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
Songqiao LiuHaibo Qiu

Abstract

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). 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 cmH2O (∆pressure). After lung recruitment, the mPaw was reduced in steps of 3 cmH2O every 6 min. Hemodynamics and blood gases were obtained in each step. Regional ventilation distribution was determined with EIT. PaO2/FiO2 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/FiO2 was 21 (18.0-21.0) cmH2O, 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-...Continue Reading

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Methods Mentioned

BETA
imaging technique
bronchoalveolar lavage
bronchoalveolar lavages

Software Mentioned

OSCILLATE
MATLAB
OSCAR

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