High-frequency oscillatory ventilation and partial liquid ventilation after acute lung injury in premature lambs with respiratory distress syndrome.
OBJECTIVE
Conventional mechanical ventilatory support (CV) contributes to lung injury in premature lambs with respiratory distress syndrome, a disease that is characterized by progressive deterioration of gas exchange and increased lung inflammation. Lung recruitment strategies, such as high-frequency oscillatory ventilation (HFOV) and partial liquid ventilation (PLV), improve gas exchange and attenuate lung inflammation when instituted immediately after birth. However, whether these recruitment strategies are effective as rescue treatment after established lung injury is unknown. To determine the separate and combined effects of HFOV and PLV when initiated after the establishment of acute lung injury in severe respiratory distress syndrome, we studied the effects of these strategies on gas exchange and histologic signs of acute lung injury in premature lambs.


METHODS
Animals were intubated, treated with surfactant and ventilated with 1.00 FIO2 for 4 hrs. After 2 hrs, animals were either continued on CV (controls) or treated with one of three strategies: HFOV; CV + PLV; or HFOV + PLV. The response to low-dose inhaled nitric oxide (5 ppm) was measured in each group at the end of the study.


METHODS
An animal laboratory affiliated with University of Colorado School of Medicine.


METHODS
A total of 20 premature lambs at 115-118 days of gestation (term = 147 days).


RESULTS
In comparison with control animals, each of the rescue therapies improved PaO2 after 1 hr of treatment. The HFOV and HFOV + PLV groups had higher PaO2 than CV + PLV or CV alone (p < .05). Mean airway pressure (Paw) was lower in the PLV groups during CV or HFOV compared with their controls (p < .05). Inhaled NO improved PaO2 in all groups; however, the increase in PaO2 was greatest in the HFOV + PLV group (p < .05). Histologic examination and myeloperoxidase assay were not different between groups.


CONCLUSIONS
We conclude that each lung recruitment strategy improved oxygenation in premature lambs with established lung injury.
Department of Pediatric Anesthesia and Intensive Care, Sahlgrenska University Hospital, Göteborg, Sweden. sylvia.gothberg@sahlgrenska.se
S
S
Göthberg
T A
TA
Parker
S H
SH
Abman
J P
JP
Kinsella
D000465:Algorithms; D000818:Animals; D000831:Animals, Newborn; D001688:Biological Products; D001784:Blood Gas Analysis; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D006439:Hemodynamics; D006612:High-Frequency Ventilation; D009569:Nitric Oxide / Q000627:therapeutic use*; D011175:Positive-Pressure Respiration; D011659:Pulmonary Gas Exchange; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012756:Sheep
D001688:Biological Products; D001993:Bronchodilator Agents; D011663:Pulmonary Surfactants; D009569:Nitric Oxide; C117342:calfactant