Open lung ventilation improves gas exchange and attenuates secondary lung injury in a piglet model of meconium aspiration

2004 ◽  
Vol 32 (2) ◽  
pp. 443-449 ◽  
Author(s):  
Anton H. van Kaam ◽  
Jack J. Haitsma ◽  
Anne De Jaegere ◽  
Wim M. van Aalderen ◽  
Joke H. Kok ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Lung Injury ◽  
Lung Ventilation ◽  
Meconium Aspiration ◽  
Open Lung

Intravenous tezosentan improves gas exchange and hemodynamics in acute lung injury secondary to meconium aspiration

2007 ◽  
Vol 34 (2) ◽  
pp. 368-376 ◽  
Author(s):  
Ralf Geiger ◽  
Axel Kleinsasser ◽  
Stephan Meier ◽  
Nikolaus Neu ◽  
Werner Pajk ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Gas Exchange ◽  
Lung Injury ◽  
Meconium Aspiration

scholarly journals Angiotensin-Converting Enzyme 2 Improves Arterial Hypoxemia in Meconium-Induced Acute Lung Injury in Piglets

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Benedikt Treml ◽  
Alexander Loeckinger ◽  
Axel Kleinsasser ◽  
Elisabeth Schoepf ◽  
Ralf Geiger ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Gas Exchange ◽  
Lung Injury ◽  
Angiotensin Converting Enzyme ◽  
Ang Ii ◽  
Converting Enzyme ◽  
Blood Gas ◽  
Meconium Aspiration ◽  
Angiotensin Converting Enzyme 2 ◽  
Partial Pressures

Objective. Meconium aspiration induces acute lung injury (ALI) in neonates born through meconium-stained amniotic fluid. As yet, there is no specific therapy for improving the outcome. Recently, angiotensin-converting enzyme 2 (ACE2), which inactivates angiotensin II (Ang II), has been shown to ameliorate murine ALI. Design. To evaluate the therapeutic potential of this substance, we studied ACE2 in a piglet model of ALI induced by meconium aspiration. Subjects. Twelve anesthetized piglets were subjected in an animal research laboratory. ALI was induced by tracheal meconium instillation. Thereafter, six animals were randomly assigned to the ACE2 group, while another 6 served as control. Measurements. Systemic, pulmonary hemodynamic, and blood gas exchange parameters and Ang II levels were examined before ALI induction and at various time points after administering ACE2 or saline. In addition, ventilation-perfusion distribution of the lung was assessed by the multiple inert gas elimination technique (MIGET). Main Results. Animals treated with ACE2 maintained significantly higher arterial partial pressures of oxygen (Pao2) and lower arterial partial pressures of carbon dioxide (Paco2), respectively. Furthermore, Ang II, which was substantially increased, returned to basal values. Conclusion. In summary, ACE2 improves blood gas exchange in meconium-induced ALI in piglets.

Positive Pressure Ventilation with the Open Lung Concept Optimizes Gas Exchange and Reduces Ventilator-Induced Lung Injury in Newborn Piglets

2003 ◽  
Vol 53 (2) ◽  
pp. 245-253 ◽  
Author(s):  
ANTON H. VAN KAAM ◽  
ANNE DE JAEGERE ◽  
JACK J. HAITSMA ◽  
WIM M. VAN AALDEREN ◽  
JOKE H. KOK, AND ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Lung Injury ◽  
Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Newborn Piglets ◽  
Open Lung ◽  
Ventilator Induced Lung Injury ◽  
Open Lung Concept

One-lung Ventilation for Thoracic Surgery: Current Perspectives

2017 ◽  
Vol 103 (6) ◽  
pp. 495-503 ◽  
Author(s):  
Filippo Bernasconi ◽  
Federico Piccioni
Keyword(s):  
Acute Lung Injury ◽  
Gas Exchange ◽  
Lung Injury ◽  
Thoracic Surgery ◽  
Scientific Evidence ◽  
Lung Ventilation ◽  
Lung Damage ◽  
Multimodal Approach ◽  
One Lung Ventilation ◽  
Pressure Application

One-lung ventilation (OLV) is an anesthesiological technique that is increasingly being used beyond thoracic surgery. This requires specific skills and knowledge about airway management, maintenance of gas exchange and prevention of acute lung injury. Sometimes maintaining adequate gas exchange and minimizing acute lung injury may be opposing processes. Parameters validated for OLV titration still have not been found, but a multimodal approach based on low tidal volume, end-expiratory pressure application and alveolar recruitment maneuvers is considered the best way to ensure protective ventilation and reduce lung damage. The purpose of this review is to analyze all these factors using the latest scientific evidence and the opinions of the most influential authors.

