Physiologically variable ventilation reduces regional lung inflammation in a pediatric model of acute respiratory distress syndrome

Rocha, André Alexandre Dos Santos; Fodor, Gergely H.; Kassai, Miklós; Dégrugilliers, Loïc; Bayat, Sam; Peták, Ferenc; Habre, Walid

doi:10.1186/s12931-020-01559-x

Cited by 7 publications

(3 citation statements)

References 54 publications

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“…The main clinical symptoms of NRDS are lung diseases such as progressive dyspnea, cyanosis, and dyspnea within six hours after birth. If the child is not treated in time, progressive hypoxemia will develop and eventually lead to respiratory failure and death [ 5 , 6 ]. Therefore, timely and effective diagnosis and real-time monitoring of disease changes are very important for the treatment and prognosis of NRDS.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Lung Image under Artificial Intelligence Algorithm in Diagnosis of Neonatal Respiratory Distress Syndrome

Wu¹,

Zhao²,

Yang³

et al. 2022

Computational and Mathematical Methods in Medicine

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In order to analyze the application of ultrasonic lung imaging diagnosis model based on artificial intelligence algorithm in neonatal respiratory distress syndrome (NRDS), an ultrasonic lung imaging diagnosis model based on a deep residual network (DRN) was proposed. In this study, 90 premature infants in the hospital were selected as the research object and divided into the experimental group (45 cases) and control group (45 cases) according to whether or not they have NRDS. DRN was compared with the deep residual network (DRWSR) based on wavelet domain, deep residual network detection with normalization framework (Fisher-DRN), and distorted image edge detection preprocessor (DIEDP). Then, it was applied to the diagnosis of NRDS. The clinical data and ultrasound imaging results of infants with NRDS and ordinary premature infants were compared. The results showed that the gestational age, birth weight, and Apgar scores of the NRDS group were remarkably lower than those of ordinary children ( P < 0.05 ). In addition, the segmentation accuracy, image feature extraction accuracy, algorithm convergence, and time loss of the DRN algorithm were better than the other three algorithms, and the differences were considerable ( P < 0.05 ). In children with NRDS, the positive rate of abnormal pleural line, disappearance of A line, appearance of B line, and alveolar interstitial syndrome (AIS) test in the results of lung ultrasound examination in children with NRDS were all 100%. The lung consolidation became 70.8%, and the white lung-like change was 50.1%, both of which were higher than those of ordinary preterm infants, and the differences were considerable ( P < 0.05 ). The diagnostic model of this study predicted that the AUC area of grade 1-2, grade 2-3, and grade 3-4 NRDS were 0.962, 0.881, and 0.902, respectively. To sum up, the ultrasound lung imaging diagnosis model based on the DRN algorithm had good diagnostic performance in children with NRDS and can provide useful information for clinical NRDS diagnosis and treatment.

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Section: Introductionmentioning

confidence: 99%

Ultrasound Lung Image under Artificial Intelligence Algorithm in Diagnosis of Neonatal Respiratory Distress Syndrome

Wu¹,

Zhao²,

Yang³

et al. 2022

Computational and Mathematical Methods in Medicine

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“…An additional limitation of the present study is that volumetric capnography provides an overall picture about the V/Q matching for the entire lungs. Expanded use of imaging techniques, such as SPECT [ 37 ], K-edge subtraction [ 38 ], electric impedance tomography [ 39 ], or quantitative V/Q analysis by inert gas elimination [ 40 ] have the potential in forthcoming studies to further investigate the mechanisms by allowing regional assessments.…”

Section: Discussionmentioning

confidence: 99%

Changes in lung mechanics and ventilation-perfusion match: comparison of pulmonary air- and thromboembolism in rats

