Document Detail


The open lung concept: pressure-controlled ventilation is as effective as high-frequency oscillatory ventilation in improving gas exchange and lung mechanics in surfactant-deficient animals.
MedLine Citation:
PMID:  10501757     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To demonstrate in experimental animals with respiratory insufficiency that under well-defined conditions, commercially available ventilators allow settings which are as effective as high-frequency oscillatory ventilators (HFOV), with respect to the levels of gas exchange, protein infiltration, and lung stability.
DESIGN: Prospective, randomized, animal study.
SETTING: Experimental laboratory of a university.
SUBJECTS: 18 adult male Sprague-Dawley rats.
INTERVENTIONS: Lung injury was induced by repeated whole-lung lavage. Thereafter, the animals were assigned to pressure-controlled ventilation (PCV) plus The Open Lung Concept (OLC) or HFOV plus OLC (HFO(OLC)). In both groups, an opening maneuver was performed by increasing airway pressures to improve the arterial oxygen tension/fractional inspired oxygen (PaO(2)/FIO(2)) ratio to L 500 mm Hg; thereafter, airway pressures were reduced to minimal values, which kept PaO(2)/FIO(2) L 500 mm Hg. Pressure amplitude was adjusted to keep CO(2) as close as possible in the normal range.
MEASUREMENTS AND RESULTS: Airway pressure, blood gas tension, and arterial blood pressure were recorded every 30 min. At the end of the 3-h study period, a pressure-volume curve was recorded and bronchoalveolar lavage was performed to determine protein content. After the recruitment maneuver, the resulting mean airway pressure to keep a PaO(2)/FIO(2) L 500 mm Hg was 25 +/- 1.3 cm H(2)O during PCV(OLC) and 25 +/- 0.5 cm H(2)O during HFOV(OLC). Arterial oxygenation in both groups was above L 500 mm Hg and arterial carbon dioxide tension was kept close to the normal range. No differences in mean arterial pressure, lung mechanics and protein influx were found between the two groups.
CONCLUSIONS: This study shows that in surfactant-deficient animals, PCV, in combination with a recruitment maneuver, opens atelectatic lung areas and keeps them open as effectively as HFOV.
Authors:
G F Vázquez de Anda; A Hartog; S J Verbrugge; D Gommers; B Lachmann
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Intensive care medicine     Volume:  25     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-12-10     Completed Date:  1999-12-10     Revised Date:  2014-07-28    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  990-6     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Animals
High-Frequency Ventilation* / instrumentation,  methods
Lung / physiopathology*
Male
Positive-Pressure Respiration* / instrumentation,  methods
Prospective Studies
Pulmonary Gas Exchange / physiology*
Pulmonary Surfactants / deficiency*
Random Allocation
Rats
Rats, Sprague-Dawley
Respiratory Insufficiency / physiopathology,  therapy
Respiratory Mechanics / physiology*
Time Factors
Ventilators, Mechanical
Chemical
Reg. No./Substance:
0/Pulmonary Surfactants

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


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