Automated expiratory ventilation assistance through a small endotracheal tube can improve venous return and cardiac output

Berlin, David; Manoach, Seth; Oromendia, Clara; Heerdt, Paul M.

doi:10.1186/s40635-018-0217-y

Cited by 7 publications

(4 citation statements)

References 27 publications

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“…In the present study, the haemodynamic impact of FCV and VCV did not differ significantly, irrespective of the volaemia status. Contrastingly in pigs with hypovolaemia induced by haemorrhage, FCV improved venous return and cardiac output compared to VCV [31]. However, differently from the present investigation, the end-expiratory pressure during FCV was negative in that study, while our animals were ventilated with a PEEP of 5 cmH 2 O in both ventilation modes.…”

Section: Discussioncontrasting

confidence: 85%

Comparative effects of flow vs. volume-controlled one-lung ventilation on gas exchange and respiratory system mechanics in pigs

Wittenstein

Scharffenberg

Ran

et al. 2020

ICMx

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Background Flow-controlled ventilation (FCV) allows expiratory flow control, reducing the collapse of the airways during expiration. The performance of FCV during one-lung ventilation (OLV) under intravascular normo- and hypovolaemia is currently unknown. In this explorative study, we hypothesised that OLV with FCV improves PaO2 and reduces mechanical power compared to volume-controlled ventilation (VCV). Sixteen juvenile pigs were randomly assigned to one of two groups: (1) intravascular normovolaemia (n = 8) and (2) intravascular hypovolaemia (n = 8). To mimic inflammation due to major thoracic surgery, a thoracotomy was performed, and 0.5 μg/kg/h lipopolysaccharides from Escherichia coli continuously administered intravenously. Animals were randomly assigned to OLV with one of two sequences (60 min per mode): (1) VCV–FCV or (2) FCV–VCV. Variables of gas exchange, haemodynamics and respiratory signals were collected 20, 40 and 60 min after initiation of OLV with each mechanical ventilation mode. The distribution of ventilation was determined using electrical impedance tomography (EIT). Results Oxygenation did not differ significantly between modes (P = 0.881). In the normovolaemia group, the corrected expired minute volume (P = 0.022) and positive end-expiratory pressure (PEEP) were lower during FCV than VCV. The minute volume (P ≤ 0.001), respiratory rate (P ≤ 0.001), total PEEP (P ≤ 0.001), resistance of the respiratory system (P ≤ 0.001), mechanical power (P ≤ 0.001) and resistive mechanical power (P ≤ 0.001) were lower during FCV than VCV irrespective of the volaemia status. The distribution of ventilation did not differ between both ventilation modes (P = 0.103). Conclusions In a model of OLV in normo- and hypovolemic pigs, mechanical power was lower during FCV compared to VCV, without significant differences in oxygenation. Furthermore, the efficacy of ventilation was higher during FCV compared to VCV during normovolaemia.

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Section: Discussioncontrasting

confidence: 85%

Comparative effects of flow vs. volume-controlled one-lung ventilation on gas exchange and respiratory system mechanics in pigs

Wittenstein

Scharffenberg

Ran

et al. 2020

ICMx

View full text Add to dashboard Cite

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“…Measurements were considered potentially interchangeable when the average difference between them (bias) was <10% of the mean of measured ESP values, and the overall error calculated as: (bias standard deviation×1.96)/mean of all data compared was ≤30%. These criteria are consistent with previously reported method comparison studies in swine involving haemodynamics [ 13 ]. Statistical analyses were performed using GraphPad Prism 9 (GraphPad Software, LLC, La Jolla, CA, USA) and SAS 9.4 (SAS Institute Inc., Cary, NC, USA).…”

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confidence: 91%

Defining end-systolic pressure for single-beat estimation of right ventricle–pulmonary artery coupling: simple… but not really

et al. 2021

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Functional adaptation of the right ventricle (RV) to its afterload plays an important prognostic role in pulmonary hypertension (PH) [1]. The preferred “multibeat” (MB) method for assessing RV–pulmonary vascular interaction involves the measurement of end-systolic elastance ( E es ), the slope of the end-systolic pressure (ESP) to end-systolic volume over sequential heart beats with varying preload. The E es value is then matched to simultaneous pulmonary arterial (PA) elastance at end systole ( E a ), calculated as ESP pressure divided by stroke volume (SV). The ratio of E es to E a ( E es / E a ) is termed RV–PA coupling, preservation of which indicates maintenance RV functioning in the face of increasing afterload [1]. However, while the MB method is generally regarded as the reference standard, it requires continuous, accurate measurement of RV volume and is therefore not readily applicable in most clinical settings.

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“…Theoretically, the effect of NEEP can be used during life-threatening hypovolaemic shock to increase cardiac output by reducing intrathoracic pressure and increasing the pressure gradient, allowing an improved venous return to the heart. This theory has been confirmed by preclinical data; however, its clinical effect is yet to be seen [ 44 , 45 ].…”

Section: Discussionmentioning

confidence: 83%

Flow-controlled ventilation – a new and promising method of ventilation presented with a review of the literature

Białka¹,

Palaczyński²,

Szułdrzyński³

et al. 2022

ait

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Substantial efforts have been undertaken to identify and minimise factors responsible for the development of ventilator-induced lung injury. A novel approach to this problem addresses energy dissipated in lung tissue during the breathing cycle as one of the key problems. Flow-controlled ventilation is a new modality of mechanical ventilation based on a constant flow during both inspiration and expiration. This review aims to evaluate the current evidence available regarding flow-controlled ventilation. Lastly, three cases of flow-controlled ventilation application are presented: ventilation with a small lumen tube during tracheal resection, one-lung ventilation during thoracoscopic lobectomy, and ventilation of a critically ill patient with acute respiratory distress syndrome in an intensive care unit setting.

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Automated expiratory ventilation assistance through a small endotracheal tube can improve venous return and cardiac output

Cited by 7 publications

References 27 publications

Comparative effects of flow vs. volume-controlled one-lung ventilation on gas exchange and respiratory system mechanics in pigs

Comparative effects of flow vs. volume-controlled one-lung ventilation on gas exchange and respiratory system mechanics in pigs

Defining end-systolic pressure for single-beat estimation of right ventricle–pulmonary artery coupling: simple… but not really

Flow-controlled ventilation – a new and promising method of ventilation presented with a review of the literature

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