Effects of positive end-expiratory pressure on hyaline membrane formation in a rabbit model of the neonatal respiratory distress syndrome

Sandhar, B. K.; Niblett, David; Argiras, E.; Dunnill, M. S.; Sykes, M.K.

doi:10.1007/bf00263527

Cited by 158 publications

(67 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is because PEEP increases lung volume (8 -11), surface area, and compliance (6,8,12). Increasing the PEEP lowers expiratory resistance (12), conserves surfactant (6), and reduces hyaline membrane formation (12)(13)(14), alveolar collapse, and the expression of proinflammatory mediators (15). Without PEEP, the lung volume falls in intubated ventilated infants (16).…”

mentioning

confidence: 99%

Positive End Expiratory Pressure during Resuscitation of Premature Lambs Rapidly Improves Blood Gases without Adversely Affecting Arterial Pressure

et al. 2004

View full text Add to dashboard Cite

Positive end expiratory pressure (PEEP) is important for neonatal ventilation but is not considered in guidelines for resuscitation. Our aim was to investigate the effects of PEEP on cardiorespiratory parameters during resuscitation of very premature lambs delivered by hysterotomy at~125 d gestation (term 147 d). Before delivery, they were intubated and lung fluid was drained. Immediately after delivery, they were ventilated with a Dräger Babylog plus ventilator in volume guarantee mode with a tidal volume of 5 mL/kg. Lambs were randomized to receive 0, 4, 8, or 12 cm H 2 O of PEEP. They were ventilated for a 15-min resuscitation period followed by 2 h of stabilization at the same PEEP. Tidal volume, peak inspiratory pressure, PEEP, arterial pressure, oxygen saturation, and blood gases were measured regularly, and respiratory system compliance and alveolar/ arterial oxygen differences were calculated. Lambs that received 12 cm H 2 O of PEEP died from pneumothoraces; all others survived without pneumothoraces. Oxygenation was significantly improved by 8 and 12 cm H 2 O of PEEP compared with 0 and 4 cm H 2 O of PEEP. Lambs with 0 PEEP did not oxygenate adequately. The compliance of the respiratory system was significantly higher at 4 and 8 cm H 2 O of PEEP than at 0 PEEP. There were no significant differences in partial pressure of carbon dioxide in arterial blood between groups. Arterial pressure was highest with 8 cm H 2 O of PEEP, and there was no cardiorespiratory compromise at any level of PEEP. Applying PEEP during resuscitation of very premature infants might be advantageous and merits further investigation. At birth, the lungs of premature infants are completely airless, fluid filled, surfactant deficient, and noncompliant. It is common for these infants to require ventilation after birth. The recommended technique of resuscitating infants is with a neonatal resuscitation bag (1,2) connected to a face mask or endotracheal tube. The most common devices used do not provide positive end expiratory pressure (PEEP) and therefore may contribute to atelectasis, acute lung injury (3), and hyaline membrane formation. Although PEEP valves are available for self-inflating resuscitation bags, they are not in common use or recommended. PEEP and continuous positive airway pressure (CPAP)

show abstract

mentioning

confidence: 99%

Positive End Expiratory Pressure during Resuscitation of Premature Lambs Rapidly Improves Blood Gases without Adversely Affecting Arterial Pressure

et al. 2004

View full text Add to dashboard Cite

show abstract

“…This may also explain why the proinflammatory mediator levels were lower in the HFOV group than in the CV group as HFOV by itself targets homogeneous alveolar recruitment. Conversely, ventilation strategies which permit inhomogeneous inflation result in pronounced atelectasis, require high inflation pressures with partial overdistension of the lung, and lead to progressive structural injury with pulmonary inflammation (1,26).…”

Section: Discussionmentioning

confidence: 99%

Partial Liquid Ventilation Reduces Release of Leukotriene B4 and Interleukin-6 in Bronchoalveolar Lavage in Surfactant-Depleted Newborn Pigs

