title: Effects of high-frequency oscillatory ventilation and conventional mechanical ventilation on oxygen metabolism and tissue perfusion in sheep models of acute respiratory distress syndrome.
abstract: BACKGROUND
  High-frequency oscillatory ventilation (HFOV) allows for small tidal volumes at mean airway pressures (mPaw) above that of conventional mechanical ventilation (CMV), but the effect of HFOV on hemodynamics, oxygen metabolism, and tissue perfusion in acute respiratory distress syndrome (ARDS) remains unclear. We investigated the effects of HFOV and CMV in sheep models with ARDS.
  
  
  METHODS
  After inducing ARDS by repeated lavage, twelve adult sheep were randomly divided into a HFOV or CMV group. After stabilization, standard lung recruitments (40 cmH2O × 40 seconds) were performed. The optimal mPaw or positive end-expiratory pressure was obtained by lung recruitment and decremental positive end-expiratory pressure titration. The animals were then ventilated for 4 hours. The hemodynamics, tissue perfusion (superior mesenteric artery blood flow, pHi, and Pg-aCO2), oxygen metabolism and respiratory mechanics were examined at baseline before saline lavage, in the ARDS model, after model stabilization, and during hourly mechanical ventilation for up to 4 hours. A two-way repeated measures analysis of variance was applied to evaluate differences between the groups.
  
  
  RESULTS
  The titrated mPaw was higher and the tidal volumes lower in the HFOV group than the positive end-expiratory pressure in the CMV group. There was no significant difference in hemodynamic parameters between the HFOV and CMV groups. There was no difference in the mean alveolar pressure between the two groups. After lung recruitment, both groups showed an improvement in the oxygenation, oxygen delivery, and DO2. Lactate levels increased in both groups after inducing the ARDS model. Compared with the CMV group, the superior mesenteric artery blood flow and pHi were significantly higher in the HFOV group, but the Pg-aCO2 decreased in the HFOV group.
  
  
  CONCLUSIONS
  Compared with CMV, HFOV with optimal mPaw has no significant side effect on hemodynamics or oxygen metabolism, and increases gastric tissue blood perfusion.
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Songqiao
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Yingzi
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Maohua
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Qiuhua
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Xie
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Li
authors.initials: L
authors.lastname: Tan
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Fengmei
authors.initials: F
authors.lastname: Guo
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Congshan
authors.initials: C
authors.lastname: Yang
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Pan
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China. Email: haiboq2000@gmail.com.
authors.forename: Haibo
authors.initials: H
authors.lastname: Qiu
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D006439:Hemodynamics / Q000502:physiology; D006612:High-Frequency Ventilation / Q000379:methods*; D008297:Male; D010100:Oxygen / Q000378:metabolism*; D011175:Positive-Pressure Respiration / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000378:metabolism* / Q000628:therapy*; D012756:Sheep
chemical_list: D010100:Oxygen