Selective tracheal gas insufflation during partial liquid ventilation improves lung function in an animal model of unilateral acute lung injury

Blanch, L.; Te, Van der Kloot; Am, Youngblood; Ab, Adams; Naveira, Alberto; Murias, Tiberio Feliz; Pv, Romero; Nahum, Avi

doi:10.1097/00003246-200112000-00003

Cited by 10 publications

(1 citation statement)

References 31 publications

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“…24 25 Experimentally, tracheal gas insufflation (TGI) has been proposed to manage patients with unilateral lung injury. 26 TGI in combination with partial liquid ventilation has also been successfully tested on unilateral lung injury model 27 with better results than TGI alone. 28 Nevertheless, these techniques are complex and there are no robust data in literature to support their safe and effective use in humans.…”

Section: History Of General Approaches For Ventilation Of Asymmetrica...mentioning

confidence: 99%

Asymmetrical Lung Injury: Management and Outcome

Bastia

Rozé

Brochard

2022

Semin Respir Crit Care Med

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Among mechanically ventilated patients, asymmetrical lung injury is probably extremely frequent in the intensive care unit but the lack of standardized measurements does not allow to describe any prevalence among mechanically ventilated patients. Many past studies have focused only on unilateral injury and have mostly described the effect of lateral positioning. The good lung put downward might receive more perfusion while the sick lung placed upward receive more ventilation than supine. This usually results in better oxygenation but can also promote atelectasis in the healthy lung and no consensus has emerged on the clinical indication of this posture. Recently, electrical impedance tomography (EIT) has allowed for the first time to precisely describe the distribution of ventilation in each lung and to better study asymmetrical lung injury. At low positive-end-expiratory pressure (PEEP), a very heterogeneous ventilation exists between the two lungs and the initial increase in PEEP first helps to recruit the sick lung and protect the healthier lung. However, further increasing PEEP distends the less injured lung and must be avoided. The right level can be found using EIT and transpulmonary pressure. In addition, EIT can show that in the two lungs, airway closure is present but with very different airway opening pressures (AOPs) which cannot be identified on a global assessment. This may suggest a very different PEEP level than on a global assessment. Lastly, epidemiological studies suggest that in hypoxemic patients, the number of quadrants involved has a strong prognostic value. The number of quadrants is more important than the location of the unilateral or bilateral nature of the involvement for the prognosis, and hypoxemic patients with unilateral lung injury should probably be considered as requiring lung protective ventilation as classical acute respiratory distress syndrome.

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