A comparison of biologically variable ventilation to recruitment manoeuvres in a porcine model of acute lung injury

Funk, Duane J.; Graham, M. Ruth; Girling, Linda G.; Thliveris, James A.; McManus, Bruce M.; Walker, E; Rector, Edward S.; Hillier, Craig; Scott, J. E.; Mutch, W. Alan C.

doi:10.1186/1465-9921-5-22

Cited by 42 publications

(52 citation statements)

References 38 publications

(43 reference statements)

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“…5 In animal models of ARDS, variable ventilation strategies are superior to conventional control mode mechanical ventilation (CMV) or CMV with recruitment maneuvers with respect to lung mechanics, gas exchange, surfactant content, and inflammatory mediators with an overall decrease in distending stress. [5][6][7][8][9][10][11][12] In a recent computed tomography (CT) imaging study, we confirmed BVV induced recruitment of both poorly and non-aerated lung regions. 13 In this study, we hypothesized that the recruitment benefit and periodic low V T breaths seen with BVV could result in enhanced resolution of edema fluid in ARDS.…”

supporting

confidence: 76%

“…These parameters were chosen as multiple previous studies have demonstrated significant BVV advantages with respect to lung mechanics, gas exchange, and inflammatory mediators within this time period with a similar number of subjects, 6,7 and Ware and Matthay 1 were able to demonstrate significant differences in fluid clearance rates in clinical subjects over a similar time frame. Given the more modest effects seen with a less severe injury model, however, significant differences were limited to the CT findings.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Briefly, breath-to-breath control of the Esprit ventilator is provided by a modulation file and laptop computer. The modulation file is derived from the breathto-breath frequency variability that was obtained from a spontaneously ventilating awake subject, captured by a data acquisition system, and processed.…”

Section: Biologically Variable Ventilationmentioning

confidence: 99%

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Resolution of pulmonary edema with variable mechanical ventilation in a porcine model of acute lung injury

Graham

Gulati

Kha

et al. 2011

Can J Anesth/J Can Anesth

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Objective Resolution of the acute respiratory distress syndrome (ARDS) requires clearance of pulmonary edema. Biologically variable ventilation (BVV) strategies that improve gas exchange, lung mechanics, and inflammatory mediators in ARDS may be beneficial in this regard. We used quantitative computed tomography (CT), a single indicator thermodilution system (PiCCOÒ) to determine extravascular lung water (EVLW), and the change in edema protein concentration over time to compare edema clearance with BVV vs conventional mechanical ventilation (CMV) in a porcine ARDS model. Methods Sixteen pigs with oleic acid lung injury were randomized to four hours of ventilation with either CMV (n = 8) or BVV (n = 8) at identical low tidal volume and minute ventilation over time. Hemodynamic variables, gas exchange, lung mechanics, and PiCCO derived EVLW were determined hourly. Computed tomography images and edema fluid samples were obtained at baseline lung injury and after four hours of ventilation. Wet and dry lung weights were determined postmortem.Results At four hours with BVV, peak airway pressure was decreased significantly and lung compliance improved compared with CMV (P = 0.003; P \ 0.001, respectively). Hemodynamic variables and gas exchange were not different between groups. Also at four hours, computed tomography revealed an increase in total gas volume (P = 0.001) and a decrease in total lung weight and global lung density (P = 0.005; P = 0.04 respectively) with BVV. These findings were associated with a significant increase in the gas volume of normally aerated lung regions (P \ 0.001) and a decrease in the poorly and non-aerated lung regions (P = 0.001). No change in any CT parameter occurred with CMV. The lung weights derived from computed tomography correlated well with postmortem wet weights (R 2 = 0.79; P \ 0.01). The decrease in PiCCO derived EVLW from injury to four hours did not differ significantly between BVV and CMV. Extravascular lung water showed no correlation with postmortem wet weights and significantly underestimated lung water. Average alveolar fluid clearance rates were positive (1.4%Áhr -1 (3%)) with BVV and negative with CMV (-2.0%Áhr -1 (4%)). Conclusions In a comparison between BVV and CMV, computed tomography evidence suggests that BVV facilitates enhanced clearance and/or redistribution of edema fluid with improved recruitment of atelectatic and poorly aerated lung regions; no such evidence was seen with either single thermodilution measurement of EVLW or edema clearance rates. The results of computed tomography provide further evidence of the benefit of BVV over conventional ventilation in ARDS. RésuméObjectif La re´solution d'un syndrome de de´tresse respiratoire aigue¨(SDRA) ne´cessite l'e´limination de