Tolnai,

Ballók,

Südy

et al. 2024

BMC Pulm Med

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Background Pulmonary air embolism (AE) and thromboembolism lead to severe ventilation-perfusion defects. The spatial distribution of pulmonary perfusion dysfunctions differs substantially in the two pulmonary embolism pathologies, and the effects on respiratory mechanics, gas exchange, and ventilation-perfusion match have not been compared within a study. Therefore, we compared changes in indices reflecting airway and respiratory tissue mechanics, gas exchange, and capnography when pulmonary embolism was induced by venous injection of air as a model of gas embolism or by clamping the main pulmonary artery to mimic severe thromboembolism. Methods Anesthetized and mechanically ventilated rats (n = 9) were measured under baseline conditions after inducing pulmonary AE by injecting 0.1 mL air into the femoral vein and after occluding the left pulmonary artery (LPAO). Changes in mechanical parameters were assessed by forced oscillations to measure airway resistance, lung tissue damping, and elastance. The arterial partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) were determined by blood gas analyses. Gas exchange indices were also assessed by measuring end-tidal CO2 concentration (ETCO2), shape factors, and dead space parameters by volumetric capnography. Results In the presence of a uniform decrease in ETCO2 in the two embolism models, marked elevations in the bronchial tone and compromised lung tissue mechanics were noted after LPAO, whereas AE did not affect lung mechanics. Conversely, only AE deteriorated PaO2, and PaCO2, while LPAO did not affect these outcomes. Neither AE nor LPAO caused changes in the anatomical or physiological dead space, while both embolism models resulted in elevated alveolar dead space indices incorporating intrapulmonary shunting. Conclusions Our findings indicate that severe focal hypocapnia following LPAO triggers bronchoconstriction redirecting airflow to well-perfused lung areas, thereby maintaining normal oxygenation, and the CO2 elimination ability of the lungs. However, hypocapnia in diffuse pulmonary perfusion after AE may not reach the threshold level to induce lung mechanical changes; thus, the compensatory mechanisms to match ventilation to perfusion are activated less effectively.

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“…The benefits of variable ventilation are due to improved recruitment of alveolar units, enhanced surfactant production, and preservation of gas exchange (1,3,(8)(9)(10)(11), which was also manifested in preserved alveolar structure reflected by maintained lung compliance (2,4,5,12) and by lower lung histological injury scores (6). The advantage of variable ventilation has been established in models of asthma (13), chronic obstructive lung disease (COPD) (14), and acute respiratory distress syndrome (ARDS) (3,(15)(16)(17). Nevertheless, the effects of variability on ventilator-induced deterioration in lung function have not been investigated in the presence of chronic fibrosis in the lung parenchyma.…”

Section: Introductionmentioning

confidence: 99%

Physiologically variable ventilation prevents lung function deterioration in a model of pulmonary fibrosis

Rocha

Peták

Carvalho³

et al. 2022

Journal of Applied Physiology

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Positive pressure ventilation exerts an increased stress and strain in the presence of pulmonary fibrosis. Thus, ventilation strategies that avoid high pressures while maintaining lung aeration are of paramount importance. While physiologically variable ventilation (PVV) has proven beneficial in various models of pulmonary disease, its potential advantages in pulmonary fibrosis have not been investigated. Therefore, we assessed the benefit of PVV over conventional pressure-controlled ventilation (PCV) in a model of pulmonary fibrosis. Lung fibrosis was induced with intratracheal bleomycin in rabbits. Fifty days later, the animals were randomized to receive 6 hours of either PCV (n=10) or PVV (n=11). The PVV pattern was prerecorded in spontaneously breathing, healthy rabbits. Respiratory mechanics and gas exchange were assessed hourly, end-expiratory lung volume and intrapulmonary shunt fraction were measured at hours 0 and 6. Histological and cellular analyses were performed. Fifty days after bleomycin treatment, the rabbits presented elevated specific airway resistance (69±26% [mean±95%confidence interval]), specific tissue damping (38±15%) and specific elastance (47±16%) along with histological evidence of fibrosis. Six hours of PCV led to increased respiratory airway resistance (Raw, 111±30%), tissue damping (G, 36±13%) and elastance (H, 58±14%), and decreased end-expiratory lung volume (EELV, -26±7%) and oxygenation (PaO2/FiO2, -14±5%). The time-matched changes in the PVV group were significantly lower for G (22±9%), H (41±6%), EELV (-13±6%) and PaO2/FiO2 ratio (-3±5%, p<0.05 for all). There was no difference in histopathology between the ventilation modes. Thus, prolonged application of PVV prevented the deterioration of gas exchange by reducing atelectasis development in bleomycin-induced lung fibrosis.

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Physiologically variable ventilation reduces regional lung inflammation in a pediatric model of acute respiratory distress syndrome

Cited by 7 publications

References 54 publications

Ultrasound Lung Image under Artificial Intelligence Algorithm in Diagnosis of Neonatal Respiratory Distress Syndrome

Ultrasound Lung Image under Artificial Intelligence Algorithm in Diagnosis of Neonatal Respiratory Distress Syndrome

Changes in lung mechanics and ventilation-perfusion match: comparison of pulmonary air- and thromboembolism in rats

Physiologically variable ventilation prevents lung function deterioration in a model of pulmonary fibrosis

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