Preserved pressure delivery during high‐frequency oscillation of bubble CPAP in a premature infant lung model with both normal and abnormal lung mechanics

A single bifurcation with an adjustable daughter branch compliance ratio (VR) was used to simultaneously study pendelluft and longitudinal mixing during flow oscillations at frequencies (f) of 1-15 Hz and amplitudes (VOp) of 25-150 ml/s. Mixing coefficients (Deff) were determined from the dispersion of a CO2 bolus centered at the bifurcation point, and pendelluft volume was computed as a fraction of mother branch tidal volume (PVF) using measurements of airflow in the daughter branches. Plotted against frequency, PVF was a bell-shaped curve insensitive to the value of VOp. When VR = 2, a PVF peak of 0.25 appeared at f = 3 Hz, and when VR = 5, a PVF peak of 0.75 appeared at f = 4 Hz. After normalization by control values at VR = 1, Deff curves were also bell shaped, insensitive to the value of VOp and with peaks appearing at the same frequencies as the PVF peaks. The normalized Deff peak values were 1.7 when VR = 2 and 4.0 when VR = 5. The similarities in the PVF and Deff curves imply a direct relationship between pendelluft and enhanced mixing.

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Open-lung Protective Ventilation with Pressure Control Ventilation, High-frequency Oscillation, and Intratracheal Pulmonary Ventilation Results in Similar Gas Exchange, Hemodynamics, and Lung Mechanics

Anesthesiology ◽

10.1097/00000542-200311000-00016 ◽

2003 ◽

Vol 99 (5) ◽

pp. 1102-1111 ◽

Cited By ~ 26

Author(s):

Khaled A. Sedeek ◽

Muneyuki Takeuchi ◽

Klaudiusz Suchodolski ◽

Sara O. Vargas ◽

Motomu Shimaoka ◽

...

Keyword(s):

Gas Exchange ◽

High Frequency ◽

Distress Syndrome ◽

Pulmonary Ventilation ◽

Pressure Control ◽

Control Ventilation ◽

Lung Mechanics ◽

High Frequency Oscillation ◽

Lung Protective Ventilation ◽

Frequency Oscillation

Background Pressure control ventilation (PCV), high-frequency oscillation (HFO), and intratracheal pulmonary ventilation (ITPV) may all be used to provide lung protective ventilation in acute respiratory distress syndrome, but the specific approach that is optimal remains controversial. Methods Saline lavage was used to produce acute respiratory distress syndrome in 21 sheep randomly assigned to receive PCV, HFO, or ITPV as follows: positive end-expiratory pressure (PCV and ITPV) and mean airway pressure (HFO) were set in a pressure-decreasing manner after lung recruitment that achieved a ratio of Pao2/Fio2 > 400 mmHg. Respiratory rates were 30 breaths/min, 120 breaths/min, and 8 Hz, respectively, for PCV, ITPV, and HFO. Eucapnia was targeted with peak carinal pressure of no more than 35 cm H2O. Animals were then ventilated for 4 h. Results There were no differences among groups in gas exchange, lung mechanics, or hemodynamics. Tidal volume (PCV, 8.9 +/- 2.1 ml/kg; ITPV, 2.7 +/- 0.8 ml/kg; HFO, approximately 2.0 ml/kg) and peak carinal pressure (PCV, 30.6 +/- 2.6 cm H2O; ITPV, 22.3 +/- 4.8 cm H2O; HFO, approximately 24.3 cm H2O) were higher in PCV. Pilot histologic data showed greater interstitial hemorrhage and alveolar septal expansion in PCV than in HFO or ITPV. Conclusion These data indicate that HFO, ITPV, and PCV when applied with an open-lung protective ventilatory strategy results in the same gas exchange, lung mechanics, and hemodynamic response, but pilot data indicate that lung injury may be greater with PCV.

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