Hemodynamic effects of positive end-expiratory pressure during partial liquid ventilation in newborn lambs

Overfield, D.Michael; Bennett, Stephen H.; Goetzman, Boyd W.; Milstein, Jay M.; Moon-Grady, Anita J.

doi:10.1053/jpsu.2001.26360

Cited by 2 publications

(1 citation statement)

References 31 publications

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“…The inspiratory to expiratory time ratio was set at 1:2. The end-expiratory lung volume was progressively increased to 30 mL/kg over the first 10 respiratory cycles to reach a lung volume similar to functional residual capacity (25-30 mL/kg) during conventional mechanical ventilation in this model (Overfield et al, 2001;Wolfson and Shaffer, 2004). Given the complexity of changing respiratory rate with our current liquid ventilator algorithms, respiratory rate was kept constant throughout TLV and tidal volumes were adjusted to maintain targeted blood gases using a permissive hypercapnia approach (pH ≥ 7.20 and PaCO 2 from 50 to 65 mmHg (Ryu et al, 2012).…”

Section: Total Liquid Ventilationmentioning

confidence: 99%

Effect of Low Versus High Tidal-Volume Total Liquid Ventilation on Pulmonary Inflammation

et al. 2020

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Animal experiments suggest that total liquid ventilation (TLV) induces less ventilatorinduced lung injury (VILI) than conventional mechanical gas ventilation. However, TLV parameters that optimally minimize VILI in newborns remain unknown. Our objective was to compare lung inflammation between low (L-V T) and high (H-V T) liquid tidal volume and evaluate impacts on the weaning process. Sixteen anesthetized and paralyzed newborn lambs were randomized in an L-V T group (initial tidal volume of 10 mL/kg at 10/min) and an H-V T group (initial tidal volume of 20 mL/kg at 5/min). Five unventilated newborn lambs served as controls. After 4 h of TLV in the supine position, the lambs were weaned in the prone position for another 4 h. The levels of respiratory support needed during the 4 h post-TLV were compared. The anterior and posterior lung regions were assessed by a histological score and real-time quantitative PCR for IL1B, IL6, and TNF plus 12 other exploratory VILI-associated genes. All but one lamb were successfully extubated within 2 h post-TLV (72 ± 26 min vs. 63 ± 25 min, p = 0.5) with similar FiO 2 at 4 h post-TLV (27 ± 6% vs. 33 ± 7%, p = 0.3) between the L-V T and H-V T lambs. No significant differences were measured in histological inflammation scores between L-V T and H-V T lambs, although lambs in both groups exhibited slightly higher scores than the control lambs. The L-V T group displayed higher IL1B mRNA expression than the H-V T group in both anterior (2.8 ± 1.5-fold increase vs. 1.3 ± 0.4-fold increase, p = 0.02) and posterior lung regions (3.0 ± 1.0-fold change increase vs. 1.1 ± 0.3-fold increase, p = 0.002), respectively. No significant differences were found in IL6 and TNF expression levels. Gene expression changes overall indicated that L-V T was associated with a qualitatively distinct inflammatory gene expression profiles compared to H-V T , which may indicate different clinical effects. In light of these findings, further mechanistic studies are warranted. In conclusion, we found no advantage of lower tidal volume use, which was in fact associated with a slightly unfavorable pattern of inflammatory gene expression.

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Section: Total Liquid Ventilationmentioning

confidence: 99%

Effect of Low Versus High Tidal-Volume Total Liquid Ventilation on Pulmonary Inflammation

et al. 2020

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Neonatal respiratory failure

Rimensberger¹

2002

Current Opinion in Pediatrics

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The classic entity of neonatal distress syndrome, as a lung disease expressing predominant surfactant deficiency, is currently changing to a more complex disease of the developing lung as a result of the number of extremely immature preterm infants. Prenatal factors, such as the fetal inflammatory response syndrome influence short- and long-term outcome in these premature infants presenting with respiratory distress syndrome at birth. Therefore, various previously dismissed treatment strategies, such as surfactant prophylaxis or newer anti-inflammatory approaches have to be reinvestigated in this emerging population. Despite the resurrection of a new picture of bronchopulmonary dysplasia, lung injury induced by mechanical ventilation remains a major issue in neonatal intensive care. With the advance in understanding of mechanical ventilation, it is becoming evident, that improvement in outcome can not be achieved by restoring normal lung physiology in the diseased lung using sophisticated ventilators and ventilation modes. A more disease specific ventilator strategy that will target as early as possible homogenous lung opening while at the same time avoiding overdistention of the lung, has the potential to affect outcome. The possible antiinflammatory properties of surfactant-proteins, nitric oxide and corticosteroids, despite some drawbacks, may show to have a synergistic effect. However, this needs further exploration.

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Hemodynamic effects of positive end-expiratory pressure during partial liquid ventilation in newborn lambs

Cited by 2 publications

References 31 publications

Effect of Low Versus High Tidal-Volume Total Liquid Ventilation on Pulmonary Inflammation

Effect of Low Versus High Tidal-Volume Total Liquid Ventilation on Pulmonary Inflammation

Neonatal respiratory failure

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