A Comparison of Micropore Membrane Inlet Mass Spectrometry–Derived Pulmonary Shunt Measurement with Riley Shunt in a Porcine Model

Duenges, Bastian; Vogt, Andreas; Bodenstein, Marc; Wang, Hemei; Böhme, S.; Röhrig, Bernd; Baumgardner, James E.; Markstaller, Klaus

doi:10.1213/ane.0b013e3181bbc401

Cited by 15 publications

(26 citation statements)

References 22 publications

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“…In future, animal experiments in this field may again use highfrequency PaO2 measurements. Event gated (inspiratory and expiratory) multiple inert gas elimination technique may differentiate shunt, dead space, and V/Q distribution during parts of the respiratory cycle [16][17].…”

Section: Discussionmentioning

confidence: 99%

Influence of fluid and volume state on PaO₂oscillations in mechanically ventilated pigs

Bodenstein

Bierschock

Boehme³

et al. 2013

Experimental Lung Research

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Varying pulmonary shunt fractions during the respiratory cycle cause oxygen oscillations during mechanical ventilation. In artificially damaged lungs, cyclical recruitment of atelectasis is responsible for varying shunt according to published evidence. We introduce a complimentary hypothesis that cyclically varying shunt in healthy lungs is caused by cyclical redistribution of pulmonary perfusion. Administration of crystalloid or colloid infusions would decrease oxygen oscillations if our hypothesis was right. Therefore, n=14 mechanically ventilated healthy pigs were investigated in 2 groups: crystalloid (fluid) versus no-fluid administration. Additional volume interventions (colloid infusion, blood withdrawal) were carried out in each pig. Intra-aortal PaO2 oscillations were recorded using fluorescence quenching technique. Phase shift of oxygen oscillations during altered inspiratory to expiratory (I:E) ventilation ratio and electrical impedance tomography (EIT) served as control methods to exclude that recruitment of atelectasis is responsible for oxygen oscillations. In hypovolemia relevant oxygen oscillations could be recorded. Fluid and volume state changed PaO2 oscillations according to our hypothesis. Fluid administration led to a mean decline of 105.3 mmHg of the PaO2 oscillations amplitude (P<0.001). The difference of the amplitudes between colloid administration and blood withdrawal was 62.4 mmHg in pigs not having received fluids (P=0.0059). Fluid and volume state also changed the oscillation phase during altered I:E ratio. EIT excluded changes of regional ventilation (i.e., recruitment of atelectasis) to be responsible for these oscillations. In healthy pigs, cyclical redistribution of pulmonary perfusion can explain the size of respiratory-dependent PaO2 oscillations.

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Section: Discussionmentioning

confidence: 99%

Influence of fluid and volume state on PaO₂oscillations in mechanically ventilated pigs

Bodenstein

Bierschock

Boehme³

et al. 2013

Experimental Lung Research

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“…The MMIMS technology is still being evaluated in on-going studies. In a prior study, the MMIMS-MIGET derived shunt fraction was shown to be highly correlated to the conventionally calculated shunt [19]. The ultrafast paO 2 measurement was previously applied and described in detail by several experimental studies [11,17,18,22,30,34].…”

Section: Discussionmentioning

confidence: 99%

“…An additional shunt calculation from blood gas samples was performed by a previously described and porcine-specific algorithm [19]. A normal saline solution containing the six inert gases, sulphur hexafluoride, krypton, desflurane, enflurane, diethyl ether and acetone, was prepared by a senior chemist (BD).…”

