Effects of helium-oxygen on respiratory mechanics, gas exchange, and ventilation-perfusion relationships in a porcine model of stable methacholine-induced bronchospasm.
OBJECTIVE
To explore the consequences of helium/oxygen (He/O(2)) inhalation on respiratory mechanics, gas exchange, and ventilation-perfusion (VA/Q) relationships in an animal model of severe induced bronchospasm during mechanical ventilation.


METHODS
Prospective, interventional study.


METHODS
Experimental animal laboratory, university hospital.


METHODS
Seven piglets were anesthetized, paralyzed, and mechanically ventilated, with all ventilator settings remaining constant throughout the protocol. Acute stable bronchospasm was obtained through continuous aerosolization of methacholine. Once steady-state was achieved, the animals successively breathed air/O(2) and He/O(2) (FIO(2) 0.3), or inversely, in random order. Measurements were taken at baseline, during bronchospasm, and after 30 min of He/O(2) inhalation.


RESULTS
Bronchospasm increased lung peak inspiratory pressure (49+/-6.9 vs 18+/-1 cm H(2)O, P<0.001), lung resistance (22.7+/-1.5 vs 6.8+/-1.5 cm H(2)O x l(-1).s, P<0.001), dynamic elastance (76+/-11.2 vs 22.8+/-4.1 cm H(2)O x l(-1), P<0.001), and work of breathing (1.51+/-0.26 vs 0.47+/-0.08, P<0.001). Arterial pH decreased (7.47+/-0.06 vs 7.32+/-0.06, P<0.001), PaCO(2) increased, and PaO(2) decreased. Multiple inert gas elimination showed an absence of shunt, substantial increases in perfusion to low VA/Q regions, and dispersion of VA/Q distribution. He/O(2) reduced lung resistance and work of breathing, and worsened hypercapnia and respiratory acidosis.


CONCLUSIONS
In this model, while He/O(2) improved respiratory mechanics and reduced work of breathing, hypercapnia and respiratory acidosis increased. Close attention should be paid to monitoring arterial blood gases when He/O(2) is used in mechanically ventilated acute severe asthma.
Watremez
Christine
C
Division of Anesthesiology, Clinique Universitaire St.-Luc, Brussels, Belgium.
Liistro
Giuseppe
G
deKock
Marc
M
Roeseler
Jean
J
Clerbaux
Thierry
T
Detry
Bruno
B
Reynaert
Marc
M
Gianello
Pierre
P
Jolliet
Philippe
P
D000208:Acute Disease; D000818:Animals; D001249:Asthma / Q000175:diagnosis / Q000628:therapy; D001986:Bronchial Spasm / Q000175:diagnosis* / Q000628:therapy*; D016085:Bronchoconstrictor Agents / Q000008:administration & dosage; D004195:Disease Models, Animal; D006371:Helium / Q000008:administration & dosage*; D016210:Methacholine Chloride; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial; D015656:Respiratory Mechanics; D013552:Swine; D016896:Treatment Outcome; D014692:Ventilation-Perfusion Ratio
D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride; D006371:Helium