Negative-pressure ventilation: better oxygenation and less lung injury.
BACKGROUND
Conventional positive-pressure ventilation delivers pressure to the airways; in contrast, negative pressure is delivered globally to the chest and abdomen.


OBJECTIVE
To test the hypothesis that ventilation with negative pressure results in better oxygenation and less injury than with positive pressure.


METHODS
Anesthetized, surfactant-depleted rabbits were ventilated for 2.5 hours in pairs (positive or negative). Tidal volume was 12 ml . kg(-1), normocapnia was maintained by adjusting respiratory rate, and Fi(O(2)) was 1.0.


RESULTS
Lung injury was assessed with histologic scoring, perfusion using thermodilution (global perfusion), and injected intravascular microspheres (regional perfusion); and dynamic computed tomography was used to determine inflation patterns. Negative pressure was associated with a higher Pa(O(2)), a lower Pa-Pet(CO(2)) gradient (despite identical minute ventilation), and less lung injury. Lung perfusion (global and regional) was similar with positive and negative pressure. Positive end-expiratory pressure applied to the airway was more efficiently transmitted to the pleural space than comparable levels of negative end-expiratory pressure applied to the chest wall; however, the oxygenation associated with any level of end-expiratory lung volume was greater when achieved by negative versus positive pressure. Dynamic computed tomography suggested that lung distension achieved with negative pressure is characterized by greater proportions of normally aerated lung (with less atelectasis) during inspiration and at end-expiration.


CONCLUSIONS
Negative-pressure ventilation results in superior oxygenation that is unrelated to lung perfusion and may be explained by more effective inflation of lung volume during both inspiration and expiration.
Grasso
Francesco
F
Department of Critical Care Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.
Engelberts
Doreen
D
Helm
Emma
E
Frndova
Helena
H
Jarvis
Steven
S
Talakoub
Omid
O
McKerlie
Colin
C
Babyn
Paul
P
Post
Martin
M
Kavanagh
Brian P
BP
D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D008176:Lung Volume Measurements; D010101:Oxygen Consumption / Q000502:physiology*; D010477:Perfusion / Q000379:methods; D011175:Positive-Pressure Respiration / Q000379:methods*; D011654:Pulmonary Edema / Q000503:physiopathology; D011659:Pulmonary Gas Exchange; D011817:Rabbits; D011897:Random Allocation; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000517:prevention & control*; D012680:Sensitivity and Specificity; D013990:Tidal Volume; D014057:Tomography, X-Ray Computed; D015919:Ventilators, Negative-Pressure