Mechanical ventilation strategies influence pulmonary mechanics in atelectasis-prone rabbits

Alexandre T. Rotta, Mark Dowhy, Paul Frisicaro, Björn Gunnarsson, David M. Steinhorn

Research output: Contribution to journalArticle

Abstract

Introduction: Ventilation strategies can modify the course of acute lung injury. Strategies that permit alveolar de-recruitment and cyclic overdistension, such as conventional mechanical ventilation with low PEEP (CMV-LP) can induce progressive injury, whereas strategies that promote lung recruitment, such as high frequency oscillatory ventilation (HFOV), are associated with better short term outcomes. We hypothesized that HFOV and CMV with high PEEP (CMV-HP) would be associated with more favorable pulmonary mechanics in comparison to a CMV-LP strategy. Methods: Thirty-three New Zealand White rabbits were anesthetized and instrumented with a tracheostomy and vascular catheters, and ventilated with a FiO2 of 1.0. Lung injury was induced by repeated saline lavage. Following injury (PaO2<100torr), all animals underwent HFOV (Paw: 16cmH2O, IT: 33%) with periods of dynamic sustained inflation (Paw: 30cmH2O) for 15 sec, until PaO2>300 torr. The animals were then randomized to 1) continue HFOV (n=8), 2) CMV-HP (n=9, TV: 10ml/kg, PEEP: 10 cm/H2O) or 3) CMV-LP (n=8, TV: 10ml/kg, PEEP: 2cm/H2O). A group of uninjured animals (n=8) ventilated with a PEEP of 5 cm/H2O served as controls. Static pressure-volume curves were obtained at randomization and at the end of the experiment. Prior to sacrifice, animals underwent chest fluoroscopy at a distending airway pressure of 16cmH2O. A lung area index (a 2-d projection image of lung volume) was derived by measuring the lung area on the digital images using dedicated software. Results: Values are means ± SD. Comparisons made by Kruskall Wallis one-way analysis of variance on ranks, with post-hoc multiple comparisons by the Dunn's method.*p<0.05 vs control. vs control. 1 p<0.05 vs CMV-LP Control HFOV CMV-HP CMV-LP Static compliance (ml/cmH2O) 1.15±0.1 0.69±0.1 1 0.57±0.2*1 0.3±0.06*Lung area index (cm2/kg) 10.1±1.7 8.79±1.5 1 8.83±2.2 1 6.15±1.1*Conclusions: Strategies that promote lung recruitment, such as HFOV and CMV-HP, result in more favorable pulmonary mechanics than CMV-LP in acutely injured, atclectasis-pronc animals after 4 hours of mechanical ventilation. HFOV animals exhibited better lung compliance than those in the CMV-HP group.

Original languageEnglish (US)
JournalCritical Care Medicine
Volume27
Issue number1 SUPPL.
StatePublished - 1999
Externally publishedYes

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Pulmonary Atelectasis
High-Frequency Ventilation
Mechanics
Artificial Respiration
Rabbits
Lung
Lung Compliance
Pressure
Vascular Access Devices
Acute Lung Injury
Tracheostomy
Therapeutic Irrigation
Fluoroscopy
Wounds and Injuries
Lung Injury
Random Allocation
Compliance
Ventilation
Analysis of Variance
Thorax

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Rotta, A. T., Dowhy, M., Frisicaro, P., Gunnarsson, B., & Steinhorn, D. M. (1999). Mechanical ventilation strategies influence pulmonary mechanics in atelectasis-prone rabbits. Critical Care Medicine, 27(1 SUPPL.).

Mechanical ventilation strategies influence pulmonary mechanics in atelectasis-prone rabbits. / Rotta, Alexandre T.; Dowhy, Mark; Frisicaro, Paul; Gunnarsson, Björn; Steinhorn, David M.

In: Critical Care Medicine, Vol. 27, No. 1 SUPPL., 1999.

