High-frequency oscillation combined with arteriovenous extracorporeal lung assist reduces lung injury

Abstract

In order to optimize the lung-protective potential of high-frequency oscillatory ventilation (HFOV), it is currently recommended to maximize oscillatory frequencies. However, very high frequencies may lead to insufficient CO(2) elimination with severe respiratory acidosis. Arteriovenous extracorporeal lung assist (av-ECLA) allows near total CO(2) removal, thereby allowing for maximization of the lung-protective potential of HFOV. The aim of this study was to determine the impact of HFOV and av-ECLA on lung inflammation and function compared to conventional lung-protective ventilation. In a porcine surfactant depletion model of lung injury, the authors randomly assigned 16 female pigs to conventional lung-protective ventilation and HFOV/ECLA. Both strategies were combined with an "open-lung" approach. Gas exchange and hemodynamic parameters were measured at intervals during the 24-hour study period. Postmortem, lung tissue was analyzed to determine histological damage and lung inflammation. The authors found that the combination of HFOV and av-ECLA (1) allows significant reductions in mean and peak airway pressures; and (2) reduces histological signs of lung inflammation in the basal regions of the lung. HFOV/av-ECLA reduces histological signs of lung inflammation compared to conventional lung-protective ventilation strategies. Thus, combination of HFOV and av-ECLA might be a further lung-protective tool if conventional ventilation strategies are failing.

Hepatic effects of lung-protective pressure-controlled ventilation and a combination of high-frequency oscillatory ventilation and extracorporeal lung assist in experimental lung injury

“…The remaining 16 animals had a mean weight of 54±4.3 kg. Fourteen of these animals, 7 per group, were also used in the companion paper [19]. …”

“…21/06) on 11 July, 2006. To yield eight animals per group as in the companion paper [19], a total of 18 animals were studied because one animal per group was unsuitable for the liver analysis. Juvenile female Pietrain pigs negative for malignant hyperthermia were fasted with unlimited water access.…”

“…In a previous publication by our research group, the combination of HFOV and arteriovenous ECLA showed less histopathologic signs of inflammation in the basal lung than pressure-controlled low tidal volume ventilation after experimental lung injury [19]. The PEEP and mean tracheal airway pressure were set above the LIP and ventilation was continued for 24 hours.…”

“…The aim of the present paper was to demonstrate the effects of those two lung-protective ventilation strategies on liver dysfunction and damage. Those data were gathered during the same experiment as in the companion paper [19]. Liver dysfunction was measured by indocyanine green plasma clearance and bilirubin serum levels.…”

The Physiological Basis of High-Frequency Oscillatory Ventilation and Current Evidence in Adults and Children: A Narrative Review

“…A similar study also found that high frequency improved lung recruitment ( Muellenbach et al, 2008 ). HFOV with extracorporeal membrane oxygenation (ECMO) has been shown to attenuate lung inflammation in a saline lavage pig model compared to a pressure control strategy with a V T of 6 ml/kg ( Muellenbach et al, 2010 ).…”