Open-lung Protective Ventilation with Pressure Control Ventilation, High-frequency Oscillation, and Intratracheal Pulmonary Ventilation Results in Similar Gas Exchange, Hemodynamics, and Lung Mechanics

Khaled A. Sedeek, Muneyuki Takeuchi, Klaudiusz Suchodolski, Sara O. Vargas, Motomu Shimaoka, Jay J. Schnitzer, Robert M. Kacmarek

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: Pressure control ventilation (PCV), high-frequency oscillation (HFO), and intratracheal pulmonary ventilation (ITPV) may all be used to provide lung protective ventilation in acute respiratory distress syndrome, but the specific approach that is optimal remains controversial. Methods: Saline lavage was used to produce acute respiratory distress syndrome in 21 sheep randomly assigned to receive PCV, HFO, or ITPV as follows: positive end-expiratory pressure (PCV and ITPV) and mean airway pressure (HFO) were set in a pressure-decreasing manner after lung recruitment that achieved a ratio of Pao2/FIO2 > 400 mmHg. Respiratory rates were 30 breaths/min, 120 breaths/min, and 8 Hz, respectively, for PCV, ITPV, and HFO. Eucapnia was targeted with peak carinal pressure of no more than 35 cm H 2O. Animals were then ventilated for 4 h. Results: There were no differences among groups in gas exchange, lung mechanics, or hemodynamics. Tidal volume (PCV, 8.9 ± 2.1 ml/kg; ITPV, 2.7 ± 0.8 ml/kg; HFO, approximately 2.0 ml/kg) and peak carinal pressure (PCV, 30.6 ± 2.6 cm H2O; ITPV, 22.3 ± 4.8 cm H2O; HFO, approximately 24.3 cm H2O) were higher in PCV. Pilot histologic data showed greater interstitial hemorrhage and alveolar septal expansion in PCV than in HFO or ITPV. Conclusion: These data indicate that HFO, ITPV, and PCV when applied with an open-lung protective ventilatory strategy results in the same gas exchange, lung mechanics, and hemodynamic response, but pilot data indicate that lung injury may be greater with PCV.

Original languageEnglish (US)
Pages (from-to)1102-1111
Number of pages10
JournalAnesthesiology
Volume99
Issue number5
DOIs
StatePublished - Nov 1 2003

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High-Frequency Ventilation
Pulmonary Ventilation
Mechanics
Ventilation
Gases
Hemodynamics
Pressure
Lung
Adult Respiratory Distress Syndrome
Positive-Pressure Respiration
Therapeutic Irrigation
Tidal Volume
Lung Injury
Respiratory Rate

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

Sedeek, Khaled A. ; Takeuchi, Muneyuki ; Suchodolski, Klaudiusz ; Vargas, Sara O. ; Shimaoka, Motomu ; Schnitzer, Jay J. ; Kacmarek, Robert M. / Open-lung Protective Ventilation with Pressure Control Ventilation, High-frequency Oscillation, and Intratracheal Pulmonary Ventilation Results in Similar Gas Exchange, Hemodynamics, and Lung Mechanics. In: Anesthesiology. 2003 ; Vol. 99, No. 5. pp. 1102-1111.
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abstract = "Background: Pressure control ventilation (PCV), high-frequency oscillation (HFO), and intratracheal pulmonary ventilation (ITPV) may all be used to provide lung protective ventilation in acute respiratory distress syndrome, but the specific approach that is optimal remains controversial. Methods: Saline lavage was used to produce acute respiratory distress syndrome in 21 sheep randomly assigned to receive PCV, HFO, or ITPV as follows: positive end-expiratory pressure (PCV and ITPV) and mean airway pressure (HFO) were set in a pressure-decreasing manner after lung recruitment that achieved a ratio of Pao2/FIO2 > 400 mmHg. Respiratory rates were 30 breaths/min, 120 breaths/min, and 8 Hz, respectively, for PCV, ITPV, and HFO. Eucapnia was targeted with peak carinal pressure of no more than 35 cm H 2O. Animals were then ventilated for 4 h. Results: There were no differences among groups in gas exchange, lung mechanics, or hemodynamics. Tidal volume (PCV, 8.9 ± 2.1 ml/kg; ITPV, 2.7 ± 0.8 ml/kg; HFO, approximately 2.0 ml/kg) and peak carinal pressure (PCV, 30.6 ± 2.6 cm H2O; ITPV, 22.3 ± 4.8 cm H2O; HFO, approximately 24.3 cm H2O) were higher in PCV. Pilot histologic data showed greater interstitial hemorrhage and alveolar septal expansion in PCV than in HFO or ITPV. Conclusion: These data indicate that HFO, ITPV, and PCV when applied with an open-lung protective ventilatory strategy results in the same gas exchange, lung mechanics, and hemodynamic response, but pilot data indicate that lung injury may be greater with PCV.",
author = "Sedeek, {Khaled A.} and Muneyuki Takeuchi and Klaudiusz Suchodolski and Vargas, {Sara O.} and Motomu Shimaoka and Schnitzer, {Jay J.} and Kacmarek, {Robert M.}",
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Open-lung Protective Ventilation with Pressure Control Ventilation, High-frequency Oscillation, and Intratracheal Pulmonary Ventilation Results in Similar Gas Exchange, Hemodynamics, and Lung Mechanics. / Sedeek, Khaled A.; Takeuchi, Muneyuki; Suchodolski, Klaudiusz; Vargas, Sara O.; Shimaoka, Motomu; Schnitzer, Jay J.; Kacmarek, Robert M.

