Effect of tracheostomy on lung development in fetal lambs

Fewell, James E.; Hislop, Alison A.; Kitterman, Joseph A.; Johnson, P

doi:10.1152/jappl.1983.55.4.1103

Cited by 86 publications

(33 citation statements)

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“…Transpulmonary pressure, a major determinant of lung liquid volume, is determined in the fetus by pleural pressure and the secretion pressure of lung liquid acting against a resistance to outflow in the upper airways (5,6). Experimental manipulations oftranspulmonary pressure have led to abnormal lung volumes and lung growth (7,8). Extreme manipulations of upper airway resistance have led to opposing effects on lung expansion and growth.…”

Section: Introductionmentioning

confidence: 99%

Role of lung fluid volume in growth and maturation of the fetal sheep lung.

Moessinger¹,

Harding²,

Adamson³

et al. 1990

J. Clin. Invest.

243

169

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We studied the effects of alterations in lung fluid volume on growth and maturation of the fetal lung. In a chronic fetal sheep preparation, right fetal lung volume was decreased by drainage of lung fluid while the volume of the left lung was expanded by mainstem bronchus ligation leading to lung fluid retention. After an experimental period of 25 d (from 105 to 129 d of gestation, term = 145 d), the right (deflated) lung was significantly hypoplastic and contained less DNA than the controls; 175.15±55.18 vs. 346.77±61.97 mg, respectively; P < 0.001. In contrast, the left (expanded) lung was significantly hyperplastic and contained more DNA than the controls; 390.74±103.53 vs. 238.85±3332 mg, respectively; P = 0.001.Biochemical indices of lung maturation, including total phospholipids, phosphatidylcholine, and disaturated phosphatidylcholine content expressed per unit of tissue DNA, were no different when comparing the hypoplastic, hyperplastic, and control lungs. These findings demonstrate that fetal lung cell multiplication is influenced by local distension with lung fluid, while the biochemical maturation of fetal lung surfactant is under systemic

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Section: Introductionmentioning

confidence: 99%

Role of lung fluid volume in growth and maturation of the fetal sheep lung.

Moessinger¹,

Harding²,

Adamson³

et al. 1990

J. Clin. Invest.

243

169

View full text Add to dashboard Cite

show abstract

“…The rationale for shunting in fetuses with upper airway obstruction is based on observations in previous sheep experiments [4,24]. It is well known that manipulation of pulmonary fluid dynamics influences pulmonary development.…”

Section: Discussionmentioning

confidence: 99%

Experimental Evaluation of Tracheo-Amniotic Shunting for Induced Congenital High Airway Obstruction in a Sheep Model

DeKoninck¹,

Endo²,

Deprest³

et al. 2015

Fetal Diagn Ther

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Objective: To evaluate the feasibility of tracheo-amniotic shunting in a sheep model for congenital high airway obstruction syndrome. Material and Methods: High airway obstruction was induced around day 95 (term = 145 days) in 10 lamb fetuses by tracheal clipping. Five days later, ultrasound-guided tracheoamniotic shunting was done using either the Harrison double-pigtail bladder stent (HS) or a double-basket device (BS). Caesarean section (CS) was done around day 110. At each time point, the cardiothoracic index (CTI) was measured. Lung-to-body weight ratio (LBWR) was calculated at fetal necropsy. The primary endpoint was successful shunting defined as anatomically correct placement and functional airway decompression; the secondary endpoint was survival until CS. Results: Two sheep aborted 3 fetuses after tracheal occlusion. Overall, the median CTI at CS was significantly smaller compared to baseline [0.52 (interquartile range, IQR: 0.52-0.54) vs. 0.58 (IQR: 0.54-0.63); p = 0.01]. In the HS group (n = 4), none of the shunts were correctly positioned. In the BS group (n = 3), there was 1 correct shunt placement; however, this fetus was stillborn. Median LBWR suggested pulmonary overgrowth [0.10 (IQR: 0.08-0.11)]. Conclusion: In our hands, using this model with a long and mobile neck and relative oligohydramnios, tracheoamniotic shunting for airway obstruction has a high failure rate. If further pursued, alternative techniques or different models should be considered.

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“…Our case demonstrates the technical feasibility of the intrauterine tracheal decompression. However, the potential benefit of prenatal tracheostomy must be balanced against the risk of lung hypoplasia seen in experimental models of in utero tracheostomy [14]. Development of hydrops before viability may warrant fetal intervention; however, most fetuses will profit from a planned early delivery using the EXIT strategy.…”

Section: Discussionmentioning

confidence: 99%

Successful Fetal Intervention for Congenital High Airway Obstruction Syndrome

Paek¹,

Kitterman

Feldstein³

et al. 2002

Fetal Diagn Ther

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Introduction: Complete congenital high airway obstruction syndrome (CHAOS) usually leads to stillbirth or death within minutes of delivery. We describe the management and long-term follow-up of a baby with a prenatally diagnosed airway obstruction. Case: Because of progressive hydrops fetalis, massive ascites and everted diaphragms due to CHAOS in a fetus at 24 weeks of gestation, a fetal tracheostomy was performed. Persistent fetal bradycardia at the time of the fetal procedure led to delivery of the infant. Adequate oxygenation and ventilation were attained using relatively low oxygen concentrations and low ventilatory pressures. Plain radiographs demonstrated that the lungs were large and the ribs thin. The infant has a permanent tracheostomy, required continuous assisted ventilation for several months and assisted ventilation at night at home for 3 years. At 4 years of age, he has no speech, all feedings are by gastrostomy, and developmentally he is mildly to moderately delayed. Conclusion: Laryngeal atresia produced over-distended lungs and hydrops. Precise prenatal imaging and fetal surgical strategies may allow the survival of affected fetuses.

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Effect of tracheostomy on lung development in fetal lambs

Cited by 86 publications

References 0 publications

Role of lung fluid volume in growth and maturation of the fetal sheep lung.

Role of lung fluid volume in growth and maturation of the fetal sheep lung.

Experimental Evaluation of Tracheo-Amniotic Shunting for Induced Congenital High Airway Obstruction in a Sheep Model

Successful Fetal Intervention for Congenital High Airway Obstruction Syndrome

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