Detecting lung overdistention in newborns treated with high-frequency oscillatory ventilation.
نویسندگان
چکیده
Positive airway pressure (Paw) during high-frequency oscillatory ventilation (HFOV) increases lung volume and can lead to lung overdistention with potentially serious adverse effects. To date, no method is available to monitor changes in lung volume (DeltaVL) in HFOV-treated infants to avoid overdistention. In five newborn piglets (6-15 days old, 2.2-4.2 kg), we investigated the use of direct current-coupled respiratory inductive plethysmography (RIP) for this purpose by evaluating it against whole body plethysmography. Animals were instrumented, fitted with RIP bands, paralyzed, sedated, and placed in the plethysmograph. RIP and plethysmography were simultaneously calibrated, and HFOV was instituted at varying Paw settings before (6-14 cmH(2)O) and after (10-24 cmH(2)O) repeated warm saline lung lavage to induce experimental surfactant deficiency. Estimates of Delta VL from both methods were in good agreement, both transiently and in the steady state. Maximal changes in lung volume (Delta VL(max)) from all piglets were highly correlated with Delta VL measured by RIP (in ml) = 1.01 x changes measured by whole body plethysmography - 0.35; r(2) = 0.95. Accuracy of RIP was unchanged after lavage. Effective respiratory system compliance (Ceff) decreased after lavage, yet it exhibited similar sigmoidal dependence on Delta VL(max) pre- and postlavage. A decrease in Ceff (relative to the previous Paw setting) as Delta VL(max) was methodically increased from low to high Paw provided a quantitative method for detecting lung overdistention. We conclude that RIP offers a noninvasive and clinically applicable method for accurately estimating lung recruitment during HFOV. Consequently, RIP allows the detection of lung overdistention and selection of optimal HFOV from derived Ceff data.
منابع مشابه
Editorial III: Remembering awareness.
High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation. beneficial effects of the 'Open Lung Approach' with low distending pressures in acute respiratory distress syndrome. Effect of protective-ventilation strategy on mortality in the acute respiratory distress syndrome. 6 The Acute Respiratory Distress Syndrome Network. V...
متن کاملHigh-frequency oscillatory ventilation on shaky ground.
We thought it was impossible. Physiological principles maintained that ventilation at tidal volumes less than the anatomical deadspace should be ineffective (i.e., inspired air not reaching the alveolae). Data from a 1980 study dispelled that myth, showing unequivocally that ventilation with tidal volumes as small as 20 to 30 ml in dogs, a mere fraction of the anatomical deadspace, could mainta...
متن کاملSystematic review of determinants of mortality in high frequency oscillatory ventilation in acute respiratory distress syndrome
INTRODUCTION Mechanical ventilation has been shown to cause lung injury and to have a significant impact on mortality in acute respiratory distress syndrome. Theoretically, high frequency oscillatory ventilation seems an ideal lung protective ventilation mode. This review evaluates determinants of mortality during use of high frequency oscillatory ventilation. METHODS PubMed was searched for ...
متن کاملHigh-frequency oscillatory ventilation is not superior to conventional mechanical ventilation in surfactant-treated rabbits with lung injury.
The aim of this study was to compare high-frequency oscillatory ventilation (HFOV) with conventional mechanical ventilation (CMV) with and without surfactant in the treatment of surfactant-deficient rabbits. A previously described saline lung lavage model of lung injury in adult rabbits was used. The efficacy of each therapy was assessed by evaluating gas exchange, lung deflation stability and ...
متن کاملPhysiological predictors of survival during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome
The last decade has seen increased appreciation of ventilator-induced lung injury. The understanding that the process of mechanical ventilation can itself damage lungs has spurned the search for ventilation strategies that are more lung protective. High-frequency oscillatory ventilation is a mode of high-frequency ventilation that may accomplish all of the current goals of lung protection. Hist...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Journal of applied physiology
دوره 89 1 شماره
صفحات -
تاریخ انتشار 2000