Review of the carotid artery loop procedure in sheep.

Carotid loop (CL) surgery involves the permanent externalization of a common carotid artery in a skin tube. The CL facilitates repeated access to the systemic arterial system for blood sampling and blood pressure measurement in laboratory sheep. It eliminates the need for arterial cut-downs and chronic indwelling catheters, reduces the risk of sepsis and infection, and adds flexibility to research protocols. The surgical procedure is aseptically performed under general anesthesia and involves isolation of the common carotid artery, creation of a bipedicled skin tube, and permanent envelopment of the artery in the skin tube. The primary complication is ischemic necrosis with sloughing of the middle of the loop and is usually due to failure to adhere to the critical length-to-width ratio (2.5:1). We have performed 150 CL procedures with an overall success rate of 94%. Nine CL ablations were required, due to necrosis with exposure of the artery (7/9) or stricture formation with loss of patency (2/9). Twenty-two CLs developed complications secondary to partial necrosis, but did not require ablation. Results indicate that the CL is a reliable method to ensure repeated access to the systemic arterial system in sheep. A modification of the standard CL procedure in which the artery is surrounded by a skin tunnel rather than enclosed in a skin loop was performed in 10 sheep. Preliminary results indicate significant reduction in the incidence of complications associated with the standard CL.

Different high-frequency ventilator strategies: effect on the propagation of tracheobronchial histopathologic changes.

To assess the role of high-frequency ventilator strategy in the propagation of airway injury, we compared the tracheobronchial histologic alterations in 20 newborn piglets ventilated for 8 hours with high-frequency flow interruption (HFFI). Ten animals were assigned to HFFI with a strategy of continuous pulsations at a frequency of 10 Hz and a mean airway pressure of 16 cm H2O. Ten piglets were treated at identical settings except for 10 one-second baseline pauses per minute to a positive end-expiratory pressure of 5 cm H2O. A semiquantitative scoring system was used to grade light microscopic tissue alterations in the trachea, carina, and mainstem bronchi. Ultrastructural changes were evaluated with scanning electron microscopy. The HFFI-continuous-treated piglets had significantly more damage in all areas than the HFFI-baseline pause group (P less than .001). The upper tracheas of animals in both groups were altered to a greater extent than the lower tracheas (P less than .007). In addition, numerous "skip" areas of injury were noted throughout the tracheas. High-frequency ventilator strategy is a determinant of the severity of airway histologic changes. Factors that adversely affect tissue oxygenation or cause direct mechanical trauma may also influence the degree of injury. Optimal operating characteristics and limitations of different high-frequency devices must be assessed before their use in human neonates.

Determinants of tracheobronchial histologic alterations during conventional mechanical ventilation.

It was hypothesized that diverse mechanisms may influence upper airway injury during mechanical ventilation. To assess the roles of several factors in the propagation of such injury, the tracheobronchial histologic changes in 53 newborn piglets were compared following conventional positive pressure ventilation. Eight animals were assigned to each of four positive pressure ventilation groups at "low" settings (an FiO2 of 0.25, a frequency of 10 breaths per minute, a peak inspiratory pressure of 20 cm H2O, a positive end-expiratory pressure of 4 cm H2O, a flow rate of 10 L/min, and an inspiratory time to expiratory time ratio of 1:2): (1) positive pressure ventilation with no hypotension or hypoxemia; (2) positive pressure ventilation with hypotension; (3) positive pressure ventilation with hypoxemia; and (4) positive pressure ventilation with both hypotension and hypoxemia. In addition, eight piglets were assigned to each of two positive pressure ventilation groups at "high" settings (greater frequency [40 breaths per minute], higher peak inspiratory pressure [40 cm H2O], and greater flow rate [17 L/min]): (1) positive pressure ventilation with no hypotension or hypoxemia; and (2) positive pressure ventilation with both hypotension and hypoxemia. The changes were mild and similar among the first three positive pressure groups at low settings. However, the injury scores of the combined hypotension and hypoxemia group (group 4) were greater than those of the former three positive pressure ventilation groups (P less than .004). The piglets receiving positive pressure ventilation at high settings with no hypotension or hypoxemia (group 5) had no more injury than those in the first three groups receiving positive pressure ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)