Optimal mean airway pressure during high-frequency oscillatory ventilation in an experimental model of acute respiratory distress syndrome: EIT-based method
机构：[1]Department of Critical Care Medicine, Zhongda Hospital, School of Medicine,Southeast University, Jiangsu Province, Nanjing 210009, China[2]Instituteof Technical Medicine, Furtwangen University, Jakob‑Kienzle Strasse 17,78054 VS‑Schwenningen, Germany[3]Department of Biomedical Engineering,Fourth Military Medical University, Xi’an, China[4]Department of Critical CareMedicine, Beijing Tongren Hospital, Capital Medical University, Bejing 100730,China首都医科大学附属北京同仁医院首都医科大学附属同仁医院[5]Department of Anesthesiology and Intensive Care Medicine, UniversityMedical Center of Schleswig–Holstein Campus Kiel, Arnold‑Heller‑Strasse3, 24105 Kiel, Germany
Background High-frequency oscillatory ventilation (HFOV) may theoretically provide lung protective ventilation. The negative clinical results may be due to inadequate mean airway pressure (mPaw) settings in HFOV. Our objective was to evaluate the air distribution, ventilatory and hemodynamic effects of individual mPaw titration during HFOV in ARDS animal based on oxygenation and electrical impedance tomography (EIT). Methods ARDS was introduced with repeated bronchoalveolar lavage followed by injurious mechanical ventilation in ten healthy male pigs (51.2 +/- 1.9 kg). Settings of HFOV were 9 Hz (respiratory frequency), 33% (inspiratory time) and 70 cmH(2)O ( increment pressure). After lung recruitment, the mPaw was reduced in steps of 3 cmH(2)O every 6 min. Hemodynamics and blood gases were obtained in each step. Regional ventilation distribution was determined with EIT. Results PaO2/FiO(2) decreased significantly during the mPaw decremental phase (p < 0.001). Lung overdistended regions decreased, while recruitable regions increased as mPaw decreased. The optimal mPaw with respect to PaO2/FiO(2) was 21 (18.0-21.0) cmH(2)O, that is comparable to EIT-based center of ventilation (EIT-CoV) and EIT-collapse/over, 19.5 (15.0-21.0) and 19.5 (18.0-21.8), respectively (p = 0.07). EIT-CoV decreasing along with mPaw decrease revealed redistribution toward non-dependent regions. The individual mPaw titrated by EIT-based indices improved regional ventilation distribution with respect to overdistension and collapse (p = 0.035). Conclusion Our data suggested personalized optimal mPaw titration by EIT-based indices improves regional ventilation distribution and lung homogeneity during high-frequency oscillatory ventilation.
基金：
Jiangsu Province’s Key Discipline/Laboratory
of Medicine (No.ZDXKA2016025), Jiangsu Province’s Key Provincial Talents
Program (ZDRCA2016082), National Natural Science Foundation of China
(81370180, Beijing, China), Natural Science Foundation of Jiangsu Province
(H201432, Nanjing, Jiangsu, China).
第一作者机构：[1]Department of Critical Care Medicine, Zhongda Hospital, School of Medicine,Southeast University, Jiangsu Province, Nanjing 210009, China
通讯作者：
推荐引用方式(GB/T 7714)：
Liu Songqiao,Zhao Zhanqi,Tan Li,et al.Optimal mean airway pressure during high-frequency oscillatory ventilation in an experimental model of acute respiratory distress syndrome: EIT-based method[J].ANNALS OF INTENSIVE CARE.2020,10(1):doi:10.1186/s13613-020-0647-z.
APA：
Liu, Songqiao,Zhao, Zhanqi,Tan, Li,Wang, Lihui,Moeller, Knut...&Qiu, Haibo.(2020).Optimal mean airway pressure during high-frequency oscillatory ventilation in an experimental model of acute respiratory distress syndrome: EIT-based method.ANNALS OF INTENSIVE CARE,10,(1)
MLA：
Liu, Songqiao,et al."Optimal mean airway pressure during high-frequency oscillatory ventilation in an experimental model of acute respiratory distress syndrome: EIT-based method".ANNALS OF INTENSIVE CARE 10..1(2020)
医学