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- Title
A QUEST TO FINDING THE OPTIMAL MECHANICAL BREATH PROFILE FOR THE MANAGEMENT OF ARDS: A PILOT ANIMAL STUDY.
- Authors
Restrepo, Ruben D.; Rowley, Daniel D.; Lamb, Keith D.; Inkrott, Jon C.; Scott, J. Brady; Hinkson, Carl R.; Kriner, Eric J.; Tanner, Donna; Pasewald, Ron; Satalin, Josh B. S.; Jain, Sumeet
- Abstract
Background: Although ARDS mortality has been reduced significantly since 1967, there has been no further decrease in mortality since 1998, and remains >40%. Early application of low volume ventilation and open lung approach have been promoted as the best strategies to manage ARDS. Identification of the optimal mechanical breath profile (MBp) to obtain lung protection has proven more difficult than anticipated. The purpose of this animal study was to evaluate three different approaches to optimize mechanical ventilation after induction oflung injury. Methods: Three Yorkshire pigs were anesthetized, surgically instrumented and placed on mechanical ventilation with a tidal volume (Vt) of lOmL/kg, PEEP of 5cmH2O, and FiO2 1.0. Following lung injury by Tween instillation they were separated into 3 groups: ARDSnet low tidal volume and High PEEP (LVt/High PEEP), LVt plus recruitment maneuvers (LVt+RM), and airway pressure release ventilation (APRV). A group of 14 clinicians (LVt/High PEEP=5; LVt+RM= 5; APRV=4) from different centers in the US and Canada were responsible for the ventilator management of each animal for 5h. Ventilator changes during the study were made after reaching consensus. ABGs were obtained at baseline, after lung injury, and every hour. Driving pressures (Driving P), Vt, lung compliance (Cst), mean arterial pressure (MAP), and P/F ratios were recorded every hour. Necropsy was performed after 5h of MV. The lungs were extracted and re-inflated with 25 cm H2O pressure to appreciate gross changes. No statistical comparisons were made between variables as limited extrapolation of results can be achieved from a single subject on each group. Results: After injury, P/F ratio decreased (LVt/High PEEP=168; LVt+RM=174; APRV=84). Table 1 shows the mean values (SD) for variables recorded during the 5h of MV post lung injury. On the gross anatomy, all lungs showed areas of atelectasis that uniformly resolved upon reexpansion. Conclusions: 1 he MBp used by reams varied considerably; reflecting the current approach to ventilate patients with ARDS. The application of different MBp resulted in acceptable pulmonary mechanics, hemodynamic, and gas exchange. Even under similar circumstances and using different approaches to MV, identifying the optimal MBp has to be individualized. Future study should extend the duration oflung protective ventilation MBp strategies to detetmine if there is a difference in clinically important markets oflung injury progression. Sponsored Research - Drager Medical funded travel for all study participants and covered the cost of animals and supplies for the pilot study. No honorariums were paid and Drager Medical had no input on the content of the summit lectures or the observational pilot study, nor did they comment during the group discussions.
- Publication
Respiratory Care, 2016, Vol 61, Issue 10, pOF39
- ISSN
0020-1324
- Publication type
Academic Journal