Spontaneous breathing during lung-protective ventilation in an experimental acute lung injury model

Yoshida, Toyohiko; Uchiyama, Akinori; Matsuura, Nariaki; Mashimo, Takashi; Fujino, Yuji

doi:10.1097/ccm.0b013e3182451c40

Cited by 243 publications

(88 citation statements)

References 23 publications

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“…Hence, it may be surmised that the introduction of NMB indeed reduced the mechanical impact of dyssynchrony by reducing the transpulmonary pressure because patient’s spontaneous effort ceased. This assumption is supported by previous experimental work in lavage-injured rabbits showing increased transpulmonary pressure despite pressure-limited ventilation using moderate V T (7–9 mL/kg) in animals with strong spontaneous breathing activity [43]. In particular, in animals with severe lung injury spontaneous breathing worsened lung injury [44].…”

Section: Discussionmentioning

confidence: 53%

Short-term effects of neuromuscular blockade on global and regional lung mechanics, oxygenation and ventilation in pediatric acute hypoxemic respiratory failure

Wilsterman

Jager

Blokpoel

et al. 2016

Ann. Intensive Care

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BackgroundNeuromuscular blockade (NMB) has been shown to improve outcome in acute respiratory distress syndrome (ARDS) in adults, challenging maintaining spontaneous breathing when there is severe lung injury. We tested in a prospective physiological study the hypothesis that continuous administration of NMB agents in mechanically ventilated children with severe acute hypoxemic respiratory failure (AHRF) improves the oxygenation index without a redistribution of tidal volume V T toward non-dependent lung zones.MethodsOxygenation index, PaO2/FiO2 ratio, lung mechanics (plateau pressure, mean airway pressure, respiratory system compliance and resistance), hemodynamics (heart rate, central venous and arterial blood pressures), oxygenation [oxygenation index (OI), PaO2/FiO2 and SpO2/FiO2], ventilation (physiological dead space-to-V T ratio) and electrical impedance tomography measured changes in end-expiratory lung volume (EELV), and V T distribution was measured before and 15 min after the start of continuous infusion of rocuronium 1 mg/kg. Patients were ventilated in a time-cycled, pressure-limited mode with pre-set V T. All ventilator settings were not changed during the study.ResultsTwenty-two patients were studied (N = 18 met the criteria for pediatric ARDS). Median age (25–75 interquartile range) was 15 (7.8–77.5) weeks. Pulmonary pathology was present in 77.3%. The median lung injury score was 9 (8–10). The overall median CoV and regional lung filling characteristics were not affected by NMB, indicating no ventilation shift toward the non-dependent lung zones. Regional analysis showed a homogeneous time course of lung inflation during inspiration, indicating no tendency to atelectasis after the introduction of NMB. NMB decreased the mean airway pressure (p = 0.039) and OI (p = 0.039) in all patients. There were no significant changes in lung mechanics, hemodynamics and EELV. Subgroup analysis showed that OI decreased (p = 0.01) and PaO2/FiO2 increased (p = 0.02) in patients with moderate or severe PARDS.ConclusionsNMB resulted in an improved oxygenation index in pediatric patients with AHRF. Distribution of V T and regional lung filling characteristics were not affected.

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Section: Discussionmentioning

confidence: 53%

Short-term effects of neuromuscular blockade on global and regional lung mechanics, oxygenation and ventilation in pediatric acute hypoxemic respiratory failure

Wilsterman

Jager

Blokpoel

et al. 2016

Ann. Intensive Care

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“…14,15 At the other extreme, the critically ill ARDS patient with air hunger and forceful spontaneous inspiratory muscle effort may have low airway pressures but large pleural and transpulmonary pressure swings and resultant tidal volumes, predisposing to barotrauma/volutrauma. 16 …”

Section: Classic Mechanisms Of Vilimentioning

confidence: 99%

Ventilator-induced Lung Injury

Beitler

Malhotra

Thompson

2016

Clinics in Chest Medicine

280

214

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“…The preservation of spontaneous breathing has marked beneficial effects [14]. However, by increasing the forces applied to the lung, an unsuppressed, severely increased respiratory drive might be harmful [15]. In states of severe hypoxemia, the question of whether to put the patient at rest or to admit his or her own respiratory drive remains unanswered.…”

Section: Hypothesis Results and Open Questionsmentioning

confidence: 99%

Another brick in the wall of needs for invasive ventilation?

Quintel

Moerer

2014

Crit Care

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Ventilator-induced lung injury and ventilator-induced diaphragmatic dysfunction are major complications in mechanically ventilated patients with acute respiratory failure. Invasive ventilation adds a further burden by increasing the risk of infections. An approach that protects both lung and diaphragm is pivotal. Mirabella and colleagues compared conventional controlled ventilation with a mode that combines several potentially lung-protective properties - non-invasively applied neurally adjusted ventilatory assist - in an animal experiment. This approach seemed to be as effective but potentially more lung-protective. Although the experimental setup and results cannot be translated directly to the clinical setting, they should motivate us to further study this innovative approach.

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Spontaneous breathing during lung-protective ventilation in an experimental acute lung injury model

Cited by 243 publications

References 23 publications

Short-term effects of neuromuscular blockade on global and regional lung mechanics, oxygenation and ventilation in pediatric acute hypoxemic respiratory failure

Short-term effects of neuromuscular blockade on global and regional lung mechanics, oxygenation and ventilation in pediatric acute hypoxemic respiratory failure

Ventilator-induced Lung Injury

Another brick in the wall of needs for invasive ventilation?

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