Individualised flow-controlled versus pressure-controlled ventilation in a porcine oleic acid-induced acute respiratory distress syndrome model.
Eur J Anaesthesiol
; 40(7): 511-520, 2023 Jul 01.
Artículo
en Inglés
| MEDLINE | ID: covidwho-2237704
ABSTRACT
BACKGROUND:
A continuous gas flow provided by flow-controlled ventilation (FCV) facilitates accurate dynamic compliance measurement and allows the clinician to individually optimise positive end-expiratory and peak pressure settings accordingly.OBJECTIVE:
The aim of this study was to compare the efficiency of gas exchange and impact on haemodynamics between individualised FCV and pressure-controlled ventilation (PCV) in a porcine model of oleic acid-induced acute respiratory distress syndrome (ARDS).DESIGN:
Randomised controlled interventional trial conducted on 16 pigs.SETTING:
Animal operating facility at the Medical University Innsbruck.INTERVENTIONS:
ARDS was induced in lung healthy pigs by intravenous infusion of oleic acid until moderate-to-severe ARDS at a stable Horowitz quotient (PaO 2 FiO 2-1 ) of 80 to 120 over a period of 30âmin was obtained. Ventilation was then either performed with individualised FCV ( n â=â8) established by compliance-guided pressure titration or PCV ( n â=â8) with compliance-guided titration of the positive end-expiratory pressure and peak pressure set to achieve a tidal volume of 6âmlâkg -1 over a period of 2âh. MAIN OUTCOMEMEASURES:
Gas exchange parameters were assessed by the PaO 2 FiO 2-1 quotient and CO 2 removal by the PaCO 2 value in relation to required respiratory minute volume. Required catecholamine support for haemodynamic stabilisation was measured.RESULTS:
The FCV group showed significantly improved oxygenation [149.2 vs. 110.4, median difference (MD) 38.7 (8.0 to 69.5) PaO 2 FiO 2-1 ; P â=â0.027] and CO 2 removal [PaCO 2 7.25 vs. 9.05, MD -1.8 (-2.87 to -0.72)âkPa; P â=â0.006] at a significantly lower respiratory minute volume [8.4 vs. 11.9, MD -3.6 (-5.6 to -1.5)âlâmin -1 ; P â=â0.005] compared with PCV. In addition, in FCV-pigs, haemodynamic stabilisation occurred with a significant reduction of required catecholamine support [norepinephrine 0.26 vs. 0.86, MD -0.61 (-1.12 to -0.09)âµgâkg -1 âmin -1 ; P â=â0.037] during 2 ventilation hours.CONCLUSION:
In this oleic acid-induced porcine ARDS model, individualised FCV significantly improved gas exchange and haemodynamic stability compared with PCV. TRIAL REGISTRATION Protocol no. BMBWF-66.011/0105-V/3b/2019).
Texto completo:
Disponible
Colección:
Bases de datos internacionales
Base de datos:
MEDLINE
Asunto principal:
Síndrome de Dificultad Respiratoria
/
Ácido Oléico
Tipo de estudio:
Estudio experimental
/
Estudio pronóstico
/
Ensayo controlado aleatorizado
Límite:
Animales
Idioma:
Inglés
Revista:
Eur J Anaesthesiol
Asunto de la revista:
Anestesiología
Año:
2023
Tipo del documento:
Artículo
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