Continuous tracheal gas insufflation enables a volume reduction strategy in hyaline membrane disease: technical aspects and clinical results

Dassieu, Gilles; Brochard, Laurent; Agudze, E; Patkaï, Juliana; Janaud, Jean-Claude; Danan, Claude

doi:10.1007/s001340050719

Cited by 46 publications

(36 citation statements)

References 18 publications

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“…This difference was likely associated to the atomization procedure, disappearing on completion. In our opinion, this effect may be related to the washout of the dead space due by the intratracheal injection of the atomizing gas with a mechanism similar to that already reported during high-flow nasal cannulae (30)(31)(32).…”

Section: Discussionsupporting

confidence: 67%

Intratracheal atomized surfactant provides similar outcomes as bolus surfactant in preterm lambs with respiratory distress syndrome

et al. 2016

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Background: Aerosolization of exogenous surfactant remains a challenge. This study is aimed to evaluate the efficacy of atomized poractant alfa (Curosurf ) administered with a novel atomizer in preterm lambs with respiratory distress syndrome. Methods: Twenty anaesthetized lambs, 127 ± 1 d gestational age, (mean ± SD) were instrumented before birth and randomized to receive either (i) positive pressure ventilation without surfactant (Control group), (ii) 200 mg/kg of bolus instilled surfactant (Bolus group) at 10 min of life or (iii) 200 mg/kg of atomized surfactant (Atomizer group) over 60 min from 10 min of life. All lambs were ventilated for 180 min with a standardized protocol. Lung mechanics, regional lung compliance (electrical impedance tomography), and carotid blood flow (CBF) were measured with arterial blood gas analysis. results: Dynamic compliance and oxygenation responses were similar in the Bolus and Atomizer groups, and both better than Control by 180 min (all P < 0.05; two-way ANOVA). Both surfactant groups demonstrated more homogeneous regional lung compliance throughout the study period. There were no differences in CBF conclusion: In a preterm lamb model, atomized surfactant resulted in similar gas exchange and mechanics as bolus administration. This study suggests evaluation of supraglottic atomization with this system when noninvasive support is warranted. s urfactant replacement therapy is a well-established standard of care for the treatment and prevention of neonatal respiratory distress syndrome (RDS), significantly reducing mortality and morbidity (1). Currently, endotracheal instillation is the only approved method of administration. However, over the last decade, the management of mild to moderate RDS has dramatically changed, endotracheal tube (ETT) intubation is often avoided and infants were managed with noninvasive modalities, such as continuous positive airway pressure whilst spontaneously breathing. In this population, surfactant administration is generally only provided when oxygen requirement increases and intubation is necessary (2,3).The increase in noninvasive ventilation use has led to less invasive methods of surfactant delivery during continuous positive airway pressure being developed (4,5). All reported methods require technical skills, some degree of invasive intervention, and still involve instillation of liquid surfactant directly into the trachea via a process that is not dissimilar to intubation (6-8). Nebulization of surfactant offers an attractive alternative. Unfortunately, studies of nebulized surfactant have shown inconsistent clinical response and surfactant distribution (9-16). Moreover, most of the studies, even those in which a lung function improvement was observed, reported very low (<10%) fractions of surfactant deposition into the lung (9,12,(17)(18)(19)(20). Notwithstanding differences in nebulizer design, and thus particle size production, such modest deposition is likely due to the fact that most studies used aerosols generated extracorporeally by ...

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Section: Discussionsupporting

confidence: 67%

Intratracheal atomized surfactant provides similar outcomes as bolus surfactant in preterm lambs with respiratory distress syndrome

et al. 2016

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“…CO 2 elimination in the respiratory tract is enhanced by a jet of fresh catheter gas which projects for a variable distance beyond the catheter orifice itself, extending the flushed region and improving distal gas mixing [4,14,15,17]. Nakos et al demonstrated that TGI has been reported as a useful adjunct mode of mechanical ventilation in patients with acute lung injury requiring mechanical ventilation [17].…”

Section: Discussionmentioning

confidence: 99%

“…However, ventilatory failure in infants with rapid and shallow ventilatory pattern or patients with preexisting cardiopulmonary disease may not be readily corrected by conventional adjustments of minute ventilation. Also, hyperventilation using conventional mechanical ventilation (CMV) in hypercapnic patients with decreased lung compliance during CDP might induce ventilator induced lung injury.Tracheal gas insufflation (TGI) has been proposed as an adjunct to controlled mechanical hypoventilation because it enhances CO 2 elimination and reduces ventilatory requirements [4,14,15,17,21]. The primary mechanism of TGIaided ventilation is washout of CO 2 from proximal airways and apparatus deadspace [21].…”

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confidence: 99%

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Tracheal Gas Insufflation-Aided Mechanical Ventilation during Carbon Dioxide-Induced Pneumoperitoneum in Rabbits

