| Comparison of intratracheal pulmonary ventilation and hybrid intratracheal pulmonary ventilation with conventional mechanical ventilation in a rabbit model of acute respiratory distress syndrome by saline lavage. | |
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MedLine Citation:
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PMID: 10752829 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To study changes in PaCO2 and PaO2 during intratracheal pulmonary ventilation (ITPV) and hybrid intratracheal pulmonary ventilation (h-ITPV) compared with conventional mechanical ventilation (CMV) in a rabbit model of respiratory failure, and to define the technique of h-ITPV that combines conventional mechanical ventilation and ITPV. DESIGN: Prospective, interventional study. SUBJECTS: Twelve adult New Zealand White rabbits. INTERVENTIONS: Surfactant deficiency was induced by saline lavage, and rabbits were randomized to either ITPV or h-ITPV. The study consisted of four phases: phase 0, CMV after saline lavage, ventilator rate 30 breaths/min; phase I, ITPV or h-ITPV initiated at the same pressure and rate as in phase 0; phase II, ITPV or 1.0 L/min h-ITPV bias flow, with peak inspiratory pressure (PIP) decreased and ventilator rate increased to achieve the lowest tidal volume while maintaining adequate gas exchange; and phase III, animals returned to CMV. MEASUREMENTS AND MAIN RESULTS: In phase I, no difference in PaCO2 was observed between ITPV, h-ITPV, or CMV. There was a decrease in PaO2 when switching from CMV to ITPV but not to h-ITPV. In phase II, it was possible to decrease PIP (average of 37% for ITPV and 36% for h-ITPV) and tidal volume (average of 64% for ITPV and 53% for h-ITPV) without compromising gas exchange (p < .05). Oxygenation tended to improve from phase 0 to the end of phase II. In phase III, PaCO2 increased (average of 71% for ITPV and 79% for h-ITPV) and pH decreased (p < .05). Normocapnia was achieved using significantly higher PIP and tidal volume, compared with phase 0 (p < .05). CONCLUSIONS: ITPV and h-ITPV can effectively ventilate and oxygenate rabbits with surfactant-deficient lungs at tidal volumes and therefore pressures lower than required with CMV. Maximum benefit appears to occur at high ventilator rates. These findings suggest that both modes of ventilation may represent powerful new tools in the management of patients with acute respiratory failure. (Crit Care Med 2000; 28:774-781) |
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Authors:
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C A Perez; K C Bui; J Bustorff-Silva; J B Atkinson |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Critical care medicine Volume: 28 ISSN: 0090-3493 ISO Abbreviation: Crit. Care Med. Publication Date: 2000 Mar |
Date Detail:
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Created Date: 2000-04-19 Completed Date: 2000-04-19 Revised Date: 2010-06-21 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 774-81 Citation Subset: AIM; IM |
Affiliation:
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Division of Pediatric Surgery, UCLA School of Medicine, Los Angeles, CA, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Adolescent Adult Animals Barotrauma / etiology, prevention & control Carbon Dioxide / blood Child Disease Models, Animal Humans Hypercapnia Infant, Newborn Oxygen / blood Positive-Pressure Respiration / adverse effects Prospective Studies Pulmonary Gas Exchange* Rabbits Random Allocation Respiration, Artificial / adverse effects, methods* Respiratory Distress Syndrome, Adult / therapy* Respiratory Insufficiency / therapy* Statistics, Nonparametric Tidal Volume |
| Chemical | |
Reg. No./Substance:
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124-38-9/Carbon Dioxide; 7782-44-7/Oxygen |
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