Effects of an open lung ventilatory strategy on lung gas exchange during laparoscopic surgery

2021 ◽  
pp. 0310057X2110476
Author(s):  
Philip J Peyton ◽  
Sarah Aitken ◽  
Mats Wallin
Keyword(s):  
Laparoscopic Surgery ◽  
Gas Exchange ◽  
Partial Pressure ◽  
Intervention Group ◽  
Lung Ventilation ◽  
Alveolar Ventilation ◽  
Control Group ◽  
Positive End Expiratory Pressure ◽  
Open Lung ◽  
Ventilation Perfusion Ratio

In general anaesthesia, early collapse of poorly ventilated lung segments with low alveolar ventilation–perfusion ratios occurs and may lead to postoperative pulmonary complications after abdominal surgery. An ‘open lung’ ventilation strategy involves lung recruitment followed by ‘individualised’ positive end-expiratory pressure titrated to maintain recruitment of low alveolar ventilation–perfusion ratio lung segments. There are limited data in laparoscopic surgery on the effects of this on pulmonary gas exchange. Forty laparoscopic bowel surgery patients were randomly assigned to standard ventilation or an ‘open lung’ ventilation intervention, with end-tidal target sevoflurane of 1% supplemented by propofol infusion. After peritoneal insufflation, stepped lung recruitment was performed in the intervention group followed by maintenance positive end-expiratory pressure of 12–15 cmH2O adjusted to maintain dynamic lung compliance at post-recruitment levels. Baseline gas and blood samples were taken and repeated after a minimum of 30 minutes for oxygen and carbon dioxide and for sevoflurane partial pressures using headspace equilibration. The sevoflurane arterial/alveolar partial pressure ratio and alveolar deadspace fraction were unchanged from baseline and remained similar between groups (mean (standard deviation) control group = 0.754 (0.086) versus intervention group = 0.785 (0.099), P = 0.319), while the arterial oxygen partial pressure/fractional inspired oxygen concentration ratio was significantly higher in the intervention group at the second timepoint (control group median (interquartile range) 288 (234–372) versus 376 (297–470) mmHg in the intervention group, P = 0.011). There was no difference between groups in the sevoflurane consumption rate. The efficiency of sevoflurane uptake is not improved by open lung ventilation in laparoscopy, despite improved arterial oxygenation associated with effective and sustained recruitment of low alveolar ventilation–perfusion ratio lung segments.

scholarly journals Perioperative Open-lung Approach, Regional Ventilation, and Lung Injury in Cardiac Surgery

2020 ◽  
Vol 133 (5) ◽  
pp. 1029-1045 ◽  
Author(s):  
David Lagier ◽  
Lionel J. Velly ◽  
Benoit Guinard ◽  
Nicolas Bruder ◽  
Catherine Guidon ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Lung Injury ◽  
Tidal Volume ◽  
Lung Ventilation ◽  
Soluble Form ◽  
Ventilation Strategy ◽  
Open Lung ◽  
Low Tidal Volume ◽  
Impedance Variation ◽  
Angiopoietin 2

