Low bias flow oscillation with heliox in oleic acid-induced lung injury

Siddappa, Rajashekhar; Dowhy, Mark S; Rotta, Alexandre T.; Hernan, Lynn J.; Fuhrman, Bradley P.

doi:10.1097/01.pcc.0000149138.65083.ef

Cited by 3 publications

(6 citation statements)

References 13 publications

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“…Heliox allowed for a reduction in minute volume ventilation, while CO 2 removal remained unaltered. These effects are in line with findings in pediatric ARDS models [12,13,14], as well as in pediatric and adult patients with respiratory failure due to exacerbation of COPD or asthma [9,10,18,19,20]. In ARDS models, heliox has mostly been studied as a driving gas during HFOV.…”

Section: Discussionsupporting

confidence: 78%

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Heliox Allows for Lower Minute Volume Ventilation in an Animal Model of Ventilator-Induced Lung Injury

et al. 2013

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BackgroundHelium is a noble gas with a low density, allowing for lower driving pressures and increased carbon dioxide (CO2) diffusion. Since application of protective ventilation can be limited by the development of hypoxemia or acidosis, we hypothesized that therefore heliox facilitates ventilation in an animal model of ventilator–induced lung injury.MethodsSprague-Dawley rats (N=8 per group) were mechanically ventilated with heliox (50% oxygen; 50% helium). Controls received a standard gas mixture (50% oxygen; 50% air). VILI was induced by application of tidal volumes of 15 mL kg-1; lung protective ventilated animals were ventilated with 6 mL kg-1. Respiratory parameters were monitored with a pneumotach system. Respiratory rate was adjusted to maintain arterial pCO2 within 4.5-5.5 kPa, according to hourly drawn arterial blood gases. After 4 hours, bronchoalveolar lavage fluid (BALF) was obtained. Data are mean (SD).ResultsVILI resulted in an increase in BALF protein compared to low tidal ventilation (629 (324) vs. 290 (181) μg mL-1; p<0.05) and IL-6 levels (640 (8.7) vs. 206 (8.7) pg mL-1; p<0.05), whereas cell counts did not differ between groups after this short course of mechanical ventilation. Ventilation with heliox resulted in a decrease in mean respiratory minute volume ventilation compared to control (123±0.6 vs. 146±8.9 mL min-1, P<0.001), due to a decrease in respiratory rate (22 (0.4) vs. 25 (2.1) breaths per minute; p<0.05), while pCO2 levels and tidal volumes remained unchanged, according to protocol. There was no effect of heliox on inspiratory pressure, while compliance was reduced. In this mild lung injury model, heliox did not exert anti-inflammatory effects.ConclusionsHeliox allowed for a reduction in respiratory rate and respiratory minute volume during VILI, while maintaining normal acid-base balance. Use of heliox may be a useful approach when protective tidal volume ventilation is limited by the development of severe acidosis.

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Section: Discussionsupporting

confidence: 78%

“…In paediatric animal models of ARDS [12,13,14], heliox ventilation was found to improve gas exchange during high–frequency oscillatory ventilation and attenuate lung inflammation [13]. However, data on the effect of heliox on ARDS during conventional mechanical ventilation are sparse and data are limited to paediatric models.…”

Section: Introductionmentioning

confidence: 99%

Heliox Allows for Lower Minute Volume Ventilation in an Animal Model of Ventilator-Induced Lung Injury

et al. 2013

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“…Moreover, heliox ventilation showed no effect on neither gas exchange or on lung inflammation. Thereby, our results are somewhat in contrast to studies investigating heliox ventilation in pediatric models as well as to findings in our own animal model of ventilator-induced lung injury, where heliox improved CO 2 removal [ 13 – 17 ].…”

Section: Discussioncontrasting

confidence: 95%

“…The use of heliox has been evaluated in pediatric animal models of ARDS induced by oleic acid or saline [ 13 – 15 ], showing that heliox ventilation improved gas exchange during high-frequency oscillatory ventilation. We recently showed that heliox improves CO 2 removal and decreases driving pressures in patients who are mechanically ventilated according to the recommended protective strategy, as well as in an animal model of lung injury inflicted by high tidal volume ventilation [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Mechanical ventilation with heliox in an animal model of acute respiratory distress syndrome

