Flow-controlled expiration: a novel ventilation mode to attenuate experimental porcine lung injury
Open Access
- 2 April 2014
- journal article
- research article
- Published by Elsevier BV in British Journal of Anaesthesia
- Vol. 113 (3), 474-483
- https://doi.org/10.1093/bja/aeu058
Abstract
Whereas the effects of various inspiratory ventilatory modifications in lung injury have extensively been studied, those of expiratory ventilatory modifications are less well known. We hypothesized that the newly developed flow-controlled expiration (FLEX) mode provides a means of attenuating experimental lung injury. Experimental acute respiratory distress syndrome was induced by i.v. injection of oleic acid in 15 anaesthetized and mechanically ventilated pigs. After established lung injury (ratio <27 kPa), animals were randomized to either a control group receiving volume-controlled ventilation (VCV) or a treatment group receiving VCV with additional FLEX (VCV+FLEX). At predefined times, lung mechanics and oxygenation were assessed. At the end of the experiment, the pigs were killed, and bronchoalveolar fluid and lung biopsies were taken. Expression of inflammatory cytokines was analysed in lung tissue and bronchoalveolar fluid. Lung injury score was determined on the basis of stained tissue samples. Compared with the control group (VCV; n=8), the VCV+FLEX group (n=7) demonstrated greater dynamic lung compliance and required less PEEP at comparable (both P<0.05), had lower regional lung wet-to-dry ratios and lung injury scores (both P<0.001), and showed less thickening of alveolar walls (an indicator of interstitial oedema) and de novo migration of macrophages into lung tissue (both P<0.001). The newly developed FLEX mode is able to attenuate experimental lung injury. FLEX could provide a novel means of lung-protective ventilation.
Keywords
This publication has 24 references indexed in Scilit:
- Acute effects of intracranial hypertension and ARDS on pulmonary and neuronal damage: a randomized experimental study in pigsIntensive Care Medicine, 2011
- Small airway remodeling in acute respiratory distress syndrome: a study in autopsy lung tissueCritical Care, 2011
- Expiratory automatic endotracheal tube compensation reduces dynamic hyperinflation in a physical lung modelCritical Care, 2009
- Animal models of acute lung injuryAmerican Journal of Physiology-Lung Cellular and Molecular Physiology, 2008
- Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress SyndromeThe New England Journal of Medicine, 2000
- Clinical evaluation of diminished early expiratory flow (DEEF) ventilation in mechanically ventilated COPD patientsIntensive Care Medicine, 1996
- Effects of breathing patterns on mechanically ventilated patients with chronic obstructive pulmonary disease and dynamic hyperinflationIntensive Care Medicine, 1995
- Time constant/volume relationship of passive expiration in mechanically ventilated ARDS patientsEuropean Respiratory Journal, 1995
- Analysis of serial measurements in medical research.BMJ, 1990
- A new experimental model of ARDS and pulmonary hypertension in the dogZeitschrift für Die Gesamte Experimentelle Medizin, 1989