Flow-controlled ventilation attenuates lung injury in a porcine model of acute respiratory distress syndrome : : a preclinical randomized controlled study

Abstract: Objectives:
Lung-protective ventilation for acute respiratory distress syndrome aims for providing sufficient oxygenation and carbon dioxide clearance, while limiting the harmful effects of mechanical ventilation. “Flow-controlled ventilation”, providing a constant expiratory flow, has been suggested as a new lung-protective ventilation strategy. The aim of this study was to test whether flow-controlled ventilation attenuates lung injury in an animal model of acute respiratory distress syndrome.
Design:
Preclinical, randomized controlled animal study.
Setting:
Animal research facility.
Subjects:
Nineteen German landrace hybrid pigs.
Intervention:
Flow-controlled ventilation (intervention group) or volume-controlled ventilation (control group) with identical tidal volume (7 mL/kg) and positive end-expiratory pressure (9 cm H2O) after inducing acute respiratory distress syndrome with oleic acid.
Measurements and Main Results:
Pao2 and Paco2, minute volume, tracheal pressure, lung aeration measured via CT, alveolar wall thickness, cell infiltration, and surfactant protein A concentration in bronchoalveolar lavage fluid. Five pigs were excluded leaving n equals to 7 for each group. Compared with control, flow-controlled ventilation elevated Pao2 (154 ± 21 vs 105 ± 9 torr; 20.5 ± 2.8 vs 14.0 ± 1.2 kPa; p = 0.035) and achieved comparable Paco2 (57 ± 3 vs 54 ± 1 torr; 7.6 ± 0.4 vs 7.1 ± 0.1 kPa; p = 0.37) with a lower minute volume (6.4 ± 0.5 vs 8.7 ± 0.4 L/min; p < 0.001). Inspiratory plateau pressure was comparable in both groups (31 ± 2 vs 34 ± 2 cm H2O; p = 0.16). Flow-controlled ventilation increased normally aerated (24% ± 4% vs 10% ± 2%; p = 0.004) and decreased nonaerated lung volume (23% ± 6% vs 38% ± 5%; p = 0.033) in the dependent lung region. Alveolar walls were thinner (5.5 ± 0.1 vs 7.8 ± 0.2 µm; p < 0.0001), cell infiltration was lower (20 ± 2 vs 32 ± 2 n/field; p < 0.0001), and normalized surfactant protein A concentration was higher with flow-controlled ventilation (1.1 ± 0.04 vs 1.0 ± 0.03; p = 0.039).
Conclusions:
Flow-controlled ventilation enhances lung aeration in the dependent lung region and consequently improves gas exchange and attenuates lung injury. Control of the expiratory flow may provide a novel option for lung-protective ventilation

Object Details

• Location: Deutsche Nationalbibliothek Frankfurt am Main
• Extent: Online-Ressource
• Language: Englisch
• Notes: Critical care medicine. - 48, 3 (2020) , e241-e248, ISSN: 0090-3493

Classification and Topics

• Keyword: Exspiration ; Atmung ; Ventilation ; Atemwege ; Beatmungsgerät ; Künstliche Beatmung

Contributors, Places and Time

• Event: Veröffentlichung
• (where): Freiburg
• (who): Universität
• (when): 2020
• Creator: Schmidt, Johannes ; Wenzel, Christin ; Spassov, Sashko G. ; Borgmann, Silke ; Lin, Ziwei ; Wollborn, Jakob ; Weber, Jonas ; Haberstroh, Jörg ; Meckel, Stephan ; Eiden, Sebastian Alexander ; Wirth, Steffen ; Schumann, Stefan

Further information

• DOI: 10.1097/ccm.0000000000004209
• URN: urn:nbn:de:bsz:25-freidok-1552859
• Rights: Der Zugriff auf das Objekt ist unbeschränkt möglich.
• Last update: 25.03.2025, 1:48 PM CET