Loss of Airway Pressure During HFOV Results in an Extended Loss of Oxygenation: A Retrospective Animal Study

Kubiak, Brian D.; Albert, Scott P.; Gatto, Louis A.; Trikha, Girish; El‐Zammar, Ola; Nieman, Gary F.

doi:10.1016/j.jss.2009.04.026

Cited by 7 publications

(7 citation statements)

References 11 publications

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“…These data support an earlier retrospective study in which increased lung injury was measured in Tween injured animals that were disconnected from HFOV for a very short period of time [10].…”

Section: Discussionsupporting

confidence: 89%

Titration of Mean Airway Pressure and FiO2 During High Frequency Oscillatory Ventilation in a Porcine Model of Acute Lung Injury

Maggio

Sadowitz

Vieau

et al. 2010

Journal of Surgical Research

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Section: Discussionsupporting

confidence: 89%

Titration of Mean Airway Pressure and FiO2 During High Frequency Oscillatory Ventilation in a Porcine Model of Acute Lung Injury

Maggio

Sadowitz

Vieau

et al. 2010

Journal of Surgical Research

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“…The concept is similar to what may happen with high-frequency oscillatory ventilation, where a de-recruitment event manifests as loss in ventilation. 28 Recruitment and PEEP always lead to its resolution. Perhaps at higher frequencies, there needs to be a prophylactic increase in PEEP.…”

Section: Discussionmentioning

confidence: 99%

Application of Mid-Frequency Ventilation in an Animal Model of Lung Injury: A Pilot Study

et al. 2014

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BACKGROUND: Mid-frequency ventilation (MFV) is a mode of pressure control ventilation based on an optimal targeting scheme that maximizes alveolar ventilation and minimizes tidal volume (V T ). This study was designed to compare the effects of conventional mechanical ventilation using a lung-protective strategy with MFV in a porcine model of lung injury. Our hypothesis was that MFV can maximize ventilation at higher frequencies without adverse consequences. We compared ventilation and hemodynamic outcomes between conventional ventilation and MFV. METHODS: This was a prospective study of 6 live Yorkshire pigs (10 ؎ 0.5 kg). The animals were subjected to lung injury induced by saline lavage and injurious conventional mechanical ventilation. Baseline conventional pressure control continuous mandatory ventilation was applied with V T ‫؍‬ 6 mL/kg and PEEP determined using a decremental PEEP trial. A manual decision support algorithm was used to implement MFV using the same conventional ventilator. We measured P aCO 2 , P aO 2 , end-tidal carbon dioxide, cardiac output, arterial and venous blood oxygen saturation, pulmonary and systemic vascular pressures, and lactic acid. RESULTS: The MFV algorithm produced the same minute ventilation as conventional ventilation but with lower V T (؊1 ؎ 0.7 mL/kg) and higher frequency (32.1 ؎ 6.8 vs 55.7 ؎ 15.8 breaths/min, P < .002). There were no differences between conventional ventilation and MFV for mean airway pressures (16.1 ؎ 1.3 vs 16.4 ؎ 2 cm H 2 O, P ‫؍‬ .75) even when auto-PEEP was higher (0.6 ؎ 0.9 vs 2.4 ؎ 1.1 cm H 2 O, P ‫؍‬ .02). There were no significant differences in any hemodynamic measurements, although heart rate was higher during MFV. CONCLUSIONS: In this pilot study, we demonstrate that MFV allows the use of higher breathing frequencies and lower V T than conventional ventilation to maximize alveolar ventilation. We describe the ventilatory or hemodynamic effects of MFV. We also demonstrate that the application of a decision support algorithm to manage MFV is feasible.

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“…Since lung injury may not become macroscopically evident as long as PEEP counteracts fluid filtration, PEEP was then suddenly zeroed. Fluid filtration should have freely occurred, driven by normal (and occasionally supra-normal) haemodynamics, had the blood-gas barrier been disrupted [18,24,27]. …”

Section: Discussionmentioning

confidence: 99%

“…Third, integrity and permeability of the blood-gas barrier were not directly assessed and minor changes cannot be completely excluded; but still, pulmonary oedema, de facto , never occurred. Finally, lung injury may have rapidly reversed once overinflation had been suddenly removed [22]; however, lowering mean airway pressure once the blood-gas barrier has been damaged usually causes alveolar flooding, with precipitous deterioration of lung mechanics and gas exchange [27]. …”

Section: Discussionmentioning

confidence: 99%

High positive end-expiratory pressure: only a dam against oedema formation?

et al. 2013

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IntroductionHealthy piglets ventilated with no positive end-expiratory pressure (PEEP) and with tidal volume (VT) close to inspiratory capacity (IC) develop fatal pulmonary oedema within 36 h. In contrast, those ventilated with high PEEP and low VT, resulting in the same volume of gas inflated (close to IC), do not. If the real threat to the blood-gas barrier is lung overinflation, then a similar damage will occur with the two settings. If PEEP only hydrostatically counteracts fluid filtration, then its removal will lead to oedema formation, thus revealing the deleterious effects of overinflation.MethodsFollowing baseline lung computed tomography (CT), five healthy piglets were ventilated with high PEEP (volume of gas around 75% of IC) and low VT (25% of IC) for 36 h. PEEP was then suddenly zeroed and low VT was maintained for 18 h. Oedema was diagnosed if final lung weight (measured on a balance following autopsy) exceeded the initial one (CT).ResultsAnimals were ventilated with PEEP 18 ± 1 cmH2O (volume of gas 875 ± 178 ml, 89 ± 7% of IC) and VT 213 ± 10 ml (22 ± 5% of IC) for the first 36 h, and with no PEEP and VT 213 ± 10 ml for the last 18 h. On average, final lung weight was not higher, and actually it was even lower, than the initial one (284 ± 62 vs. 347 ± 36 g; P = 0.01).ConclusionsHigh PEEP (and low VT) do not merely impede fluid extravasation but rather preserve the integrity of the blood-gas barrier in healthy lungs.

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Loss of Airway Pressure During HFOV Results in an Extended Loss of Oxygenation: A Retrospective Animal Study

Cited by 7 publications

References 11 publications

Titration of Mean Airway Pressure and FiO2 During High Frequency Oscillatory Ventilation in a Porcine Model of Acute Lung Injury

Titration of Mean Airway Pressure and FiO2 During High Frequency Oscillatory Ventilation in a Porcine Model of Acute Lung Injury

Application of Mid-Frequency Ventilation in an Animal Model of Lung Injury: A Pilot Study

High positive end-expiratory pressure: only a dam against oedema formation?

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