Document Detail


Pressure- versus volume-cycled ventilation in liquid-ventilated neonatal piglet lungs.
MedLine Citation:
PMID:  9694114     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/PURPOSE: If the goal of partial liquid ventilation (PLV) with perfluorocarbons in the management of respiratory failure is to improve dynamic lung compliance (Cdyn) and pulmonary vascular resistance (PVR) while sustaining O2 delivery, the optimal ventilatory management is unclear. The authors asked if volume-cycled or pressure-limited ventilation had different effects on PVR, cardiac index (CI), and Cdyn in uninjured and injured neonatal piglet lungs. METHODS: Anesthetized piglets (6 to 8 kg) were ventilated after tracheostomy. Cdyn was measured by in-line Fleisch pneumotach/PC data acquisition terminal. Thermodilution instrumentation allowed determination of both CI and PVR. Volume-control or pressure-limited ventilation was established in uninjured or injured (surfactant deficiency induced by saline lavage at 18 mL/kg) animals. After a stable 30-minute baseline, animals were assigned randomly to one of four groups: group I (n = 9), uninjured animals plus volume-cycled ventilation (intermittent mandatory ventilation [IMV], 10 bpm; tidal volume [TV], 15 mL/kg, positive end-expiratory pressure [PEEP], 5 cm H2O; FIO2, 1.0; and PLV for 150 minutes); group II (n = 9), uninjured animals plus pressure-limited ventilation (IMV, 10 bpm; peak inspiratory pressure (PIP), 25 cm H2O, PEEP, 5 cm H2O, FIO2, 1.0; and PLV for 150 minutes); group III (n = 7), injured animals plus volume-cycled ventilation (IMV, 10 bpm; TV, 15 mL/kg; PEEP, 5 cm H2O; FIO2, 1.0 for 30 minutes, followed by saline injury for group IV (n = 7), injured animals plus pressure-limited ventilation (IMV, 10 bpm; PIP, 25 cm H2O; PEEP, 5 cm H2O; FIO2, 1.0 for 30 minutes, followed by saline injury, and PLV rescue). Comparison within and between groups was accomplished by repeated measures analysis of variance (ANOVA) with Tukey correction. RESULTS: There was no significant difference between volume-cycled or pressure-limited ventilation in healthy lungs; however, in the setting of lung injury, dynamic compliance was 1.44 +/- 0.15 after 180 minutes in the volume-cycled group and 0.91 +/- 0.10 in the pressure-limited group after the same interval (mL/cm H2O x kg +/- SEM). Similarly, PVR was 100 +/- 6 in the volume-cycled group and 145 +/- 12 in the pressure-limited group after 180 minutes of lung injury (mm Hg/L/kg x min +/- SEM). Cardiac index declined significantly in all groups independent of ventilatory mode. CONCLUSIONS: These results suggest that in the setting of lung injury, Cdyn and PVR improved significantly when volume-cycled, compared with pressure-limited ventilation was used. Although no difference existed between ventilatory modes in healthy lungs, pressure-limited ventilation, when combined with PLV in injured lungs, had adverse effects on lung compliance and pulmonary vascular resistance. Volume-cycled ventilation may optimize the ability of perfluorocarbon to recruit collapsed or atelectatic lung regions.
Authors:
J Weiswasser; M Lueders; C J Stolar
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  33     ISSN:  0022-3468     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  1998 Jul 
Date Detail:
Created Date:  1998-10-22     Completed Date:  1998-10-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1158-62     Citation Subset:  IM    
Affiliation:
Division of Pediatric Surgery, Columbia University, College of Physicians & Surgeons, and Babies & Children's Hospital of New York, Columbia Presbyterian Medical Center, New York 10032, USA.
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Animals
Animals, Newborn
Disease Models, Animal
Fluorocarbons / administration & dosage*
Intermittent Positive-Pressure Ventilation
Lung Compliance
Pulmonary Ventilation / physiology*
Respiration, Artificial / methods*
Respiratory Insufficiency / therapy*
Swine
Thermodilution
Vascular Resistance
Chemical
Reg. No./Substance:
0/Fluorocarbons

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


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