Background In the Protective Ventilation in Cardiac Surgery (PROVECS) randomized, controlled trial, an open-lung ventilation strategy did not improve postoperative respiratory outcomes after on-pump cardiac surgery. In this prespecified subanalysis, the authors aimed to assess the regional distribution of ventilation and plasma biomarkers of lung epithelial and endothelial injury produced by that strategy. Methods Perioperative open-lung ventilation consisted of recruitment maneuvers, positive end-expiratory pressure (PEEP) = 8 cm H2O, and low-tidal volume ventilation including during cardiopulmonary bypass. Control ventilation strategy was a low-PEEP (2 cm H2O) low-tidal volume approach. Electrical impedance tomography was used serially throughout the perioperative period (n = 56) to compute the dorsal fraction of ventilation (defined as the ratio of dorsal tidal impedance variation to global tidal impedance variation). Lung injury was assessed serially using biomarkers of epithelial (soluble form of the receptor for advanced glycation end-products, sRAGE) and endothelial (angiopoietin-2) lung injury (n = 30). Results Eighty-six patients (age = 64 ± 12 yr; EuroSCORE II = 1.65 ± 1.57%) undergoing elective on-pump cardiac surgery were studied. Induction of general anesthesia was associated with ventral redistribution of tidal volumes and higher dorsal fraction of ventilation in the open-lung than the control strategy (0.38 ± 0.07 vs. 0.30 ± 0.10; P = 0.004). No effect of the open-lung strategy on the dorsal fraction of ventilation was noted at the end of surgery after median sternotomy closure (open-lung = 0.37 ± 0.09 vs. control = 0.34 ± 0.11; P = 0.743) or in extubated patients at postoperative day 2 (open-lung = 0.63 ± 0.18 vs. control = 0.59 ± 0.11; P > 0.999). Open-lung ventilation was associated with increased intraoperative plasma sRAGE (7,677 ± 3,097 pg/ml vs. 6,125 ± 1,400 pg/ml; P = 0.037) and had no effect on angiopoietin-2 (P > 0.999). Conclusions In cardiac surgery patients, open-lung ventilation provided larger dorsal lung ventilation early during surgery without a maintained benefit as compared with controls at the end of surgery and postoperative day 2 and was associated with higher intraoperative plasma concentration of sRAGE suggesting lung overdistension. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Effects of Vaporized Perfluorocarbon on Pulmonary Blood Flow and Ventilation/Perfusion Distribution in a Model of Acute Respiratory Distress Syndrome

2001 ◽  
Vol 95 (6) ◽  
pp. 1414-1421 ◽  
Author(s):  
Matthias Hübler ◽  
Jennifer E. Souders ◽  
Erin D. Shade ◽  
Nayak L. Polissar ◽  
Carmel Schimmel ◽  
...  
Keyword(s):  
Blood Flow ◽  
Oleic Acid ◽  
Gas Exchange ◽  
Lung Injury ◽  
Repeated Measures ◽  
Pulmonary Blood Flow ◽  
Analysis Of Covariance ◽  
Inert Gas ◽  
Low Flow ◽  
Repeated Measures Analysis

Background Perfluorocarbon (PFC) liquids are known to improve gas exchange and pulmonary function in various models of acute respiratory failure. Vaporization has been recently reported as a new method of delivering PFC to the lung. Our aim was to study the effect of PFC vapor on the ventilation/perfusion (VA/Q) matching and relative pulmonary blood flow (Qrel) distribution. Methods In nine sheep, lung injury was induced using oleic acid. Four sheep were treated with vaporized perfluorohexane (PFX) for 30 min, whereas the remaining sheep served as control animals. Vaporization was achieved using a modified isoflurane vaporizer. The animals were studied for 90 min after vaporization. VA/Q distributions were estimated using the multiple inert gas elimination technique. Change in Qrel distribution was assessed using fluorescent-labeled microspheres. Results Treatment with PFX vapor improved oxygenation significantly and led to significantly lower shunt values (P < 0.05, repeated-measures analysis of covariance). Analysis of the multiple inert gas elimination technique data showed that animals treated with PFX vapor demonstrated a higher VA/Q heterogeneity than the control animals (P < 0.05, repeated-measures analysis of covariance). Microsphere data showed a redistribution of Qrel attributable to oleic acid injury. Qrel shifted from areas that were initially high-flow to areas that were initially low-flow, with no difference in redistribution between the groups. After established injury, Qrel was redistributed to the nondependent lung areas in control animals, whereas Qrel distribution did not change in treatment animals. Conclusion In oleic acid lung injury, treatment with PFX vapor improves gas exchange by increasing VA/Q heterogeneity in the whole lung without a significant change in gravitational gradient.

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