High Frequency Oscillatory Ventilation Suppresses Inflammatory Response in Lung Tissue and Microdissected Alveolar Macrophages in Surfactant Depleted Piglets

Hardt, Katharina von der; Kandler, Michael Andreas; Fink, Ludger; Schoof, Ellen; Dötsch, Jörg; Brandenstein, Olga; Bohle, Rainer M.; Rascher, Wolfgang

doi:10.1203/01.pdr.0000106802.55721.8a

Cited by 54 publications

(19 citation statements)

References 35 publications

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“…Furthermore, HFOV may cause a direct lung injury and, thus, prolong lung ORIGINAL ARTICLE recovery. However, animal studies do not support this hypothesis (24)(25)(26), and human data do not exist. The overall management strategies of mechanical ventilation may differ with HFOV as compared with CMV.…”

Section: Discussionmentioning

confidence: 95%

Early High-Frequency Oscillatory Ventilation in Pediatric Acute Respiratory Failure. A Propensity Score Analysis

Bateman

Borasino

Asaro³

et al. 2016

Am J Respir Crit Care Med

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Rationale: The use of high-frequency oscillatory ventilation (HFOV) for acute respiratory failure in children is prevalent despite the lack of efficacy data.Objectives: To compare the outcomes of patients with acute respiratory failure managed with HFOV within 24-48 hours of endotracheal intubation with those receiving conventional mechanical ventilation (CMV) and/or late HFOV.Methods: This is a secondary analysis of data from the RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) study, a prospective cluster randomized clinical trial conducted between 2009 and 2013 in 31 U.S. pediatric intensive care units. Propensity score analysis, including degree of hypoxia in the model, compared the duration of mechanical ventilation and mortality of patients treated with early HFOV matched with those treated with CMV/late HFOV.Measurements and Main Results: Among 2,449 subjects enrolled in RESTORE, 353 patients (14%) were ever supported on HFOV, of which 210 (59%) had HFOV initiated within 24-48 hours of intubation. The propensity score model predicting the probability of receiving early HFOV included 1,064 patients (181 early HFOV vs. 883 CMV/late HFOV) with significant hypoxia (oxygenation index >8). The degree of hypoxia was the most significant contributor to the propensity score model. After adjusting for risk category, early HFOV use was associated with a longer duration of mechanical ventilation (hazard ratio, 0.75; 95% confidence interval, 0.64-0.89; P = 0.001) but not with mortality (odds ratio, 1.28; 95% confidence interval, 0.92-1.79; P = 0.15) compared with CMV/late HFOV. Conclusions:In adjusted models including important oxygenation variables, early HFOV was associated with a longer duration of mechanical ventilation. These analyses make supporting the current approach to HFOV less convincing.

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Section: Discussionmentioning

confidence: 95%

Early High-Frequency Oscillatory Ventilation in Pediatric Acute Respiratory Failure. A Propensity Score Analysis

Bateman

Borasino

Asaro³

et al. 2016

Am J Respir Crit Care Med

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“…HFO has been previously found to be protective in animal models of lung injury. 28,29 Other authors have used HFO in animals of similar size 30 and because the tidal volumes delivered with HFO represent only a fraction of conventional tidal volumes, its use in the initial series of experiments reduced the potential for concomitant ventilator-induced lung injury.…”