Research output: Contribution to journalArticle

Rotta, AT, Dowhy, M, Frisicaro, P, Gunnarsson, B & Steinhorn, DM 1999, 'Mechanical ventilation strategies influence pulmonary mechanics in atelectasis-prone rabbits', Critical Care Medicine, vol. 27, no. 1 SUPPL..
Rotta AT, Dowhy M, Frisicaro P, Gunnarsson B, Steinhorn DM. Mechanical ventilation strategies influence pulmonary mechanics in atelectasis-prone rabbits. Critical Care Medicine. 1999;27(1 SUPPL.).
Rotta, Alexandre T. ; Dowhy, Mark ; Frisicaro, Paul ; Gunnarsson, Björn ; Steinhorn, David M. / Mechanical ventilation strategies influence pulmonary mechanics in atelectasis-prone rabbits. In: Critical Care Medicine. 1999 ; Vol. 27, No. 1 SUPPL.
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abstract = "Introduction: Ventilation strategies can modify the course of acute lung injury. Strategies that permit alveolar de-recruitment and cyclic overdistension, such as conventional mechanical ventilation with low PEEP (CMV-LP) can induce progressive injury, whereas strategies that promote lung recruitment, such as high frequency oscillatory ventilation (HFOV), are associated with better short term outcomes. We hypothesized that HFOV and CMV with high PEEP (CMV-HP) would be associated with more favorable pulmonary mechanics in comparison to a CMV-LP strategy. Methods: Thirty-three New Zealand White rabbits were anesthetized and instrumented with a tracheostomy and vascular catheters, and ventilated with a FiO2 of 1.0. Lung injury was induced by repeated saline lavage. Following injury (PaO2<100torr), all animals underwent HFOV (Paw: 16cmH2O, IT: 33{\%}) with periods of dynamic sustained inflation (Paw: 30cmH2O) for 15 sec, until PaO2>300 torr. The animals were then randomized to 1) continue HFOV (n=8), 2) CMV-HP (n=9, TV: 10ml/kg, PEEP: 10 cm/H2O) or 3) CMV-LP (n=8, TV: 10ml/kg, PEEP: 2cm/H2O). A group of uninjured animals (n=8) ventilated with a PEEP of 5 cm/H2O served as controls. Static pressure-volume curves were obtained at randomization and at the end of the experiment. Prior to sacrifice, animals underwent chest fluoroscopy at a distending airway pressure of 16cmH2O. A lung area index (a 2-d projection image of lung volume) was derived by measuring the lung area on the digital images using dedicated software. Results: Values are means ± SD. Comparisons made by Kruskall Wallis one-way analysis of variance on ranks, with post-hoc multiple comparisons by the Dunn's method.*p<0.05 vs control. vs control. 1 p<0.05 vs CMV-LP Control HFOV CMV-HP CMV-LP Static compliance (ml/cmH2O) 1.15±0.1 0.69±0.1 1 0.57±0.2*1 0.3±0.06*Lung area index (cm2/kg) 10.1±1.7 8.79±1.5 1 8.83±2.2 1 6.15±1.1*Conclusions: Strategies that promote lung recruitment, such as HFOV and CMV-HP, result in more favorable pulmonary mechanics than CMV-LP in acutely injured, atclectasis-pronc animals after 4 hours of mechanical ventilation. HFOV animals exhibited better lung compliance than those in the CMV-HP group.",
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AU - Rotta, Alexandre T.

AU - Dowhy, Mark

AU - Frisicaro, Paul

AU - Gunnarsson, Björn

AU - Steinhorn, David M.

PY - 1999

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N2 - Introduction: Ventilation strategies can modify the course of acute lung injury. Strategies that permit alveolar de-recruitment and cyclic overdistension, such as conventional mechanical ventilation with low PEEP (CMV-LP) can induce progressive injury, whereas strategies that promote lung recruitment, such as high frequency oscillatory ventilation (HFOV), are associated with better short term outcomes. We hypothesized that HFOV and CMV with high PEEP (CMV-HP) would be associated with more favorable pulmonary mechanics in comparison to a CMV-LP strategy. Methods: Thirty-three New Zealand White rabbits were anesthetized and instrumented with a tracheostomy and vascular catheters, and ventilated with a FiO2 of 1.0. Lung injury was induced by repeated saline lavage. Following injury (PaO2<100torr), all animals underwent HFOV (Paw: 16cmH2O, IT: 33%) with periods of dynamic sustained inflation (Paw: 30cmH2O) for 15 sec, until PaO2>300 torr. The animals were then randomized to 1) continue HFOV (n=8), 2) CMV-HP (n=9, TV: 10ml/kg, PEEP: 10 cm/H2O) or 3) CMV-LP (n=8, TV: 10ml/kg, PEEP: 2cm/H2O). A group of uninjured animals (n=8) ventilated with a PEEP of 5 cm/H2O served as controls. Static pressure-volume curves were obtained at randomization and at the end of the experiment. Prior to sacrifice, animals underwent chest fluoroscopy at a distending airway pressure of 16cmH2O. A lung area index (a 2-d projection image of lung volume) was derived by measuring the lung area on the digital images using dedicated software. Results: Values are means ± SD. Comparisons made by Kruskall Wallis one-way analysis of variance on ranks, with post-hoc multiple comparisons by the Dunn's method.*p<0.05 vs control. vs control. 1 p<0.05 vs CMV-LP Control HFOV CMV-HP CMV-LP Static compliance (ml/cmH2O) 1.15±0.1 0.69±0.1 1 0.57±0.2*1 0.3±0.06*Lung area index (cm2/kg) 10.1±1.7 8.79±1.5 1 8.83±2.2 1 6.15±1.1*Conclusions: Strategies that promote lung recruitment, such as HFOV and CMV-HP, result in more favorable pulmonary mechanics than CMV-LP in acutely injured, atclectasis-pronc animals after 4 hours of mechanical ventilation. HFOV animals exhibited better lung compliance than those in the CMV-HP group.

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