In: Anesthesiology, Vol. 99, No. 5, 01.11.2003, p. 1102-1111.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Open-lung Protective Ventilation with Pressure Control Ventilation, High-frequency Oscillation, and Intratracheal Pulmonary Ventilation Results in Similar Gas Exchange, Hemodynamics, and Lung Mechanics

AU - Sedeek, Khaled A.

AU - Takeuchi, Muneyuki

AU - Suchodolski, Klaudiusz

AU - Vargas, Sara O.

AU - Shimaoka, Motomu

AU - Schnitzer, Jay J.

AU - Kacmarek, Robert M.

PY - 2003/11/1

Y1 - 2003/11/1

N2 - Background: Pressure control ventilation (PCV), high-frequency oscillation (HFO), and intratracheal pulmonary ventilation (ITPV) may all be used to provide lung protective ventilation in acute respiratory distress syndrome, but the specific approach that is optimal remains controversial. Methods: Saline lavage was used to produce acute respiratory distress syndrome in 21 sheep randomly assigned to receive PCV, HFO, or ITPV as follows: positive end-expiratory pressure (PCV and ITPV) and mean airway pressure (HFO) were set in a pressure-decreasing manner after lung recruitment that achieved a ratio of Pao2/FIO2 > 400 mmHg. Respiratory rates were 30 breaths/min, 120 breaths/min, and 8 Hz, respectively, for PCV, ITPV, and HFO. Eucapnia was targeted with peak carinal pressure of no more than 35 cm H 2O. Animals were then ventilated for 4 h. Results: There were no differences among groups in gas exchange, lung mechanics, or hemodynamics. Tidal volume (PCV, 8.9 ± 2.1 ml/kg; ITPV, 2.7 ± 0.8 ml/kg; HFO, approximately 2.0 ml/kg) and peak carinal pressure (PCV, 30.6 ± 2.6 cm H2O; ITPV, 22.3 ± 4.8 cm H2O; HFO, approximately 24.3 cm H2O) were higher in PCV. Pilot histologic data showed greater interstitial hemorrhage and alveolar septal expansion in PCV than in HFO or ITPV. Conclusion: These data indicate that HFO, ITPV, and PCV when applied with an open-lung protective ventilatory strategy results in the same gas exchange, lung mechanics, and hemodynamic response, but pilot data indicate that lung injury may be greater with PCV.

AB - Background: Pressure control ventilation (PCV), high-frequency oscillation (HFO), and intratracheal pulmonary ventilation (ITPV) may all be used to provide lung protective ventilation in acute respiratory distress syndrome, but the specific approach that is optimal remains controversial. Methods: Saline lavage was used to produce acute respiratory distress syndrome in 21 sheep randomly assigned to receive PCV, HFO, or ITPV as follows: positive end-expiratory pressure (PCV and ITPV) and mean airway pressure (HFO) were set in a pressure-decreasing manner after lung recruitment that achieved a ratio of Pao2/FIO2 > 400 mmHg. Respiratory rates were 30 breaths/min, 120 breaths/min, and 8 Hz, respectively, for PCV, ITPV, and HFO. Eucapnia was targeted with peak carinal pressure of no more than 35 cm H 2O. Animals were then ventilated for 4 h. Results: There were no differences among groups in gas exchange, lung mechanics, or hemodynamics. Tidal volume (PCV, 8.9 ± 2.1 ml/kg; ITPV, 2.7 ± 0.8 ml/kg; HFO, approximately 2.0 ml/kg) and peak carinal pressure (PCV, 30.6 ± 2.6 cm H2O; ITPV, 22.3 ± 4.8 cm H2O; HFO, approximately 24.3 cm H2O) were higher in PCV. Pilot histologic data showed greater interstitial hemorrhage and alveolar septal expansion in PCV than in HFO or ITPV. Conclusion: These data indicate that HFO, ITPV, and PCV when applied with an open-lung protective ventilatory strategy results in the same gas exchange, lung mechanics, and hemodynamic response, but pilot data indicate that lung injury may be greater with PCV.

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