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01.01.2008 | Original

High-frequency percussive ventilation attenuates lung injury in a rabbit model of gastric juice aspiration

verfasst von: Jérôme Allardet-Servent, Fabienne Bregeon, Stéphane Delpierre, Jean-Guillaume Steinberg, Marie-José Payan, Sylvie Ravailhe, Laurent Papazian

Erschienen in: Intensive Care Medicine | Ausgabe 1/2008

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Abstract

Objective

To test the effects of high-frequency percussive ventilation (HFPV) compared with high-frequency oscillatory ventilation (HFOV) and low-volume conventional mechanical ventilation (LVCMV), on lung injury course in a gastric juice aspiration model.

Design

Prospective, randomized, controlled, in-vivo animal study.

Setting

University animal research laboratory.

Subjects

Forty-three New Zealand rabbits.

Interventions

Lung injury was induced by intratracheal instillation of human gastric juice in order to achieve profound hypoxaemia (PaO₂/F_IO₂ ≤ 50). Animals were ventilated for 4 h after randomization in one of the following four groups: HFPV (median pressure 15 cmH₂O); LVCMV (V_T 6 ml kg^–1 and PEEP set to reach 15 cmH₂O plateau pressure); HFOV (mean pressure 15 cmH₂O); and a high-volume control group HVCMV (V_T 12 ml kg^–1 and ZEEP).

Measurements and results

Static respiratory compliance increased after the ventilation period in the HFPV, LVMCV and HFOV groups, in contrast with the HVCMV group. PaO₂/F_IO₂ improved similarly in the HFPV, LVCMV and HFOV groups, and remained lower in the HVCMV group than in the three others. Lung oedema, myeloperoxidase and histological lung injury score were higher in the HVCMV group, but not different among all others. Arterial lactate markedly increased after 4 h of ventilation in the HVCMV group, while lower but similar levels were observed in the three other groups.

Conclusion

HFPV, like HFOV and protective CMV, improves respiratory mechanics and oxygenation, and attenuates lung damage. The HFPV provides attractive lung protection, but further studies should confirm these results before introducing HFPV into the clinical arena.

Halter JM, Steinberg JM, Gatto LA, Dirocco JD, Pavone LA, Schiller HJ, Albert S, Lee HM, Carney D, Nieman GF (2007) Effect of positive end-expiratory pressure and tidal volume on lung injury induced by alveolar instability. Crit Care DOI 10.1186/cc5695

Halter JM, Steinberg JM, Schiller HJ, DaSilva M, Gatto LA, Landas S, Nieman GF (2003) Positive end-expiratory pressure after a recruitment maneuver prevents both alveolar collapse and recruitment/derecruitment. Am J Respir Crit Care Med 167:1620–1626PubMedCrossRef

Ito Y, Veldhuizen RA, Yao LJ, McCaig LA, Bartlett AJ, Lewis JF (1997) Ventilation strategies affect surfactant aggregate conversion in acute lung injury. Am J Respir Crit Care Med 155:493–499PubMed

Steinberg JM, Schiller HJ, Halter JM, Gatto LA, Lee HM, Pavone LA, Nieman GF (2004) Alveolar instability causes early ventilator-induced lung injury independent of neutrophils. Am J Respir Crit Care Med 169:57–63PubMedCrossRef

Pinhu L, Whitehead T, Evans T, Griffiths M (2003) Ventilator-associated lung injury. Lancet 361:332–340PubMedCrossRef

ARDSNet (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308CrossRef

Ranieri VM, Suter PM, Tortorella C, Tullio R de, Dayer JM, Brienza A, Bruno F, Slutsky AS (1999) Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. J Am Med Assoc 282:54–61CrossRef

Hamilton PP, Onayemi A, Smyth JA, Gillan JE, Cutz E, Froese AB, Bryan AC (1983) Comparison of conventional and high-frequency ventilation: oxygenation and lung pathology. J Appl Physiol 55:131–138PubMed

Imai Y, Nakagawa S, Ito Y, Kawano T, Slutsky AS, Miyasaka K (2001) Comparison of lung protection strategies using conventional and high-frequency oscillatory ventilation. J Appl Physiol 91:1836–1844PubMed

10.

Kolton M, Cattran CB, Kent G, Volgyesi G, Froese AB, Bryan AC (1982) Oxygenation during high-frequency ventilation compared with conventional mechanical ventilation in two models of lung injury. Anesth Analg 61:323–332PubMedCrossRef

11.

Van Kaam AH, de Jaegere A, Haitsma JJ, Van Aalderen WM, Kok JH, Lachmann B (2003) Positive pressure ventilation with the open lung concept optimizes gas exchange and reduces ventilator-induced lung injury in newborn piglets. Pediatr Res 53:245–253PubMed

12.

Van Kaam AH, Haitsma JJ, De Jaegere A, van Aalderen WM, Kok JH, Lachmann B (2004) Open lung ventilation improves gas exchange and attenuates secondary lung injury in a piglet model of meconium aspiration. Crit Care Med 32:443–449PubMedCrossRef

13.

Vazquez de Anda GF, Gommers D, Verbrugge SJ, De Jaegere A, Lachmann B (2000) Mechanical ventilation with high positive end-expiratory pressure and small driving pressure amplitude is as effective as high-frequency oscillatory ventilation to preserve the function of exogenous surfactant in lung-lavaged rats. Crit Care Med 28:2921–2925PubMedCrossRef

14.