Kim

Lee²,

Jang

et al. 2003

The Journal of Veterinary Medical Science

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ABSTRACT. Despite numerous benefits of laparoscopic procedures, the serious hypercapnia and respiratory acidosis in hypercapnic patients with decreased pulmonary compliance during carbon dioxide-induced pneumoperitoneum (CDP) may be developed. Tracheal gas insufflation (TGI) has been shown to be a useful adjunct to controlled mechanical hypoventilation. This study was undertaken to identify whether TGI superimposed on controlled mechanical ventilation (CMV) improve ventilatory efficiency during CDP in rabbits. Sixteen paralyzed and anesthetized rabbits were used. The animals were assigned to two groups-CMV group: CMV alone; TGI group: CMV superimposed by TGI with flow rate of 2L/min. The animals were insufflated to intra-abdominal pressure of 8 mmHg with CO 2 gas. Then, tidal volume (V T ) was changed to maintain the set peak inspiratory pressure (PIP) value, while other ventilatory settings were kept constant. The set PIP value corresponding to 30, 60, and 90 min after the start of peritoneal insufflation of CO 2 were 15, 22, and 25 cmH 2 O, respectively. During CDP with TGI, PaCO 2 decreased significantly (p<0.01) from CMV without TGI of 82.1 ± 14.1 to 47.5 ± 5.5, 58.1 ± 9.9 to 40.0 ± 4.6, 47.1 ± 9.4 to 32.7 ± 5.1 mmHg at PIP of 15, 22, and 25 cmH 2 O, respectively. The inspired V T decreased significantly (p<0.05) from CMV without TGI of 18.4 ± 3.9 to 12.8 ± 2.8 ml at PIP of 15 cmH 2 O. TGI superimposed on CMV is more effective than CMV alone in enhancing ventilatory efficiency during CDP in rabbits. KEY WORDS: anesthesia, gas insufflation, hypercapnia.J. Vet. Med. Sci. 65(8): 907-912, 2003 Laparoscopic procedures, including laparoscopic diagnosis, appendectomy, cholecystectomy, liver biopsy, hypertrophic pyloric stenosis, splenectomy, and adhesive intestinal obstruction are being performed increasingly in neonates and children [3,25]. Rabbits have been reported as appropriate training models with which to practice the skills needed for laparoscopic surgery in neonates or infants due to their size and abdominal anatomy [11,19,20].Although laparoscopic procedures appear to be associated with a low operative mortality rate through small incision and reduced operative dissection, the serious hypercapnia and respiratory acidosis may develop during carbon dioxide-induced pneumoperitoneum (CDP) [6,9,24]. The ensuing respiratory acidosis induced by hypercapnia can contribute to arrhythmias and even cardiovascular collapse. These risks resulted from CDP may be higher in neonates and infants than in adults and older children.Hyperventilation through increment of ventilatory rate and/or tidal volume in hypercapnic patients during CDP has been routinely recommended as a ventilatory maneuver [6]. However, ventilatory failure in infants with rapid and shallow ventilatory pattern or patients with preexisting cardiopulmonary disease may not be readily corrected by conventional adjustments of minute ventilation. Also, hyperventilation using conventional mechanical ventilation (CMV) in hypercapnic patients with decreased l...

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“…One reason may be a drop in EtCO 2 due to using one's voice, as observed in a study done on healthy subjects [116]. Another potential reason is dead-space washout in the upper airway that has been found to coincide with an increase in tidal volumes in other studies [117,118]. With our current data, we cannot categorically state, however, that tidal volumes increased for patients in this study.…”

Section: Discussionmentioning

confidence: 54%

Towards an improved understanding of the effect of a speaking valve on lung volumes and communication in the critically ill tracheostomised patient

Sutt¹

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Tracheostomised mechanically ventilated patients are often left unable to speak, which is frustrating for patients and the staff caring for them. Having no voice causes major distress and feelings of helplessness for patients. Voicelessness frequently leads to reduced information exchange between the patient and healthcare team, frequently to the detriment of patient care. An in-line speaking valve (SV) is a one-way valve that may be used in the mechanical ventilation circuit to enable verbal communication in tracheostomised patients.Limited data exist regarding the effect of SVs on respiratory mechanics. Deflation of the tracheostomy cuff is required for placement of the SV, effectively causing a "leak" in the As an experienced speech pathologist, I believe concerns over SV use to date have little evidence. The main objective, and first aim of this thesis was to investigate the effect of SV use on respiratory mechanics to determine whether SVs should be used in-line with mechanical ventilation of tracheostomised patients. The second aim was to assess the effect of introducing SVs into a cardio-thoracic ICU on patient tracheostomy specific outcomes. The third aim was to further clarify the effect of SVs on success with healthrelated communication for ICU patients. To achieve these aims, 5 studies were conducted, resulting in 5 manuscripts.For the first aim, 20 tracheostomised ICU patients using a SV that met the inclusion criteria were recruited to the study from November 2013-December 2014. Electrical Impedance iii Tomography (EIT) was used to assess the patients' end-expiratory lung impedance (EELI) and ventilation distribution continuously over 60 minutes (before, during and after SV use). For the third aim, 25 patients and 52 nursing staff were asked to fill out a custom-made questionnaire on success with health communication, firstly when the patients were voiceless, and, secondly, when they were using a SV. Chapter 7 highlights individual differences and some disparity between patient and nursing ratings of communication success. Overall, however, following SV use both the patients and nursing staff reported a significant improvement in success with health communication. Additional variables included oxygenation (SpOIn conclusion, the findings of this thesis addressed the research aims, and provide new knowledge through use of an innovative approach to assessing lung mechanics. Having iv already resulted in real clinical changes in our centre, the results indicate the potential for optimising communication, using SVs in tracheostomised cardiothoracic ICU patients undergoing weaning from mechanical ventilation.v

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Continuous tracheal gas insufflation enables a volume reduction strategy in hyaline membrane disease: technical aspects and clinical results

Abstract: CTGI may be a useful adjunct to conventional ventilation in preterm neonates with respiratory disease, enabling an increase in CO2 clearance or a reduction in ventilatory pressure.

Cited by 46 publications

References 18 publications

Intratracheal atomized surfactant provides similar outcomes as bolus surfactant in preterm lambs with respiratory distress syndrome

Intratracheal atomized surfactant provides similar outcomes as bolus surfactant in preterm lambs with respiratory distress syndrome

Tracheal Gas Insufflation-Aided Mechanical Ventilation during Carbon Dioxide-Induced Pneumoperitoneum in Rabbits

Towards an improved understanding of the effect of a speaking valve on lung volumes and communication in the critically ill tracheostomised patient

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