Beurskens

Arazi

Beer

et al. 2014

ICMx

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BackgroundHeliox has a lower density and higher diffusion capacity compared to oxygen-in-air. We hypothesized that heliox ventilation allows for a reduction in minute volume ventilation and inspiratory pressures needed for adequate gas exchange in an animal model of an acute lung injury.MethodsAfter intratracheal instillation of lipopolysaccharide (10 mg/kg), adult rats were randomized to ventilation with either a gas mixture of helium/oxygen (50:50%) or oxygen/air (50:50%). They were mechanically ventilated according to the ARDSnet recommendations with tidal volumes of 6 ml/kg and monitored with a pneumotachometer. Bronchoalveolar lavage fluid was analyzed for markers of lung injury, and embedded lung sections were histologically scored for lung injury.ResultsHeliox limited the increase in driving pressures needed to achieve preset tidal volumes, with a concomitant decrease in loss of compliance. Heliox did neither allow for reduced minute volume ventilation in this model nor improve gas exchange. Also, heliox did not reduce lung injury.ConclusionsHeliox modestly improved respiratory mechanics but did not improve lung injury in this rat model of acute respiratory distress syndrome.

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“…In an adult rabbit model of ARDS, lung injury was induced by oleic acid instillation [29]. Animals were ventilated with low bias flow oscillation with a CO 2 scrubber, which is a modified HFOV system to reduce gas utilisation.…”

Section: Resultsmentioning

confidence: 99%

The Potential of Heliox as a Therapy for Acute Respiratory Distress Syndrome in Adults and Children: A Descriptive Review

et al. 2015

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Background: In neonatal respiratory distress syndrome (RDS) and acute RDS (ARDS) mechanical ventilation is often necessary to manage hypoxia, whilst protecting the lungs through lower volume ventilation and permissive hypercapnia. Mechanical ventilation can, however, induce or aggravate the lung injury caused by the respiratory distress. Helium, in a gas mixture with oxygen (heliox), has a low density and can reduce the flow in narrow airways and allow for lower driving pressures. Objectives: The aim of this study was to review preclinical and clinical studies of the use of heliox ventilation in acute lung injury associated with respiratory failure. Methods: A systematic search was executed in the PubMed and EMBASE databases, with search terms referring to ARDS or an acute lung injury condition associated with respiratory failure and the corresponding intervention. Results: A total of 576 papers were retrieved. After the majority had been excluded 20 papers remained, of which 6 articles described animal models (3 paediatric; 3 adult animal models) and 14 were clinical studies, of which 12 described paediatric patient populations and 2 adult patient populations. In both paediatric and adult animal models, heliox improved gas exchange while allowing for less invasive ventilation in a wide variety of models using different ventilation modes. Clinical studies show a reduction in the work of breathing during heliox ventilation, with a concomitant increase in pH and decrease in PaCO₂ levels compared to oxygen ventilation. Conclusions: Although evidence so far is limited, there may be a rationale for heliox ventilation in ARDS as an intervention to improve ventilation and reduce the work of breathing.

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Low bias flow oscillation with heliox in oleic acid-induced lung injury

Abstract: Helium concentrations greater than 40% increase Co(2) clearance from oleic acid-injured lungs of rabbits during low bias flow oscillation. The low bias flow oscillation system makes this possible using 1% of the gas volume required during high-frequency oscillatory ventilation.

Cited by 3 publications

References 13 publications

Heliox Allows for Lower Minute Volume Ventilation in an Animal Model of Ventilator-Induced Lung Injury

Heliox Allows for Lower Minute Volume Ventilation in an Animal Model of Ventilator-Induced Lung Injury

Mechanical ventilation with heliox in an animal model of acute respiratory distress syndrome

The Potential of Heliox as a Therapy for Acute Respiratory Distress Syndrome in Adults and Children: A Descriptive Review

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