Section: Methodsmentioning

confidence: 99%

Influence of respiratory rate and end-expiratory pressure variation on cyclic alveolar recruitment in an experimental lung injury model

et al. 2012

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IntroductionCyclic alveolar recruitment/derecruitment (R/D) is an important mechanism of ventilator-associated lung injury. In experimental models this process can be measured with high temporal resolution by detection of respiratory-dependent oscillations of the paO2 (ΔpaO2). A previous study showed that end-expiratory collapse can be prevented by an increased respiratory rate in saline-lavaged rabbits. The current study compares the effects of increased positive end-expiratory pressure (PEEP) versus an individually titrated respiratory rate (RRind) on intra-tidal amplitude of Δ paO2 and on average paO2 in saline-lavaged pigs.MethodsAcute lung injury was induced by bronchoalveolar lavage in 16 anaesthetized pigs. R/D was induced and measured by a fast-responding intra-aortic probe measuring paO2. Ventilatory interventions (RRind (n = 8) versus extrinsic PEEP (n = 8)) were applied for 30 minutes to reduce Δ paO2. Haemodynamics, spirometry and Δ paO2 were monitored and the Ventilation/Perfusion distributions were assessed by multiple inert gas elimination. The main endpoints average and Δ paO2 following the interventions were analysed by Mann-Whitney-U-Test and Bonferroni's correction. The secondary parameters were tested in an explorative manner.ResultsBoth interventions reduced Δ paO2. In the RRind group, ΔpaO2 was significantly smaller (P < 0.001). The average paO2 continuously decreased following RRind and was significantly higher in the PEEP group (P < 0.001). A sustained difference of the ventilation/perfusion distribution and shunt fractions confirms these findings. The RRind application required less vasopressor administration.ConclusionsDifferent recruitment kinetics were found compared to previous small animal models and these differences were primarily determined by kinetics of end-expiratory collapse. In this porcine model, respiratory rate and increased PEEP were both effective in reducing the amplitude of paO2 oscillations. In contrast to a recent study in a small animal model, however, increased respiratory rate did not maintain end-expiratory recruitment and ultimately resulted in reduced average paO2 and increased shunt fraction.

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“…The FiO 2 was therefore set at 1.0. A previously validated, porcine‐specific algorithm was applied . Body temperature was measured by a rectal probe and normothermia was maintained by body surface warming.…”

Section: Methodsmentioning

confidence: 99%

An inhaled tumor necrosis factor‐alpha‐derived TIP peptide improves the pulmonary function in experimental lung injury

Hartmann

Boehme

Duenges

et al. 2012

Acta Anaesthesiol Scand

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A Comparison of Micropore Membrane Inlet Mass Spectrometry–Derived Pulmonary Shunt Measurement with Riley Shunt in a Porcine Model

Abstract: Shunt derived from MMIMS inert gas retention data correlated well with R-S during breathing of oxygen. Shunt as derived by MMIMS was generally less than R-S.

Cited by 15 publications

References 22 publications

Influence of fluid and volume state on PaO₂oscillations in mechanically ventilated pigs

Influence of fluid and volume state on PaO₂oscillations in mechanically ventilated pigs

Influence of respiratory rate and end-expiratory pressure variation on cyclic alveolar recruitment in an experimental lung injury model

An inhaled tumor necrosis factor‐alpha‐derived TIP peptide improves the pulmonary function in experimental lung injury

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A Comparison of Micropore Membrane Inlet Mass Spectrometry–Derived Pulmonary Shunt Measurement with Riley Shunt in a Porcine Model

Abstract: Shunt derived from MMIMS inert gas retention data correlated well with R-S during breathing of oxygen. Shunt as derived by MMIMS was generally less than R-S.

Cited by 15 publications

References 22 publications

Influence of fluid and volume state on PaO2oscillations in mechanically ventilated pigs

Influence of fluid and volume state on PaO2oscillations in mechanically ventilated pigs

Influence of respiratory rate and end-expiratory pressure variation on cyclic alveolar recruitment in an experimental lung injury model

An inhaled tumor necrosis factor‐alpha‐derived TIP peptide improves the pulmonary function in experimental lung injury

Contact Info

Product

Resources

About

Influence of fluid and volume state on PaO₂oscillations in mechanically ventilated pigs

Influence of fluid and volume state on PaO₂oscillations in mechanically ventilated pigs