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supporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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Resolution of pulmonary edema with variable mechanical ventilation in a porcine model of acute lung injury

Graham

Gulati

Kha

et al. 2011

Can J Anesth/J Can Anesth

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“…Variable controlled mechanical ventilation outperformed conventional controlled mechanical ventilation in terms of arterial oxygenation in 10 out of 12 experimental studies in models of ARDS, including surfactant depletion [15,28], oleic acid [13,14,[29][30][31] and HCl aspiration [32]. In two studies using oleic acid injury, variable controlled mechanical ventilation did not improve arterial oxygenation compared to conventional controlled mechanical ventilation in mongrel dogs [33] or in pigs [34].…”

Section: Gas Exchange Effectsmentioning

confidence: 99%

Variable Ventilation from Bench to Bedside

Huhle¹,

Pelosi²,

Abreu³

2016

Annual Update in Intensive Care and Emergency Medicine

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“…Time series of V T and respiratory rate values during variable mechanical ventilation may show longrange correlations, which are more strictly 'biological' , or simply random (noisy). Both biological and noisy patterns of variable mechanical ventilation have been shown to improve oxygenation and respiratory mechanics, and reduce diff use alveolar damage in experimental ALI/ ARDS [40,41]. Although diff erent mechanisms have been postulated to explain such fi ndings, lung recruitment seems to play a pivotal role.…”

Section: The Role Of Variable Ventilation As a Recruitment Maneuvermentioning

confidence: 99%

New and Conventional Strategies for Lung Recruitment in Acute Respiratory Distress Syndrome

Pelosi¹,

Abreu²,

Rocco³

2010

Intensive Care Medicine

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This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. Pelosi et al. Critical Care 2010, 14:210 http://ccforum.com/content/14/2/210 © Springer-Verlag Berlin Heidelberg 2010. This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. recruitment maneuvers may also contribute to VILI [11,12], with translocation of pulmonary bacteria [13] and cytokines into the systemic circulation [14]. Furthermore, since recruitment maneuvers increase mean thoracic pressure, they may lead to a reduction in venous return with impairment of cardiac output [15]. R E V I E WVarious factors may infl uence the response to a recruitment maneuver, namely: 1) Th e nature and extent of lung injury, and 2) patient positioning. Nature and extent of lung injuryTh e nature of the underlying injury can aff ect the response to a recruitment maneuver. In direct (pulmonary) lung injury, the primary structure damaged is the alveolar epithelium resulting in alveolar fi lling by edema, fi brin, and neutrophilic aggregates. In indirect (extrapulmonary) lung injury, infl ammatory mediators are released from extrapulmonary foci into the systemic circulation leading to microvessel congestion and interstitial edema with relative sparing of intra-alveolar spaces [16]. Th erefore, recruitment maneuvers should be more eff ective to open atelectatic lung regions in indirect compared to direct lung injury. Based on this hypothesis, Kloot et al. [17] investigated the eff ects of recruitment maneuvers on gas exchange and lung volumes in three experimental models of ALI: Saline lavage or surfactant depletion, oleic acid, and pneumonia, and observed improvement in oxygenation only in ALI induced by surfactant depletion. Riva et al. [18] compared the eff ects of a recruitment maneuver in models of pulmonary and extrapulmonary ALI, induced by intratracheal and intraperitoneal instillation of Escherichia coli lipo polysaccharide, with similar transpulmonary pressures. Th ey found that the recruitment maneuver was more eff ective for opening collapsed alveoli in extrapulmonary compared to pulmonary ALI, improving lung mechanics and oxygenation with limited damage to alveolar epithelium. Using electrical imp...

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A comparison of biologically variable ventilation to recruitment manoeuvres in a porcine model of acute lung injury

Cited by 42 publications

References 38 publications

Resolution of pulmonary edema with variable mechanical ventilation in a porcine model of acute lung injury

Resolution of pulmonary edema with variable mechanical ventilation in a porcine model of acute lung injury

Variable Ventilation from Bench to Bedside

New and Conventional Strategies for Lung Recruitment in Acute Respiratory Distress Syndrome

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