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Dorsal Recruitment with Flow-controlled Expiration (FLEX): an Experimental Study in Mechanically Ventilated Lung-healthy and Lung-injured Pigs

Silke BorgmannJohannes P. SchmidtUlrich GöbelJörg HaberstrohJoseph GuttmannStefan Schumann

出版	Universität, 2018
URL	http://books.google.com.hk/books?id=FH4ivwEACAAJ&hl=&source=gbs_api

註釋Abstract: Background: Concepts for optimizing mechanical ventilation focus mainly on modifying the inspiratory phase. We propose flow-controlled expiration (FLEX) as an additional means for lung protective ventilation and hypothesize that it is capable of recruiting dependent areas of the lungs. This study investigates potential recruiting effects of FLEX using models of mechanically ventilated pigs before and after induction of lung injury with oleic acid.
Methods: Seven pigs in the supine position were ventilated with tidal volume 8 ml·kg− 1 and positive end-expiratory pressure (PEEP) set to maintain partial pressure of oxygen in arterial blood (paO2) at ≥ 60 mmHg and monitored with electrical impedance tomography (EIT). Two ventilation sequences were recorded - one before and one after induction of lung injury. Each sequence comprised 2 min of conventional volume-controlled ventilation (VCV), 2 min of VCV with FLEX and 1 min again of conventional VCV. Analysis of the EIT recordings comprised global and ventral and dorsal baseline levels of impedance curves, end-expiratory no-flow periods, tidal variation in ventral and dorsal areas, and regional ventilation delay index.
Results: With FLEX, the duration of the end-expiratory zero flow intervals was significantly shortened (VCV 1.4 ± 0.3 s; FLEX 0.7 ± 0.1 s, p 0.001), functional residual capacity was significantly elevated in both conditions of the lungs (global: healthy, increase of 87 ± 12 ml, p