High-frequency oscillatory ventilation attenuates oxidative lung injury in a rabbit model of acute lung injury

Ronchi, Carlos Fernando; Ferreira, Ana Lúcia dos Anjos; Campos, Fábio Joly; Kurokawa, Cilmery Suemi; Carpi, Mário Ferreira; Moraes, Marcela Aparecida de; Bonatto, Rossano César; Defaveri, Júlio; Yeum, Kyung‐Jin; Fioretto, José Roberto

doi:10.1258/ebm.2011.011085

Cited by 19 publications

(25 citation statements)

References 48 publications

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“…17 Overall, HFOV improves oxygenation, reduces inflammatory processes and histopathological damages, and attenuates oxidative lung injury compared with protective mechanical ventilation. 18 Conceptually, HFOV constitutes an attractive lung-protective ventilatory modality.…”

Section: Critical Care Medicinementioning

confidence: 99%

Higher Frequency Ventilation Attenuates Lung Injury during High-frequency Oscillatory Ventilation in Sheep Models of Acute Respiratory Distress Syndrome

et al. 2013

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Background: High-frequency oscillatory ventilation (HFOV) at higher frequencies minimizes the tidal volume. However, whether increased frequencies during HFOV can reduce ventilator-induced lung injury remains unknown. Methods: After the induction of acute respiratory distress syndrome in the model by repeated lavages, 24 adult sheep were randomly divided into four groups (n = 6): three HFOV groups (3, 6, and 9 Hz) and one conventional mechanical ventilation (CMV) group. Standard lung recruitments were performed in all groups until optimal alveolar recruitment was reached. After lung recruitment, the optimal mean airway pressure or positive end-expiratory pressure was determined with decremental pressure titration, 2 cm H 2 O every 10 min. Animals were ventilated for 4 h. Results: After lung recruitment, sustained improvements in gas exchange and compliance were observed in all groups. Compared with the HFOV-3 Hz and CMV groups, the transpulmonary pressure and tidal volumes were statistically significantly lower in the HFOV-9 Hz group. The lung injury scores and wet/dry weight ratios were significantly reduced in the HFOV-9 Hz group compared with the HFOV-3 Hz and CMV groups. Expression of interleukin-1β and interleukin-6 in the lung tissue, decreased significantly in the HFOV-9 Hz group compared with the HFOV-3 Hz and CMV groups. Malondialdehyde expression and myeloperoxidase activity in lung tissues in the HFOV-9 Hz group decreased significantly, compared with the HFOV-3 Hz and CMV groups. Conclusion: The use of HFOV at 9 Hz minimizes lung stress and tidal volumes, resulting in less lung injury and reduced levels of inflammatory mediators compared with the HFOV-3 Hz and CMV conditions. A CUTE respiratory distress syndrome (ARDS) is the most severe manifestation of acute lung injury caused by various direct and indirect factors. Inflammatory pulmonary edema, severe hypoxemia, and diffuse endothelial and epithelial injury are key characteristics of ARDS, which can often lead to multiple organ failure.1,2 Despite being the most widely used approach to treat ARDS, conventional mechanical ventilation (CMV) can induce ventilatorinduced lung injury (VILI) due to alveolar overdistension and the cyclic collapse/reopening of lung units, eliciting inflammatory responses, and worsening the damage. 3,4 Recently, protective CMV has been shown to decrease lung and systemic inflammatory responses and improve What We Already Know about This Topic• High-frequency oscillatory ventilation provides efficient gas exchange using very high frequencies and low tidal volumes, while maintaining a constant mean airway pressure • The effects of frequency in high-frequency oscillatory ventilation on ventilation-induced lung injury are yet to be evaluated What This Article Tells Us That Is New• This study suggests that high-frequency oscillatory ventilation at higher frequencies minimizes lung stress and tidal volume, resulting in less lung injury and reduced local lung inflammation

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Section: Critical Care Medicinementioning

confidence: 99%

Higher Frequency Ventilation Attenuates Lung Injury during High-frequency Oscillatory Ventilation in Sheep Models of Acute Respiratory Distress Syndrome

et al. 2013

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“…In several models of lung injury, HFOV has been associated with lower concentrations of inflammatory cytokines than CMV (6,7).…”

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confidence: 99%

High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury

Rettig

Smallwood

Walsh

et al. 2015

Critical Care Medicine

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Given the number of centers and subjects included in the database, these findings provide a robust description of current practice regarding the use of high-frequency oscillatory ventilation for pediatric hypoxic respiratory failure. Patients with severe hypoxic respiratory failure and immunocompromise had the highest mortality risk, and those with respiratory syncytial virus had the lowest. A means of identifying the risk of 30-day mortality for subjects can be obtained by identifying the underlying disease and oxygenation index on conventional ventilation preceding the initiation of high-frequency oscillatory ventilation.

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“…High frequency ventilation work at lower proximal airway pressures than conventional ventilation, reduced ventilator-induced lung injury and lung inflammatory markers, improved gas exchange, and decreased oxygen exposure (Froese et al 1993;Jackson et al 1994;Yoder et al 2000). In a rabbit model of acute lung injury, high frequency ventilation showed better oxygenation, less histopathological injury score, and lower lung inflammatory responses, and oxidative stress in comparison with lungprotective conventional ventilation with V T of 6 ml/kg (Ronchi et al 2011). In a study of Imai et al (1994), high frequency ventilation decreased production of inflammatory mediators and resulted in less severe lung injury than conventional ventilation.…”

Section: Discussionmentioning

confidence: 93%