The effect of positive-end expiratory pressure on oxygenation during high frequency jet ventilation and conventional mechanical ventilation in the rabbit model of acute lung injury

Abstract

BackgroundThe use of positive end expiratory pressure (PEEP) in patients with acute lung injury (ALI) improves arterial oxygenation by alleviating pulmonary shunting, helping the respiratory muscles to decrease the work of breathing, decreasing the rate of infiltrated and atelectatic tissues, and increasing functional residual capacity. In a rabbit model of saline lavage-induced ALI, we examined the effects of PEEP on gas exchange, hemodynamics, and oxygenation during high frequency jet ventilation (HFJV), and then compared these parameters with those during conventional mechanical ventilation (CMV).MethodsTwelve rabbits underwent repeated saline lavage to create ALI. The animals were divided in 2 groups: 1) Group CMV (n = 6), and 2) Group HFJV (n = 6). In both groups, we applied 2 levels of PEEP (5 cmH2O and 10 cmH2O) and then measured the arterial blood gas, mixed venous blood gas, and hemodynamic parameters.ResultsWith administration of PEEP of either 5 cmH2O or 10 cmH2O, the arterial oxygen content of both groups was increased, although without statistically significant differences between groups. On the contrary, the arterial carbon dioxide content was significantly decreased in the HFJV group, as compared with the CMV group, during the entire experiment. Furthermore, there was significant decreases in mean arterial pressures in both groups with a PEEP of 10 cmH2O.ConclusionsThe application of PEEP in rabbits with ALI effectively improves oxygenation in either HFJV or CMV.

Feasibility of neurally adjusted positive end-expiratory pressure in rabbits with early experimental lung injury

“…In the event of high tonic Edi, cNAVA may provide too high levels of expiratory pressure, possibly compromising hemodynamics [ 40 ] or causing apnea [ 9 ] However, in the present study, we did not observe such high end-expiratory pressures (highest 6 cm H 2 O), and apnea was never observed. We did find a statistically lower mean arterial blood pressure during cNAVA, but it is difficult to interpret the clinical implications of this drop (and was on average only 3.3 mmHg lower).…”

Prospect in Pediatric Diseases Medicine

“…A positive response to HFJV has been shown in a rabbit model of acute lung injury (Bang et al 2012). These findings are akin to those of Bang et al (2012) in the rabbit model of respiratory insufficiency and of Carlo et al (1984) in infants with respiratory distress syndrome who have found that HFJV lowers PaCO 2 . In the rabbit model of MAS, HFJV improved gas exchange, lung compliance, and reduced rightto-left pulmonary shunts (Sevecova et al 2003).…”

“…In preterm infants with respiratory distress syndrome treated with exogenous surfactant, HFJV reduced the incidence of bronchopulmonary dysplasia and a need for home oxygen, as there was no increase in adverse outcomes compared with CMV (Keszler et al 1997). A positive response to HFJV has been shown in a rabbit model of acute lung injury (Bang et al 2012). HFJV has been also found effective in improving oxygenation in infants with hypoxemic respiratory failure unresponsive to high frequency oscillatory ventilation (Friedlich et al 2003).…”

Jet ventilation for the extraction of endobronchial foreing body in a patient with drained pneumothorax: A case report☆

“…En insuficiencia respiratoria grave, con la VJAF es posible mantener un volumen alto al final de la espiración para aumentar la capacidad funcional residual sin elevar la presión alveolar máxima. Una publicación reciente demostró que la asociación de VJAF con presión positiva al final de la espiración (PEEP) mejoró la oxigenación en conejos con lesión pulmonar aguda 7 .…”