Limiting ventilator-associated lung injury in a preterm porcine neonatal model

详细信息    查看全文

• 作者：Michaela Kollisch-Singule^a ; ^{KolliscM@upstate.edu} ; Sumeet V. Jain^a ; ^{JainSu@upstate.edu} ; Joshua Satalin^a ; ^{SatalinJ@upstate.edu} ; Penny Andrews^b ; ^{plandrews@intensivecareonline.com} ; Quinn Searles^a ; ^{SearlesQ@upstate.edu} ; Zhiyong Liu^a ; ^{LiuZh@upstate.edu} ; Yan Zhou^a ; ^{ZhouYa@upstate.edu} ; Guirong Wang^a ; ^{WangG@upstate.edu} ; Andreas H. Meier^a ; ^{MeierAn@upstate.edu} ; Louis A. Gatto^a ; ^c ; ^{Louis.Gatto@cortland.edu} ; Gary F. Nieman^a ; ^{NiemanG@upstate.edu} ; Nader M. Habashi^b ; ^{nmh@xmxmail.com}
• 关键词：Respiratory distress syndrome ; Ventilator-induced injury ; Airway pressure release ventilation
• 刊名：Journal of Pediatric Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：52
• 期：1
• 页码：50-55
• 全文大小：692 K
• 卷排序：52

文摘

Preterm infants are prone to respiratory distress syndrome (RDS), with severe cases requiring mechanical ventilation for support. However, there are no clear guidelines regarding the optimal ventilation strategy. We hypothesized that airway pressure release ventilation (APRV) would mitigate lung injury in a preterm porcine neonatal model.MethodsPreterm piglets were delivered on gestational day 98 (85% of 115 day term), instrumented, and randomized to volume guarantee (VG; n = 10) with low tidal volumes (5.5 cm3 kg− 1) and PEEP 4 cmH2O or APRV (n = 10) with initial ventilator settings: PHigh 18 cmH2O, PLow 0 cmH2O, THigh 1.30 s, TLow 0.15 s. Ventilator setting changes were made in response to clinical parameters in both groups. Animals were monitored continuously for 24 hours.ResultsThe mortality rates between the two groups were not significantly different (p > 0.05). The VG group had relatively increased oxygen requirements (FiO2 50% ± 9%) compared with the APRV group (FiO2 28% ± 5%; p > 0.05) and a decrease in PaO2/FiO2 ratio (VG 162 ± 33 mmHg; APRV 251 ± 45 mmHg; p < 0.05). The compliance of the VG group (0.51 ± 0.07 L·cmH2O− 1) was significantly less than the APRV group (0.90 ± 0.06 L·cmH2O− 1; p < 0.05).ConclusionThis study demonstrates that APRV improves oxygenation and compliance as compared with VG. This preliminary work suggests further study into the clinical uses of APRV in the neonate is warranted.Level of EvidenceNot Applicable (Basic Science Animal Study)