Document Detail


Biologically variable ventilation increases arterial oxygenation over that seen with positive end-expiratory pressure alone in a porcine model of acute respiratory distress syndrome.
MedLine Citation:
PMID:  10921579     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We compared biologically variable ventilation (BVV) (as previously described) (1) with conventional control mode ventilation (CV) in a model of acute respiratory distress syndrome (ARDS) both at 10 cm H2O positive end-expiratory pressure. DESIGN: Randomized, controlled, prospective study. SETTING: University research laboratory. SUBJECTS: Farm-raised 3- to 4-month-old swine. INTERVENTIONS: Oleic acid (OA) was infused at 0.2 mL/kg/hr with FIO2 = 0.5 and 5 cm H2O positive end-expiratory pressure until PaO2 was < or =60 mm Hg; then all animals were placed on an additional 5 cm H2O positive end-expiratory pressure for the next 4 hrs. Animals were assigned randomly to continue CV (n = 9) or to have CV computer controlled to deliver BVV (variable respiratory rate and tidal volume; n = 8). Hemodynamic, expired gas, airway pressure, and volume data were obtained at baseline (before OA), immediately after OA, and then at 60-min intervals for 4 hrs. MEASUREMENTS AND MAIN RESULTS: At 4 hrs after OA injury, significantly higher PaO2 (213+/-17 vs. 123+/-47 mm Hg; mean+/-SD), lower shunt fraction (6%+/-1% vs. 18%+/-14%), and lower PaCO2 (50+/-8 vs. 65+/-11 mm Hg) were seen with BVV than with CV. Respiratory system compliance was greater by experiment completion with BVV (0.37+/-0.05 vs. 0.31+/-0.08 mL/cm H2O/kg). The improvements in oxygenation, CO2 elimination, and respiratory mechanics occurred without a significant increase in either mean airway pressure (14.3+/-0.9 vs. 14.9+/-1.1 cm H2O) or mean peak airway pressure (39.3+/-3.5 vs. 44.5+/-7.2 cm H2O) with BVV. The oxygen index increased five-fold with OA injury and decreased to significantly lower levels over time with BVV. CONCLUSIONS: In this model of ARDS, BVV with 10 cm H2O positive end-expiratory pressure improved arterial oxygenation over and above that seen with CV with positive end-expiratory pressure alone. Proposed mechanisms for BVV efficacy are discussed.
Authors:
W A Mutch; S Harms; G R Lefevre; M R Graham; L G Girling; S E Kowalski
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  28     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2000-08-16     Completed Date:  2000-08-16     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2457-64     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesia and Neuroanesthesia Research Laboratory, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Animals
Blood Gas Analysis
Cardiotonic Agents / therapeutic use
Disease Models, Animal
Dopamine / therapeutic use
Hemodynamics / drug effects
Oleic Acid
Oxygen / blood*
Positive-Pressure Respiration*
Pulmonary Gas Exchange
Respiration, Artificial / methods*
Respiratory Distress Syndrome, Adult / blood,  chemically induced,  therapy*
Swine
Tidal Volume / drug effects
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 112-80-1/Oleic Acid; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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