Dynamic alveolar mechanics and ventilator-induced lung injury

Carney, David E.; DiRocco, Joseph D.; Nieman, Gary F.

doi:10.1097/01.ccm.0000155928.95341.bc

Cited by 123 publications

(101 citation statements)

References 42 publications

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“…1,2 The two types of NCPAP commonly used in the neonatal intensive care unit are ventilator-derived NCPAP (V-NCPAP) and bubble NCPAP (B-NCPAP). During V-NCPAP, flow is constant and the CPAP level is maintained at the distal expiratory-limb orifice, which adjusts to keep the delivered CPAP at the desired level.…”

Section: Introductionmentioning

confidence: 99%

Bubble and ventilator-derived nasal continuous positive airway pressure in premature infants: work of breathing and gas exchange

et al. 2010

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Objective: During bubble nasal continuous positive airway pressure (B-NCPAP), gas flows through the expiratory limb of CPAP tubing submerged underwater to a depth in centimeters considered equal to the desired end expiratory pressure. Ventilator-derived NCPAP (V-NCPAP) controls the delivered pressure at the expiratory orifice. Limited data exist comparing the two forms of NCPAP on work of breathing (WOB) and other short-term respiratory outcomes. We compared WOB and gas exchange between B-NCPAP and V-NCPAP at equivalent delivered nasal prong pressures among a cohort of preterm infants on NCPAP.Study Design: We performed a randomized crossover study in 18 premature infants <1500 g (BW 1101±254 g, GA 28±2 weeks, study age 13 ± 8 days (means ± s.d.)), who were already on NCPAP for mild respiratory distress, comparing B-NCPAP to V-NCPAP. Each infant was studied at a constant flow rate and varying pressures of 3, 5, 7, 4 and 2 cm H 2 O in that order. Tidal volumes were obtained by calibrated respiratory inductance plethysmography. Intrapleural pressure was estimated by an esophageal catheter. WOB (inspiratory, elastic and resistive) was calculated from pressure volume data. Breathing asynchrony was assessed with phase angle. Comparisons of respiratory rate, heart rate, tidal volume, minute ventilation, breathing asynchrony, lung compliance, oxygen saturation and transcutaneous (Tc) O 2 and CO 2 were also made.Result: WOB and most respiratory parameters were not different between B-NCPAP and V-NCPAP. TcO 2 was higher with B-NCPAP compared to V-NCPAP (P ¼ 0.01). TcCO 2 was not different. None of the other measured parameters was significantly different between the two devices.Conclusion: WOB and ventilation with B-NCPAP and V-NCPAP are similar when equivalent delivered prong pressures are assured. Improved oxygenation with B-NCPAP is intriguing and requires further investigation.

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Section: Introductionmentioning

confidence: 99%

Bubble and ventilator-derived nasal continuous positive airway pressure in premature infants: work of breathing and gas exchange

et al. 2010

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“…There have also been a substantial number of direct dynamic studies imaging the pleural surface aspect of alveoli using twodimensional in vivo video microscopy techniques (8)(9)(10)(11)(12)(13)(14)(15). These studies evaluate the alveolar dimensions as seen through the overlying pleural surface with the expected lack of detailed morphology and measurement.…”

mentioning

confidence: 99%

Alveolar Dynamics during Respiration

Namati¹,

Thiesse²,

Ryk³

et al. 2008

Am J Respir Cell Mol Biol

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The change in alveolar size and number during the full breathing cycle in mammals remains unanswered, yet these descriptors are fundamental for understanding alveolar-based diseases and for improving ventilator management. Genetic and environmental mouse models are used increasingly to evaluate the evolution of disease in the peripheral lung; however, little is known regarding alveolar structure and function in the fresh, intact lung. Therefore, we have developed an optical confocal process to evaluate alveolar dynamics in the fresh intact mouse lung and as an initial experiment, have evaluated mouse alveolar dynamics during a single respiratory cycle immediately after passive lung deflation. We observe that alveoli become smaller and more numerous at the end of inspiration, and propose that this is direct evidence for alveolar recruitment in the mouse lung. The findings reported support a new hypothesis that requires recruitable secondary (daughter) alveoli to inflate via primary (mother) alveoli rather than from a conducting airway.

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“…[7][8][9] Mechanical ventilation using high tidal volumes can result in overdistention of alveoli that mainly causes ventilator-associated lung injury. 10 Lung-protective ventilation refers to the use of low tidal volumes and moderate to high levels of positive end-expiratory pressure, with or without a recruitment manoeuvre. 11 Lung-protective ventilation has been found to reduce morbidity and mortality among patients with acute lung injury and acute respiratory distress syndrome.…”

mentioning

confidence: 99%

Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials

Wang

Liu

2014

CMAJ

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Interpretation:Anesthetized patients who received ventilation with lower tidal volumes during surgery had a lower risk of lung injury and pulmonary infection than those given conventional ventilation with higher tidal volumes. Implementation of a lung-protective ventilation strategy with lower tidal volumes may lower the incidence of these outcomes. Abstract Research E102CMAJ, February 17, 2015, 187(3)

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Dynamic alveolar mechanics and ventilator-induced lung injury

Cited by 123 publications

References 42 publications

Bubble and ventilator-derived nasal continuous positive airway pressure in premature infants: work of breathing and gas exchange

Bubble and ventilator-derived nasal continuous positive airway pressure in premature infants: work of breathing and gas exchange

Alveolar Dynamics during Respiration

Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials

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