title: Limiting ventilator-associated lung injury in a preterm porcine neonatal model.
abstract: OBJECTIVE
  Preterm infants are prone to respiratory distress syndrome (RDS), with severe cases requiring mechanical ventilation for support. However, there are no clear guidelines regarding the optimal ventilation strategy. We hypothesized that airway pressure release ventilation (APRV) would mitigate lung injury in a preterm porcine neonatal model.
  
  
  METHODS
  Preterm piglets were delivered on gestational day 98 (85% of 115day term), instrumented, and randomized to volume guarantee (VG; n=10) with low tidal volumes (5.5cm3kg-1) and PEEP 4cmH2O or APRV (n=10) with initial ventilator settings: PHigh18cmH2O, PLow0cmH2O, THigh1.30s, TLow0.15s. Ventilator setting changes were made in response to clinical parameters in both groups. Animals were monitored continuously for 24hours.
  
  
  RESULTS
  The mortality rates between the two groups were not significantly different (p>0.05). The VG group had relatively increased oxygen requirements (FiO250%±9%) compared with the APRV group (FiO228%±5%; p>0.05) and a decrease in PaO2/FiO2ratio (VG 162±33mmHg; APRV 251±45mmHg; p<0.05). The compliance of the VG group (0.51±0.07L·cmH2O-1) was significantly less than the APRV group (0.90±0.06L·cmH2O-1; p<0.05).
  
  
  CONCLUSIONS
  This study demonstrates that APRV improves oxygenation and compliance as compared with VG. This preliminary work suggests further study into the clinical uses of APRV in the neonate is warranted.
  
  
  METHODS
  Not Applicable (Basic Science Animal Study).
authors.affiliation: Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: KolliscM@upstate.edu.
authors.forename: Michaela
authors.initials: M
authors.lastname: Kollisch-Singule
authors.affiliation: Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: JainSu@upstate.edu.
authors.forename: Sumeet V
authors.initials: SV
authors.lastname: Jain
authors.affiliation: Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: SatalinJ@upstate.edu.
authors.forename: Joshua
authors.initials: J
authors.lastname: Satalin
authors.affiliation: Department of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, 21201, USA. Electronic address: plandrews@intensivecareonline.com.
authors.forename: Penny
authors.initials: P
authors.lastname: Andrews
authors.affiliation: Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: SearlesQ@upstate.edu.
authors.forename: Quinn
authors.initials: Q
authors.lastname: Searles
authors.affiliation: Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: LiuZh@upstate.edu.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: ZhouYa@upstate.edu.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: WangG@upstate.edu.
authors.forename: Guirong
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: MeierAn@upstate.edu.
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Meier
authors.affiliation: Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA; Department of Biological Sciences, SUNY Cortland, 22 Graham Ave, Cortland, NY, 13045, USA. Electronic address: Louis.Gatto@cortland.edu.
authors.forename: Louis A
authors.initials: LA
authors.lastname: Gatto
authors.affiliation: Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: NiemanG@upstate.edu.
authors.forename: Gary F
authors.initials: GF
authors.lastname: Nieman
authors.affiliation: Department of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, 21201, USA. Electronic address: nmh@xmxmail.com.
authors.forename: Nader M
authors.initials: NM
authors.lastname: Habashi
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D055370:Lung Injury / Q000209:etiology / Q000517:prevention & control*; D011897:Random Allocation; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D013552:Swine; D013990:Tidal Volume
keywords: Airway pressure release ventilation; Respiratory distress syndrome; Ventilator-induced injury