lead to hypoventilation with respiratory acidosis, the setting of the ventilator should be carefully adjusted with respect to the therapeutic response in patients with respiratory distress syndrome who are treated with supplementary surfactant. 921

show abstract

“…РОССИЙСКИЙ ВЕСТНИК ПЕРИНАТОЛОГИИ И ПЕДИАТРИИ, 2017; 62: (5) ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII, 2017; 62: (5) Формы наблюдения недоношенных детей в различных странах мира Последние 20 лет в США действует программа раннего вмешательства в виде части С законодатель-ства об образовании индивидуумов с нарушениями развития, известная как IDEA -Individuals with Disability Education Act. Эта часть разработана как сер-висная модель, включающая следующие элементы: индивидуальный план обслуживания/помощи семье, направленный на выявление специфических потреб-ностей и необходимых услуг для ребенка и поддерж-ку участия родителей в вопросах принятия решений; наличие координатора для облегчения взаимодей-ствия между различными сервисными службами; ин-теграция ребенка и семьи в общество; создание меж-ведомственных советов по координации сервисных служб; изменение плана по достижении ребенком возраста 3 лет; обеспечение обслуживания в условиях среды, где непосредственно находится ребенок [7][8][9].…”

Section: обзоры литературыunclassified

“…В результате исследовательской работы подобных центров в на-шей стране сформировался подход к недоношенно-сти как к состоянию с длительным периодом наблю-дения и медицинского сопровождения детей. (5) глубоконедоношенных детей [17]. Внедрение совре-менных акушерских и неонатальных стратегий (при-менение стероидов в антенатальном периоде с целью улучшения адаптации легких плода к родам, исполь-зование экзогенного сурфактанта с первых минут жизни ребенка в сочетании с подбором оптимальных режимов респираторной поддержки, внедрение мето-да СРАР -Continuous Positive Airways Pressure, вытес-нение пролонгированной интубации и механической вентиляции), оптимизация условий выхаживания и вскармливания привели к значительному сниже-нию частоты тяжелого поражения жизненно важных органов и ЦНС.…”

Section: обзоры литературыunclassified

“…ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII, 2017; 62: (5) программ -моделирования действий ухаживающего персонала в зависимости от поведения ребенка [31]. При проведении метаанализа с оценкой эффек-тивности развивающих индивидуальных программ статистически значимого снижения частоты внутри-желудочковых кровоизлияний, сроков функциониро-вания фетальных коммуникаций сердечно-сосудистой системы, некротизирующего энтероколита или рети-нопатии не выявлено.…”

Section: российский вестник перинатологии и педиатрии 2017; 62:(5)unclassified

See 1 more Smart Citation

Premature birth as a medical social problem. Part 3. Methods of premature infants follow-up

Сахарова¹,

Keshishyan²,

Alyamovskaya³

2017

Ross. vestn. perinatol. pediatr.

View full text Add to dashboard Cite

Effect of Alterations in Mechanical Ventilator Settings on Pulmonary Gas Exchange in Hyaline Membrane Disease

Cited by 144 publications

References 25 publications

Application of Mid-Frequency Ventilation in an Animal Model of Lung Injury: A Pilot Study

Application of Mid-Frequency Ventilation in an Animal Model of Lung Injury: A Pilot Study

Combined Effects of Surfactant Substitution and Prolongation of Inspiration Phase in Artificially Ventilated Premature Newborn Rabbits

Premature birth as a medical social problem. Part 3. Methods of premature infants follow-up

Contact Info

Product

Resources

About