Merz¹,

Klosterhalfen

Häusler³

et al. 2002

Pediatr Res

View full text Add to dashboard Cite

Perfluorocarbons have been shown to reduce the inflammatory process generated by alveolar macrophages in vitro. The aim of this study was to evaluate the impact of different ventilator modalities such as partial liquid ventilation (PLV), conventional ventilation (CV), and high-frequency oscillatory ventilation (HFOV) on the release of inflammatory mediators in vivo. Acute lung injury was induced in 30 male piglets by repeated saline lavage (arterial oxygen tension, Ͻ60 mm Hg; fraction of inspired oxygen, 1.0). Thereafter, animals were randomly assigned to one of five groups of six animals each: 1) 24 h of CV; 2) 24 h of CV plus surfactant therapy (SϩCV); 3) 24 h of HFOV plus surfactant therapy (SϩHFOV); 4) 1 h of PLV followed by 23 h of CV (PLV); and 5) 24 h of CV without previous lung injury (control group). Piglets randomized to SϩCV or SϩHFOV received natural surfactant (100 mg/kg). PLV with FC-77 was started in an initial dose of 30 mL/kg over 30 min followed by 0.5 mL·kg Ϫ1 ·min Ϫ1 for another 30 min. After 1 h of PLV the animals were conventionally ventilated for 23 h. Before acute lung injury and after 24 h the number of inflammatory cells and the levels of IL-6, leukotriene B 4 , and tumor necrosis factor-␣ were measured in the bronchoalveolar lavage fluid. Additionally, the oxygenation index and the histopathologic damage were evaluated. Before acute lung injury, the number of inflammatory cells and the levels of mediators in bronchoalveolar lavage fluid were not different among the groups. After 24 h, the number of granulocytes in the PLV group was as low as in the control group. leukotriene B 4 and IL-6 levels were found to be elevated in all groups except the control group (p Ͻ 0.01). The release of leukotriene B 4 and IL-6 was lowest in the PLV group when compared with SϩHFOV, SϩCV, or CV (p Ͻ 0.05). No differences among the groups were detected for tumor necrosis factor-␣. Although the concentrations of leukotriene B 4 and IL-6 after PLV were lowest in the PLV group, histopathologic evidence of damage and the oxygenation index in the PLV group did not differ from that found in the SϩCV or SϩHFOV groups. In conclusion, PLV with perfluorocarbons may protect the lung from acute pulmonary inflammation more effectively than CV or HFOV does. Mechanical ventilation of the S-deficient lung may cause ALI in children and adults (1). Despite the widespread use of S, preferentially extremely premature infants are at high risk to develop chronic lung disease as result of the ALI (2, 3). Although the pathogenesis of chronic lung disease is very complex, pulmonary inflammation seems to play a major role in the development of this disease (4, 5). The severity of the ALI and the subsequent process of pulmonary inflammation can be modified by improved ventilation strategies.

show abstract

“…This was fully defined in animal models, but the significance in humans has not been established. Several studies suggest that the adverse effects of mechanical ventilation can be reduced by the application of PEEP (Webb HH et al 1974;Argiras EP et al 1987;Dreyfuss D et al 1988;Sandhar BK et al 1988;Yardimci Ç et al, 2001). Ventilation washed isolated rat lung airways with low volume (5-6 mL/kg) and low PEEP or PEEP equal to zero, causing lung injury that can be reduced by high levels of PEEP (Muscedere JG et al, 1994).…”

Section: # Paco2 -The Partial Pressure Of Carbon Dioxide In Arterial mentioning

confidence: 99%

Comparative analysis of changes in the lungs of experimental animals’ induced conventional and lung protective ventilation

Videnović

Mladenović²,

Videnovic³

et al. 2018

J Hellenic Vet Med Soc

View full text Add to dashboard Cite

Mechanical ventilation has long been the leader in the treatment of critically ill and injured patients in an intensive care unit. The aim of this study was to examine the impact of the application of positive end-expiratory pressure on histopathological findings and on the parameters of ventilation, oxygenation and acid-base status. The experimental study included 42 animals (piglets), which were divided into of tree groups, each containing 14. The animals of the control group (conventional ventilation) were ventilated with the tidal volume of 10-15 mL/kg. Tidal volume of 6 mL/kg was applied in the low tidal ventilation group, whereas the ventilation strategy in the lung protective ventilation group meant the application of a tidal volume of 6 mL/kg and the 7 mbar of positive end-expiratory pressure. Mechanical ventilation in each animal lasted for 4 hours. After conducting mechanical ventilation, samples were taken from the lung tissue, which were sent for histopathological examination. The parameters of ventilation, oxygenation and acid-base status were measured after each hour’s duration of mechanical ventilation. Application of positive end-expiratory pressure 5-10 mbar during mechanical ventilation is a safe and useful method which is not followed by the occurrence of significant abnormalities in the structure of the ventilated lung. However, a low tidal volume without positive end-expiratory pressure causes significant changes in the histological structure of healthy lungs. Positive end-expiratory pressure keeps the alveoli open throughout the respiratory cycle which allows the lungs to maintain homeostasis in terms of adequate ventilation, oxygenation and acid-base status.

show abstract

Effects of positive end-expiratory pressure on hyaline membrane formation in a rabbit model of the neonatal respiratory distress syndrome

Cited by 158 publications

References 24 publications

Positive End Expiratory Pressure during Resuscitation of Premature Lambs Rapidly Improves Blood Gases without Adversely Affecting Arterial Pressure

Positive End Expiratory Pressure during Resuscitation of Premature Lambs Rapidly Improves Blood Gases without Adversely Affecting Arterial Pressure

Partial Liquid Ventilation Reduces Release of Leukotriene B4 and Interleukin-6 in Bronchoalveolar Lavage in Surfactant-Depleted Newborn Pigs

Comparative analysis of changes in the lungs of experimental animals’ induced conventional and lung protective ventilation

Contact Info

Product

Resources

About