Respiratory and haemodynamic effects of conventional volume controlled PEEP ventilation, pressure regulated volume controlled ventilation and low frequency positive pressure ventilation with extracorporeal carbon dioxide removal in pigs with acute ARDS |
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Authors: | J. KESECIOGLU,L. TELCI,F. ESEN,K. AKPIR,A. S. TÜ TÜ NCÜ ,T. DENKEL,W. ERDMANN,B. LACHMANN |
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Affiliation: | Department of Anesthesiology;Pediatric Surgery, Erasmus University Hospital Dijkzigt, Rotterdam and Sophia Children's Hospital, The Netherlands;Department of Anesthesiology, University of Istanbul, Faculty of Medicine, Istanbul, Turkey |
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Abstract: | The purpose of this study was to evaluate whether any benefit of low frequency positive pressure ventilation with extracorporeal carbon dioxide removal (LFPPV–ECCO2R) existed over either volume controlled ventilation (VCV) with measured best–PEEP or pressure regulated volume controlled ventilation (PRVCV) with an inspiration/expiration (I/E) ratio of 4:1, with respect to arterial oxygenation, lung mechanics and haemodynamics, in acute respiratory failure. Fifteen adult pigs were used for the study. Respiratory failure was induced by surfactant depletion by repeated lung lavage. The different therapeutic approaches were applied randomly to each pig for 1 h. Measurements of gas exchange, airway pressures and haemodynamics were performed during ventilatory and haemodynamic steady state. Paco2 was kept constant in all modes. At almost similar total–PEEP, Pao2 values were significantly higher with LFPPV–ECCO2R comared to VCV with best–PEEP. Peak inspiratory pressure (PIP) and intrapulmonary pressure amplitude defined as the difference between PIP and total–PEEP were significantly lower with PRVCV and LFPPV–ECCO2R compared to VCV with best–PEEP. There was no significant difference between the modes concerning cardiocircu–latory parameters. PRVCV with I/E ratio of 4:1 and LFPPV–ECCO2R proved to be better modes to achieve better gas exchange and lower PIP at lower intrapulmonary pressure amplitudes. It is concluded that PRVCV is an adequate form of treatment under these experimental conditions imitating acute respiratory failure, without necessitating other invasive measures. |
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Keywords: | Adult respiratory distress syndrome best–PEEP blood gases hemodynamics low frequency positive pressure ventilation with extracorporeal carbon dioxide removal lung mechanics pressure regulated volume controlled ventilation volume controlled ventilation |
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