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New indicators for optimal lung recruitment during high frequency oscillator ventilation
Author(s) -
Rodríguez Sánchez de la Blanca Ana,
Sánchez Luna Manuel,
González Pacheco Noelia,
Ramos Navarro Cristina,
Santos González Martín,
Tendillo Cortijo Francisco
Publication year - 2020
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.25084
Subject(s) - tidal volume , medicine , mean airway pressure , in vivo , peak inspiratory pressure , ventilation (architecture) , anesthesia , ex vivo , pulmonary compliance , lung , lung volumes , positive end expiratory pressure , oxygenation , respiratory system , mechanical ventilation , biology , physics , microbiology and biotechnology , thermodynamics
Previous research has demonstrated the potential benefit derived from the combination of high frequency oscillatory ventilation and volume guarantee mode (HFOV‐VG), a procedure that allows us to explore and control very low tidal volumes. We hypothesized that secondary spontaneous change in oscillation pressure amplitude (∆Phf), while increasing the mean airway pressure (MAP) using HFOV‐VG can target the lung recruitment. Methods A two‐step animal distress model study was designed; in the first‐step (ex vivo model), the animal's lungs were isolated to visually check lung recruitment and, in the second one (in vivo model), they were checked through arterial oxygen partial pressure improvement. Baseline measurements were performed, ventilation was set for 10 min and followed by bronchoalveolar lavage with isotonic saline to induce depletion of surfactant and thereby achieve a low compliance lung model. The high‐frequency tidal volume and frequency remained constant and the MAP was increased by 2 cmH 2 O (ex vivo) and 3 cmH 2 O steps (in vivo) every 2 min. Changes in ΔPhf to achieve the fixed volume were recorded at the end of each interval to describe the maximum drop point as the recruitment point. Results Fourteen Wistar Han rats were included, seven on each sub‐study described. After gradual MAP increments, a progressive decrease in ΔPhf related to recruited lung regions was visually demonstrated. In the in vivo model we detected a significant comparative decrease of ΔPhf, when measured against the previous value, after reaching a MAP of 11 cmH 2 O up to 17 cmH 2 O, correlating with a significant improvement in oxygenation. Conclusion The changes in ∆Phf, linked to a progressive increase in MAP during HFOV‐VG, might identify optimal lung recruitment and could potentially be used as an additional lung recruitment marker.