Academic Journal
Variable positive end-expiratory pressure in an experimental model of acute respiratory distress syndrome: an advanced ventilation modality
| العنوان: | Variable positive end-expiratory pressure in an experimental model of acute respiratory distress syndrome: an advanced ventilation modality |
|---|---|
| المؤلفون: | Sudy R., Diaper J., Bizzotto D., Dellaca' R., Petak F., Habre W., Dos Santos Rocha A. |
| المساهمون: | Sudy, R., Diaper, J., Bizzotto, D., Dellaca', R., Petak, F., Habre, W., Dos Santos Rocha, A. |
| سنة النشر: | 2024 |
| المجموعة: | RE.PUBLIC@POLIMI - Research Publications at Politecnico di Milano |
| مصطلحات موضوعية: | gas exchange, lung function, lung oxygenation index, variable ventilation, ventilator-induced lung injury |
| الوصف: | Background: Introducing variability in tidal volume, ventilatory frequency, or both is beneficial during mechanical ventilation in acute respiratory distress syndrome (ARDS). We investigated whether applying cycle-by-cycle variability in the positive end-expiratory pressure (PEEP) exerts beneficial effect on lung function in a model of ARDS. Methods: Rabbits with lung injury were randomly allocated to receive mechanical ventilation for 6 h by applying a pressure-controlled mode with constant PEEP of 7 cm H2O (PC group: n=6) or variable PEEP (VEEP) with a coefficient of variation of 21.4%, range 4–10 cm H2O (PC-VEEP group; n=6). Lung oxygenation index (PaO2/FiO2) after 6 h of ventilation (H6) was the primary outcome and respiratory mechanics, lung volume, intrapulmonary shunt, and lung inflammatory markers were secondary outcomes. Results: After lung injury, both groups presented moderate-to-severe ARDS (PaO2/FiO2 <27 kPa). The PaO2/FiO2 was significantly higher in the PC-VEEP group than in the PC group at H6 (12.3 [SD 3.5] vs 19.2 [7.2] kPa, P=0.013) and a lower arterial partial pressure of CO2 at 1–3 h (P<0.02). The ventilation-induced increases in airway resistance and tissue elastance were prevented by PC-VEEP. There was no evidence for a difference in minute volume, driving pressure, end-tidal CO2, lung volumes, intrapulmonary shunt fraction, and cytokines between the ventilation modes. Conclusions: Prolonged mechanical ventilation with cycle-by-cycle VEEP prevents deterioration in gas exchange and respiratory mechanics in a model of ARDS, suggesting the benefit of this novel ventilation strategy to optimise gas exchange without increasing driving pressure and lung overdistension. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| Relation: | info:eu-repo/semantics/altIdentifier/pmid/39224447; volume:11; firstpage:1; lastpage:10; numberofpages:10; journal:BJA OPEN; https://hdl.handle.net/11311/1273324 |
| DOI: | 10.1016/j.bjao.2024.100302 |
| الاتاحة: | https://hdl.handle.net/11311/1273324 https://doi.org/10.1016/j.bjao.2024.100302 |
| رقم الانضمام: | edsbas.478A8426 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1016/j.bjao.2024.100302 |
|---|