Vazquez de Anda GF, Hartog A, Verbrugge SJ, Gommers D, Lachmann B (1999) The open lung concept: pressure-controlled ventilation is as effective as high-frequency oscillatory ventilation in improving gas exchange and lung mechanics in surfactant-deficient animals. Intensive Care Med 25:990–996PubMedCrossRef

15.

Bollen CW, van Well GT, Sherry T, Beale RJ, Shah S, Findlay G, Monchi M, Chiche JD, Weiler N, Uiterwaal CS (2005) High frequency oscillatory ventilation compared with conventional mechanical ventilation in adult respiratory distress syndrome: a randomized controlled trial. Crit Care doi:10.1186/cc3737

16.

Derdak S, Mehta S, Stewart TE, Smith T, Rogers M, Buchman TG, Carlin B, Lowson S, Granton J (2002) High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. Am J Respir Crit Care Med 166:801–808PubMedCrossRef

17.

Salim A, Martin M (2005) High-frequency percussive ventilation. Crit Care Med 33:S241–S245PubMedCrossRef

18.

Eastman A, Holland D, Higgins J, Smith B, Delagarza J, Olson C, Brakenridge S, Foteh K, Friese R (2006) High-frequency percussive ventilation improves oxygenation in trauma patients with acute respiratory distress syndrome: a retrospective review. Am J Surg 192:191–195PubMedCrossRef

19.

Gallagher TJ, Boysen PG, Davidson DD, Miller JR, Leven SB (1989) High-frequency percussive ventilation compared with conventional mechanical ventilation. Crit Care Med 17:364–366PubMedCrossRef

20.

Paulsen SM, Killyon GW, Barillo DJ (2002) High-frequency percussive ventilation as a salvage modality in adult respiratory distress syndrome: a preliminary study. Am Surg 68:852–856PubMed

21.

Reper P, Wibaux O, Van Laeke P, Vandeenen D, Duinslaeger L, Vanderkelen A (2002) High frequency percussive ventilation and conventional ventilation after smoke inhalation: a randomised study. Burns 28:503–508PubMedCrossRef

22.

Velmahos GC, Chan LS, Tatevossian R, Cornwell EE, Dougherty WR, Escudero J, Demetriades D (1999) High-frequency percussive ventilation improves oxygenation in patients with ARDS. Chest 116:440–446PubMedCrossRef

23.

Institute of Laboratory Animal Ressources Commission on Life Sciences (1996) Guide for the Care and Use of Laboratory Animals. National Academy Press, Washington, D.C.

24.

Kolobow T, Moretti MP, Fumagalli R, Mascheroni D, Prato P, Chen V, Joris M (1987) Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation. An experimental study. Am Rev Respir Dis 135:312–315PubMed

25.

Bregeon F, Delpierre S, Chetaille B, Kajikawa O, Martin TR, Autillo-Touati A, Jammes Y, Pugin J (2005) Mechanical ventilation affects lung function and cytokine production in an experimental model of endotoxemia. Anesthesiology 102:331–339PubMedCrossRef

26.

Chang HK (1984) Mechanisms of gas transport during ventilation by high-frequency oscillation. J Appl Physiol 56:553–563PubMed

27.

Allan PF, Thurlby JR, Naworol GA (2007) Measurement of pulsatile tidal volume, pressure amplitude, and gas flow during high-frequency percussive ventilation, with and without partial cuff deflation. Respir Care 52:45–49PubMed

28.

Lucangelo U, Antonaglia V, Zin WA, Fontanesi L, Peratoner A, Bird FM, Gullo A (2004) Effects of mechanical load on flow, volume and pressure delivered by high-frequency percussive ventilation. Respir Physiol Neurobiol 142:81–91PubMedCrossRef

29.

Cioffi WG, deLemos RA, Coalson JJ, Gerstmann DA, Pruitt BA (1993) Decreased pulmonary damage in primates with inhalation injury treated with high-frequency ventilation. Ann Surg 218:328–335PubMedCrossRef

30.

Sibilla S, Tredici S, Porro A, Irace M, Guglielmi M, Nicolini G, Tredici G, Valenza F, Gattinoni L (2002) Equal increases in respiratory system elastance reflect similar lung damage in experimental ventilator-induced lung injury. Intensive Care Med 28:196–203PubMedCrossRef

31.

Rotta AT, Gunnarsson B, Fuhrman BP, Hernan LJ, Steinhorn DM (2001) Comparison of lung protective ventilation strategies in a rabbit model of acute lung injury. Crit Care Med 29:2176–2184PubMedCrossRef

32.

Steinberg J, Schiller HJ, Halter JM, Gatto LA, Dasilva M, Amato M, McCann UG, Nieman GF (2002) Tidal volume increases do not affect alveolar mechanics in normal lung but cause alveolar overdistension and exacerbate alveolar instability after surfactant deactivation. Crit Care Med 30:2675–2683PubMedCrossRef

33.

Fraisse A, Bregeon F, Delpierre S, Gaudart J, Payan MJ, Pugin J, Papazian L (2007) Hemodynamics in experimental gastric juice induced aspiration pneumonitis. Intensive Care Med 33:300–307PubMedCrossRef

Titel: High-frequency percussive ventilation attenuates lung injury in a rabbit model of gastric juice aspiration
verfasst von: Jérôme Allardet-Servent
Fabienne Bregeon
Stéphane Delpierre
Jean-Guillaume Steinberg
Marie-José Payan
Sylvie Ravailhe
Laurent Papazian
Publikationsdatum: 01.01.2008
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 1/2008
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0848-z

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High-frequency percussive ventilation attenuates lung injury in a rabbit model of gastric juice aspiration