title: Pulmonary effects of expiratory-assisted small-lumen ventilation during upper airway obstruction in pigs.
abstract: Novel devices for small-lumen ventilation may enable effective inspiration and expiratory ventilation assistance despite airway obstruction. In this study, we investigated a porcine model of complete upper airway obstruction. After ethical approval, we randomly assigned 13 anaesthetised pigs either to small-lumen ventilation following airway obstruction (n = 8) for 30 min, or to volume-controlled ventilation (sham setting, n = 5). Small-lumen ventilation enabled adequate gas exchange over 30 min. One animal died as a result of a tension pneumothorax in this setting. Redistribution of ventilation from dorsal to central compartments and significant impairment of the distribution of ventilation/perfusion occurred. Histopathology demonstrated considerable lung injury, predominantly through differences in the dorsal dependent lung regions. Small-lumen ventilation maintained adequate gas exchange in a porcine airway obstruction model. The use of this technique for 30 min by inexperienced clinicians was associated with considerable end-expiratory collapse leading to lung injury, and may also carry the risk of severe injury.
authors.affiliation: Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Ziebart
authors.affiliation: Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Garcia-Bardon
authors.affiliation: Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Kamuf
authors.affiliation: Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Thomas
authors.affiliation: Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Liu
authors.affiliation: Institute of Pathology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Schad
authors.affiliation: Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Duenges
authors.affiliation: Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors.forename: M
authors.initials: M
authors.lastname: David
authors.affiliation: Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
authors.forename: E K
authors.initials: EK
authors.lastname: Hartmann
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology; D000402:Airway Obstruction / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D000818:Animals; D004195:Disease Models, Animal; D006439:Hemodynamics / Q000502:physiology; D008297:Male; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D034421:Sus scrofa; D013990:Tidal Volume / Q000502:physiology; D014140:Tracheotomy / Q000379:methods
chemical_list: D010100:Oxygen