title: Sustained inflations improve respiratory compliance during high-frequency oscillatory ventilation but not during large tidal volume positive-pressure ventilation in rabbits.
abstract: OBJECTIVE
  To determine whether volume recruitment maneuvers that induce significant lung reexpansion during high-frequency oscillatory ventilation are also of value during conventional positive-pressure ventilation.
  
  
  METHODS
  Crossover comparison of volume recruitment maneuvers administered during high-frequency oscillatory ventilation and positive-pressure ventilation in normal and surfactant-deficient adult rabbits.
  
  
  METHODS
  Laboratory.
  
  
  METHODS
  Nineteen adult New Zealand white rabbits (weight 2.3 to 3.3 kg).
  
  
  METHODS
  Respiratory system compliance was measured plethysmographically before and after sustained inflations in six normal and five saline-lavaged anesthetized rabbits, using both ventilators over a range of mean and end-expiratory pressures.
  
  
  RESULTS
  Under conditions where sustained inflations during high-frequency oscillatory ventilation at 15 Hz increased respiratory system compliance 50 +/- 28%, sustained inflations during conventional positive-pressure ventilation at a rate of 30 to 40 breaths/min and tidal volumes of 14 to 17 mL/kg did not change respiratory system compliance (mean change 3 +/- 9%). Sustained inflations during conventional positive-pressure ventilation could not be made effective by increasing the positive end-expiratory pressure level to equal the mean pressure during high-frequency oscillatory ventilation. Sustained inflations on conventional positive-pressure ventilation remained ineffective up to positive end-expiratory pressure levels of 17.5 cm H2O. In lavaged rabbits, sustained inflations increased respiratory system compliance 49 +/- 14% during high-frequency oscillatory ventilation and 0 +/- 3% during conventional positive-pressure ventilation. Sustained inflations increased compliance significantly during conventional positive-pressure ventilation only when ventilating with tidal volumes of 7 mL/kg and low end-expiratory pressure.
  
  
  CONCLUSIONS
  Active recruitment of lung volume during high-frequency oscillatory ventilation appears necessary, because small pressure/volume cycles adequate to support high-frequency gas transport are not able to reexpand atelectatic lung units without the aid of a sustained inflation. We conclude that volume recruitment maneuvers improve respiratory system compliance substantially during high-frequency oscillatory ventilation at 15 Hz, but these maneuvers offer potential risk and no benefit during conventional positive-pressure ventilation with large tidal volumes or when using smaller tidal volumes and high levels of positive end-expiratory pressure.
authors.affiliation: Department of Anaesthesia, Queen's University, Kingston, ON, Canada.
authors.forename: D M
authors.initials: DM
authors.lastname: Bond
authors.forename: J
authors.initials: J
authors.lastname: McAloon
authors.forename: A B
authors.initials: AB
authors.lastname: Froese
mesh_terms: D000403:Airway Resistance / Q000502:physiology; D000818:Animals; D001784:Blood Gas Analysis; D005069:Evaluation Studies as Topic; D006612:High-Frequency Ventilation / Q000379:methods*; D007327:Insufflation / Q000379:methods; D008170:Lung Compliance / Q000502:physiology*; D016555:Matched-Pair Analysis; D010991:Plethysmography; D011175:Positive-Pressure Respiration / Q000379:methods*; D001261:Pulmonary Atelectasis / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*; D011817:Rabbits; D007507:Therapeutic Irrigation; D013990:Tidal Volume / Q000502:physiology*; D013997:Time Factors