Gas exchange and lung inflammation using nasal intermittent positive-pressure ventilation versus synchronized intermittent mandatory ventilation in piglets with saline lavage-induced lung injury: an observational study.
OBJECTIVE
Physiologic and pathologic comparison of two modes of assisted ventilation, nasal intermittent positive-pressure ventilation (NIPPV) and synchronized intermittent mandatory ventilation (SIMV), in spontaneously breathing term newborn piglets with saline lavage-induced lung injury.


METHODS
After inducing acute lung injury via repetitive saline lavage, piglets were randomized to NIPPV (n = 12) or SIMV (n = 11) and treated for 6 hrs.


METHODS
Clinical laboratory.


METHODS
Spontaneously breathing term newborn piglets.


METHODS
Invasive (SIMV) or noninvasive (NIPPV) assisted ventilation for 6 hrs.


METHODS
Physiologic parameters and arterial blood gases were continuously monitored. At the conclusion of the study, lung tissue was obtained to analyze for evidence of inflammation, including myeloperoxidase, interleukin-8, and hydrogen peroxide levels, as well as for evidence of pathologic injury.


RESULTS
Piglets treated with NIPPV demonstrated higher arterial blood gas pH (p < .001), lower PaCO2 (p < .05), and a lower set respiratory rate (p < .0001) as compared with the SIMV-treated piglets. The piglets in the SIMV group had higher PaO2/PaO2 ratio than those in the NIPPV group (p = .001). There was significantly more interstitial inflammation (p = .04) in the SIMV-treated piglets compared with the NIPPV-treated piglets. Total respiratory rate, heart rate, blood pressure, oxygen saturation, and biochemical markers of lung inflammation were not different between the groups.


CONCLUSIONS
In surfactant-deficient term newborn piglets, NIPPV offers an effective and noninvasive ventilatory strategy with the potential for less pathologic lung inflammation.
Lampland
Andrea L
AL
Department of Pediatrics, Division of Neonatology, University of Minnesota Medical School, Minneapolis, MN, USA.
Meyers
Patricia A
PA
Worwa
Cathy T
CT
Swanson
Elizabeth C
EC
Mammel
Mark C
MC
D000818:Animals; D018893:Bronchoalveolar Lavage; D004195:Disease Models, Animal; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods*; D011014:Pneumonia / Q000378:metabolism* / Q000503:physiopathology; D011659:Pulmonary Gas Exchange; D011897:Random Allocation; D012128:Respiratory Distress Syndrome / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy*; D012965:Sodium Chloride; D013552:Swine
D012965:Sodium Chloride