Gas exchange mechanisms in preterm infants on HFOV – a computational approach

Roth, Christian; Förster, Kai; Hilgendorff, Anne; Ertl‐Wagner, Birgit; Wall, Wolfgang A.; Flemmer, Andreas W.

doi:10.1038/s41598-018-30830-x

Cited by 21 publications

(28 citation statements)

References 29 publications

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“…Moreover, in vivo flow data in neonatal HFV are still beyond reach despite progress with magnetic resonance imaging-based modalities using hyper-polarized gases [24,25]. A recent numerical simulation on a premature neonatal lung model [26] recognized the existence of various transport mechanisms, but the debate persists on whether flows under HFV are indeed fundamentally different from CMV [27], as is often described [28,29]. Several studies have alluded to the increase in convective-driven recirculation from local secondary flows [30,31] and pendelluft [32][33][34] near reversal times between inhalation and exhalation.…”

Section: Introductionmentioning

confidence: 99%

Ventilation-induced jet suggests biotrauma in reconstructed airways of the intubated neonate

Nof

Heller-Algazi

Coletti

et al. 2020

J. R. Soc. Interface.

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We investigate respiratory flow phenomena in a reconstructed upper airway model of an intubated neonate undergoing invasive mechanical ventilation, spanning conventional to high-frequency ventilation (HFV) modes. Using high-speed tomographic particle image velocimetry, we resolve transient, three-dimensional flow fields and observe a persistent jet flow exiting the endotracheal tube whose strength is directly modulated according to the ventilation protocol. We identify this synthetic jet as the dominating signature of convective flow under intubated ventilation. Concurrently, our in silico wall shear stress analysis reveals a hitherto overlooked source of ventilator-induced lung injury as a result of jet impingement on the tracheal carina, suggesting damage to the bronchial epithelium; this type of injury is known as biotrauma. We find HFV advantageous in mitigating the intensity of such impingement, which may contribute to its role as a lung protective method. Our findings may encourage the adoption of less invasive ventilation procedures currently used in neonatal intensive care units.

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Section: Introductionmentioning

confidence: 99%

Ventilation-induced jet suggests biotrauma in reconstructed airways of the intubated neonate

Nof

Heller-Algazi

Coletti

et al. 2020

J. R. Soc. Interface.

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“… 16 In contrast to conventional mechanical ventilation, HFOV can deliver tidal volume smaller than respiratory dead space to alveoli. 19 HFOV transfer gas by various mechanisms which includes turbulent vortices in larger airways, asymmetric velocity profiles during inspiration and expiration, radial mixing in main bronchi, laminar airflow with Taylor dispersion in higher generations of the respiratory tract, pendelluft, direct ventilation of central alveoli, and molecular diffusion. 19 , 20 All these mechanisms are interdependent, and the open airway strategy may improve airflow at larger airways initially and small peripheral airways over time.…”

Section: Discussionmentioning

confidence: 99%

“… 19 , 20 All these mechanisms are interdependent, and the open airway strategy may improve airflow at larger airways initially and small peripheral airways over time. 16 , 19 …”

Section: Discussionmentioning

confidence: 99%

High-frequency oscillatory ventilation as a rescue for severe asthma crisis in a child

Sharma

Hack-Prestinary

Vidal

2020

SAGE Open Medical Case Reports

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Mechanical ventilation in the asthmatic child may be complicated by dynamic air trapping leading to hemodynamic compromise and cardiac arrest. High-frequency oscillatory ventilation is relatively contraindicated because it may cause hyperinflation compared to conventional mechanical ventilation. A 2-year-old girl (weight, 11 kg) with a history of asthma was admitted because of status asthmaticus. Despite treatment with intravenous methylprednisolone, continuous albuterol, terbutaline, aminophylline, and magnesium sulfate, she had persistent respiratory distress. She required endotracheal intubation and mechanical ventilation because of worsening respiratory fatigue and hypercarbia ((PCO2), 96 mm Hg). Severe airflow obstruction persisted, and the hypercarbia worsened despite conventional mechanical ventilation (PCO2 > 134 mm Hg). It was judged that the patient was at risk for dynamic air trapping leading to hemodynamic compromise and cardiac arrest. High-frequency oscillatory ventilation was started to overcome airflow obstruction, and a decrease in arterial PCO2 to 87 mm Hg was observed within 2 h. High-frequency oscillatory ventilation was discontinued after 5 h, and conventional mechanical ventilation resumed. The patient was extubated after 5 days without further complications. In summary, this case shows that high-frequency oscillatory ventilation may be considered as a rescue treatment in children who have severe status asthmaticus with persistent airflow obstruction and hypercarbia unresponsive to pharmacological therapy and conventional mechanical ventilation.

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“…HFOV is used to recruit compromised lung, improve oxygenation through combined high mean airway pressures (MAPs) and less tidal volumes, and eliminate carbon dioxide with almost no adverse cerebral side effects [3][4][5][6]. Although HFOV is theoretically bene cial for lung protection in preterm infants with severe hypoxemia and hypercapnia [7,8], there are few information regarding how HFOV-treated premature neonates are managed, especially how ventilation settings and adjunctive therapies used before and after use of HFOV would affect the outcomes [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Effects and Outcomes of Rescue High-Frequency Oscillatory Ventilation for Premature Infants With Severe Refractory Respiratory Failure

Hsu

Yang

Chu

et al. 2020

Preprint

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Background: Despite wide application of high frequency oscillatory ventilation (HFOV) in neonates with respiratory distress, little has been reported about its rescue use in preterm infants. We aimed to evaluate the therapeutic effects of HFOV in preterm neonates with refractory respiratory failure and investigate the independent risk factors of in-hospital mortality.Methods: We retrospectively analyzed data collected prospectively (January 2011-December 2018) in four neonatal intensive care units of two tertiary-level medical centers in Taiwan. All premature infants (gestational age 24-34 weeks) receiving HFOV as rescue therapy for refractory respiratory failure were included.Results: A total of 668 preterm neonates with refractory respiratory failure were enrolled. The median (IQR) gestational age and birth weight were 27.3 (25.3-31.0) weeks and 915.0 (710.0-1380.0) g, respectively. Pre-HFOV use of cardiac inotropic agents and inhaled nitric oxide were 70.5% and 23.4%, respectively. The oxygenation index (OI), FiO2, and AaDO2 were markedly increased after HFOV initiation (all p < 0.001), and can be decreased within 24-48 hours (all p < 0.001) after use of HFOV. 375 (56.1%) patients had a good response to HFOV within 3 days. The final in-hospital mortality rate was 34.7%. No association was found between specific primary pulmonary disease and survival in multivariate analysis. We found preterm neonates with gestational age < 28 weeks, occurrences of sepsis, severe hypotension, multiple organ dysfunctions, initial higher severity of respiratory failure and response to HFOV within the first 72 hours were independently associated with final in-hospital mortality.Conclusions: The mortality rate of preterm neonates with severe respiratory failure remains high after rescue HFOV treatment. Aggressive therapeutic interventions to treat sepsis and prevent organ dysfunctions are the suggested strategies to optimize outcomes.

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Gas exchange mechanisms in preterm infants on HFOV – a computational approach

Cited by 21 publications

References 29 publications

Ventilation-induced jet suggests biotrauma in reconstructed airways of the intubated neonate

Ventilation-induced jet suggests biotrauma in reconstructed airways of the intubated neonate

High-frequency oscillatory ventilation as a rescue for severe asthma crisis in a child

Therapeutic Effects and Outcomes of Rescue High-Frequency Oscillatory Ventilation for Premature Infants With Severe Refractory Respiratory Failure

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