Section: Implications Of Resultsmentioning

confidence: 99%

Hypocapnia attenuates mesenteric ischemia-reperfusion injury in a rat model

Duggan

Engelberts

Jankov

et al. 2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Hypocapnia, a recognized complication of high frequency oscillation ventilation, has multiple adverse effects on lung and brain physiology in vivo, including potentiation of free radical injury. We hypothesized that hypocapnia would potentiate the effects of mesenteric ischemia-reperfusion on bowel, liver and lung injury.M Me et th ho od ds s: : Anesthetized male Sprague-Dawley rats were ventilated with high frequency oscillation and were randomized to one of four groups, exposed to either mesenteric ischemia-reperfusion or sham surgery, and to either hypocapnia or normocapnia.R Re es su ul lt ts s: : All animals survived the protocol. Ischemia-reperfusion caused significant histologic bowel injury. Bowel 8-isoprostane generation was greater in ischemia-reperfusion vs sham, but was attenuated by hypocapnia. Laser-Doppler flow studies of bowel perfusion confirmed that hypocapnia attenuated reperfusion following ischemia. Plasma alanine transaminase, reflecting overall hepatocellular injury, was not increased by ischemia-reperfusion but was increased by hypocapnia; however, hepatic isoprostane generation was increased by ischemia-reperfusion, and not by hypocapnia. Oxygenation was comparable in all groups, and compliance was impaired by ischemia-reperfusion but not by hypocapnia.C Co on nc cl lu us si io on n: : Hypocapnia, although directly injurious to the liver, attenuates ischemia-reperfusion induced lipid peroxidation in the bowel, possibly through attenuation of blood flow during reperfusion. Objectif

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“…This was due to animal ethical considerations, evaluation of cost-benefits and in accordance with Norwegian standards since it would have necessitated an immense number of animals to perform time-response experiments for all inflammatory markers and then run a series for everyone. We therefore sought literature and found 4 hours [2, 15, 16, 22, 23] post-resuscitation time to be the best general time-point for all parameters. The choice of inflammatory markers to prove lung injury was also based on literature research, i.e.…”

Section: Discussionmentioning

confidence: 99%

Lung Injury in Asphyxiated Newborn Pigs Resuscitated from Cardiac Arrest - The Impact of Supplementary Oxygen, Longer Ventilation Intervals and Chest Compressions at Different Compression-to- Ventilation Ratios

Dannevig¹,

Solevåg

Saugstad

et al. 2012

TORMJ

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Introduction:Non-specific lung inflammatory events caused by severe asphyxia may be intensified by the way we resuscitate the newly born. Assessing lung injury is potentially important because if alternative resuscitation approaches induces similar inflammatory responses or less lung injury. then we may choose the resuscitation approach that is most gentle, and easiest to perform and learn. We investigated the levels of lung inflammatory markers by comparing different ventilation, chest compression and inhaled oxygen fraction strategies in resuscitation of newly born pigs at cardiac arrest.Materials and Methodology:Progressive asphyxia in newborn pigs was induced until asystole occurred. With current resuscitation guidelines as a reference group, pigs were randomized to receive initial ventilation before chest compressions for 30s, 60s or 90s, or to compression-to-ventilation ratios 3:1or 9:3, or to resuscitation using pure oxygen or air. We analysed inflammatory markers in bronchoalveolar lavage fluid (BAL), IL8 and TNFα, and lung tissue qPCR for genes matrix metalloproteinases (MMP)2, MMP9, TNFα and ICAM-1.Results:BAL-levels of TNFα and IL8 tended to be higher in the 30s group compared to 60s group (p = 0.028 and p = 0.023, respectively) as was gene expression in lung tissue of ICAM-1 and MMP2 (p=0.012 and p=0.043, respectively). MMP2 expression was slightly higher in the 30s group compared to 90s group (p = 0.020). No differences were found between pigs resuscitated with C:V ratio 9:3 and 3:1 or pure oxygen versus air.Conclusion:Compared to current guidelines, with respect to lung injury, resuscitation with longer initial ventilation should be considered. Longer series of chest compressions did not change the lung inflammatory response, neither did the use of air instead of pure oxygen in severely asphyxiated pigs resuscitated from asystole.

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High Frequency Oscillatory Ventilation Suppresses Inflammatory Response in Lung Tissue and Microdissected Alveolar Macrophages in Surfactant Depleted Piglets

Cited by 54 publications

References 35 publications

Early High-Frequency Oscillatory Ventilation in Pediatric Acute Respiratory Failure. A Propensity Score Analysis

Early High-Frequency Oscillatory Ventilation in Pediatric Acute Respiratory Failure. A Propensity Score Analysis

Hypocapnia attenuates mesenteric ischemia-reperfusion injury in a rat model

Lung Injury in Asphyxiated Newborn Pigs Resuscitated from Cardiac Arrest - The Impact of Supplementary Oxygen, Longer Ventilation Intervals and Chest Compressions at Different Compression-to- Ventilation Ratios

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