Michaela Kollisch-Singule1, Sumeet V Jain2, Joshua Satalin3, Penny Andrews4, Quinn Searles5, Zhiyong Liu6, Yan Zhou7, Guirong Wang8, Andreas H Meier9, Louis A Gatto10, Gary F Nieman11, Nader M Habashi12. 1. Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: KolliscM@upstate.edu. 2. Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: JainSu@upstate.edu. 3. Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: SatalinJ@upstate.edu. 4. Department of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, 21201, USA. Electronic address: plandrews@intensivecareonline.com. 5. Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: SearlesQ@upstate.edu. 6. Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: LiuZh@upstate.edu. 7. Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: ZhouYa@upstate.edu. 8. Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: WangG@upstate.edu. 9. Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: MeierAn@upstate.edu. 10. Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA; Department of Biological Sciences, SUNY Cortland, 22 Graham Ave, Cortland, NY, 13045, USA. Electronic address: Louis.Gatto@cortland.edu. 11. Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: NiemanG@upstate.edu. 12. Department of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, 21201, USA. Electronic address: nmh@xmxmail.com.
Abstract
PURPOSE: Preterm infants are prone to respiratory distress syndrome (RDS), with severe cases requiring mechanical ventilation for support. However, there are no clear guidelines regarding the optimal ventilation strategy. We hypothesized that airway pressure release ventilation (APRV) would mitigate lung injury in a preterm porcine neonatal model. METHODS: Preterm piglets were delivered on gestational day 98 (85% of 115day term), instrumented, and randomized to volume guarantee (VG; n=10) with low tidal volumes (5.5cm3kg-1) and PEEP 4cmH2O or APRV (n=10) with initial ventilator settings: PHigh 18cmH2O, PLow 0cmH2O, THigh 1.30s, TLow 0.15s. Ventilator setting changes were made in response to clinical parameters in both groups. Animals were monitored continuously for 24hours. RESULTS: The mortality rates between the two groups were not significantly different (p>0.05). The VG group had relatively increased oxygen requirements (FiO2 50%±9%) compared with the APRV group (FiO2 28%±5%; p>0.05) and a decrease in PaO2/FiO2 ratio (VG 162±33mmHg; APRV 251±45mmHg; p<0.05). The compliance of the VG group (0.51±0.07L·cmH2O-1) was significantly less than the APRV group (0.90±0.06L·cmH2O-1; p<0.05). CONCLUSION: This study demonstrates that APRV improves oxygenation and compliance as compared with VG. This preliminary work suggests further study into the clinical uses of APRV in the neonate is warranted. LEVEL OF EVIDENCE: Not Applicable (Basic Science Animal Study).
PURPOSE: Preterm infants are prone to respiratory distress syndrome (RDS), with severe cases requiring mechanical ventilation for support. However, there are no clear guidelines regarding the optimal ventilation strategy. We hypothesized that airway pressure release ventilation (APRV) would mitigate lung injury in a preterm porcine neonatal model. METHODS: Preterm piglets were delivered on gestational day 98 (85% of 115day term), instrumented, and randomized to volume guarantee (VG; n=10) with low tidal volumes (5.5cm3kg-1) and PEEP 4cmH2O or APRV (n=10) with initial ventilator settings: PHigh 18cmH2O, PLow 0cmH2O, THigh 1.30s, TLow 0.15s. Ventilator setting changes were made in response to clinical parameters in both groups. Animals were monitored continuously for 24hours. RESULTS: The mortality rates between the two groups were not significantly different (p>0.05). The VG group had relatively increased oxygen requirements (FiO2 50%±9%) compared with the APRV group (FiO2 28%±5%; p>0.05) and a decrease in PaO2/FiO2 ratio (VG 162±33mmHg; APRV 251±45mmHg; p<0.05). The compliance of the VG group (0.51±0.07L·cmH2O-1) was significantly less than the APRV group (0.90±0.06L·cmH2O-1; p<0.05). CONCLUSION: This study demonstrates that APRV improves oxygenation and compliance as compared with VG. This preliminary work suggests further study into the clinical uses of APRV in the neonate is warranted. LEVEL OF EVIDENCE: Not Applicable (Basic Science Animal Study).
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