Setting Mean Airway Pressure during High-frequency Oscillatory Ventilation According to the Static Pressure–Volume Curve in Surfactant-deficient Lung Injury

Author:

Luecke Thomas1,Meinhardt Juergen P.1,Herrmann Peter2,Weisser Gerald3,Pelosi Paolo4,Quintel Michael5

Affiliation:

1. Staff Anesthesiologist.

2. Biomedical Engineer.

3. Staff Radiologist, Department of Radiology, University Hospital of Mannheim, Faculty of Clinical Medicine Mannheim, University of Heidelberg.

4. Professor, Department of Clinical and Biological Sciences, University of Insubria.

5. Professor, Department of Anesthesiology and Intensive Care Medicine.

Abstract

Background Numerous studies suggest setting positive end-expiratory pressure during conventional ventilation according to the static pressure-volume (P-V) curve, whereas data on how to adjust mean airway pressure (P(aw)) during high-frequency oscillatory ventilation (HFOV) are still scarce. The aims of the current study were to (1) examine the respiratory and hemodynamic effects of setting P(aw) during HFOV according to the static P-V curve, (2) assess the effect of increasing and decreasing P(aw) on slice volumes and aeration patterns at the lung apex and base using computed tomography, and (3) study the suitability of the P-V curve to set P(aw) by comparing computed tomography findings during HFOV with those obtained during recording of the static P-V curve at comparable pressures. Methods Saline lung lavage was performed in seven adult pigs. P-V curves were obtained with computed tomography scanning at each volume step at the lung apex and base. The lower inflection point (Pflex) was determined, and HFOV was started with P(aw) set at Pflex. The pigs were provided five 1-h cycles of HFOV. P(aw), first set at Pflex, was increased to 1.5 times Pflex (termed 1.5 Pflex(inc)) and 2 Pflex and decreased thereafter to 1.5 times Pflex and Pflex (termed 1.5 Pflex(dec) and Pflex(dec)). Hourly measurements of respiratory and hemodynamic variables as well as computed tomography scans at the apex and base were made. Results High-frequency oscillatory ventilation at a P(aw) of 1.5 Pflex(inc) reestablished preinjury arterial oxygen tension values. Further increase in P(aw) did not change oxygenation, but it decreased oxygen delivery as a result of decreased cardiac output. No differences in respiratory or hemodynamic variables were observed when comparing HFOV at corresponding P(aw) during increasing and decreasing P(aw). Variation in total slice lung volume (TLVs) was far less than expected from the static P-V curve. Overdistended lung volume was constant and less than 3% of TLVs. TLVs values during HFOV at Pflex, 1.5 Pflex(inc), and 2 Pflex were significantly greater than TLVs values at corresponding tracheal pressures on the inflation limb of the static P-V curve and located near the deflation limb. In contrast, TLVs values during HFOV at decreasing P(aw) (i.e., 1.5 Pflex(dec) and Pflex(dec)) were not significantly greater than corresponding TLV on the deflation limb of the static P-V curves. The marked hysteresis observed during static P-V curve recordings was absent during HFOV. Conclusions High-frequency oscillatory ventilation using P(aw) set according to a static P-V curve results in effective lung recruitment, and slice lung volumes during HFOV are equal to those from the deflation limb of the static P-V curve at equivalent pressures.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

Reference33 articles.

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3