Shortened Automatic Lung Recruitment Maneuvers in an In Vivo Model of Neonatal ARDS.
BACKGROUND: The aim of this study was to assess the safety and efficacy of 2 protocols for automatic lung recruitment maneuvers (LRMs) using stepwise increases in PEEP in a neonatal ARDS model. These protocols were designed with lower maximum opening pressures than traditional methods and differ eac...
| Publicado en: | Respiratory Care Vol. 68; no. 5; pp. 628 - 638 |
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| Autores principales: | , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
May2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=163323496&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 163323496 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: May2023 vid: 68 iid: 5 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 163323496 163323496 163323496 10.4187/respcare.10438 163323496 ppf: 628 ppct: 10 formats: fmt: @attributes: type: P tig: atl: Shortened Automatic Lung Recruitment Maneuvers in an In Vivo Model of Neonatal ARDS. aug: au: Guilló-Moreno, Verónica Gutiérrez-Martínez, Alberto Serrano-Zueras, Clara Santos-González, Martín Romero-Berrocal, Antonio García-Fernández, Javier affil: Department of Anaesthesiology, Intensive Care and Pain, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain sug: subj: Respiratory Distress Syndrome, Newborn Therapy Positive End-Expiratory Pressure Methods Positive End-Expiratory Pressure Adverse Effects Respiration, Artificial Adverse Effects Hemodynamics Evaluation Treatment Outcomes Evaluation Protocols Animal Studies Swine Models, Biological Prospective Studies Experimental Studies Wilcoxon Signed Rank Test Regression In Vivo Studies Descriptive Statistics Monitoring, Physiologic Data Analysis Software Confidence Intervals Comparative Studies ab: BACKGROUND: The aim of this study was to assess the safety and efficacy of 2 protocols for automatic lung recruitment maneuvers (LRMs) using stepwise increases in PEEP in a neonatal ARDS model. These protocols were designed with lower maximum opening pressures than traditional methods and differ each one in the duration of the opening phases (short vs prolonged). We described hemodynamic changes through invasive monitoring, and we analyzed if the behavior of the variables depends on the duration of the opening phase of the LRM. METHODS: We designed a prospective, experimental study with 10 Landrace x Large White pigs < 48 h old. Under general anesthesia, tracheal intubation, invasive hemodynamic monitoring with a pediatric arterial thermodilution catheter was performed. An ARDS model was developed with bronchoalveolar lavages. Two types of LRMs were performed in each piglet, with a maximum peak inspiratory pressure (PIP) of 30 cm H2O and a PEEP 15 cm H2O applied during 8.5 s in the short LRM and 17 s in the prolonged LRM. A comparative analysis by virtue of the Wilcoxon signed-rank test and a regression analysis using generalized estimation equation were performed. RESULTS: We found that both LRMs were effective regarding oxygenation and respiratory mechanics. Shortening the duration of the opening phase and lowering the maximum opening pressures to PIP 30 and PEEP 15 cm H2O were above the critical opening pressure to reverse alveolar collapse in our neonatal ARDS model. Although we observed hemodynamic variations during both types of LRMs, these were well tolerated. CONCLUSIONS: Our LRM protocols exceeded critical opening pressures to reverse alveolar collapse in our neonatal ARDS model. This range of pressures might involve less hemodynamic disturbance. Duration of the maximum opening pressure step is a determining factor for hemodynamic alterations. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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