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Flow-controlled Ventilation Attenuates Lung Injury in a Porcine Model of Acute Respiratory Distress Syndrome
Johannes Schmidt
Christin Wenzel
Sashko G. Spassov
Silke Borgmann
Ziwei Lin
Jakob Wollborn
Jonas Weber
Jörg Haberstroh
Stephan Meckel
Sebastian Alexander Eiden
Steffen Wirth
Stefan Schumann
其他書名
A Preclinical Randomized Controlled Study
出版
Universität
, 2020
URL
http://books.google.com.hk/books?id=HrWhzQEACAAJ&hl=&source=gbs_api
註釋
Abstract: Objectives:
Lung-protective ventilation for acute respiratory distress syndrome aims for providing sufficient oxygenation and carbon dioxide clearance, while limiting the harmful effects of mechanical ventilation. "Flow-controlled ventilation", providing a constant expiratory flow, has been suggested as a new lung-protective ventilation strategy. The aim of this study was to test whether flow-controlled ventilation attenuates lung injury in an animal model of acute respiratory distress syndrome.
Design:
Preclinical, randomized controlled animal study.
Setting:
Animal research facility.
Subjects:
Nineteen German landrace hybrid pigs.
Intervention:
Flow-controlled ventilation (intervention group) or volume-controlled ventilation (control group) with identical tidal volume (7 mL/kg) and positive end-expiratory pressure (9 cm H2O) after inducing acute respiratory distress syndrome with oleic acid.
Measurements and Main Results:
Pao2 and Paco2, minute volume, tracheal pressure, lung aeration measured via CT, alveolar wall thickness, cell infiltration, and surfactant protein A concentration in bronchoalveolar lavage fluid. Five pigs were excluded leaving n equals to 7 for each group. Compared with control, flow-controlled ventilation elevated Pao2 (154 ± 21 vs 105 ± 9 torr; 20.5 ± 2.8 vs 14.0 ± 1.2 kPa; p = 0.035) and achieved comparable Paco2 (57 ± 3 vs 54 ± 1 torr; 7.6 ± 0.4 vs 7.1 ± 0.1 kPa; p = 0.37) with a lower minute volume (6.4 ± 0.5 vs 8.7 ± 0.4 L/min; p 0.001). Inspiratory plateau pressure was comparable in both groups (31 ± 2 vs 34 ± 2 cm H2O; p = 0.16). Flow-controlled ventilation increased normally aerated (24% ± 4% vs 10% ± 2%; p = 0.004) and decreased nonaerated lung volume (23% ± 6% vs 38% ± 5%; p = 0.033) in the dependent lung region. Alveolar walls were thinner (5.5 ± 0.1 vs 7.8 ± 0.2 μm; p 0.0001), cell infiltration was lower (20 ± 2 vs 32 ± 2 n/field; p