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- Title
PHYSIOLOGIC EFFECTS OF VOLUME-TARGETED MODES AND ENDOTRACHEAL TUBE LEAK IN SURFACTANT-DEFICIENT JUVENILE RABBITS.
- Authors
DiBlasi, Rob M.; Kearney, Christine; Crotwell, Dave N.; Chan, Maia; Hotz, Justin
- Abstract
BACKGROUND: Neonatal volume-targeted modes adjust peak inspiratory pressure (PIP) in response to a measured tidal volume (VT). Several ventilator manufacturers offer these modes but there are differences per brand about location of VT monitoring and whether the PIP is adjusted based on measured inspiratory, expiratory, or a leak compensated VT. We hypothesized that there would be no differences in PIP, PEEP, mean airway pressure, inspiratory work of breathing, and gas exchange in surfactant-deficient, spontaneously breathing juvenile rabbits (with and without ET tube leak) between modes that regulate PIP based on inspiratory, expiratory, or leak corrected VT measurements. METHODS: Rabbits (1.61 ± 0.20 kg, n=12) were sedated, anesthetized, intubated, and favaged, and then stabilized on mechanical ventilation. The trachea was dissected and umbilical tape was used to adjust the size of the ET tube leak. An esophageal balloon was placed to estimate pleural pressure. Animals were randomized and in a crossover design to be supported by AVEA (Carefusion, Yorba Linda, CA), VN500 (Draeger, Lubeck, Germany), and Servo I (Maquet, Solna, Sweden) with and without an induced ET tube leak (50% at PIP 20 cmH2O). These ventilators use expiratory VT (proximal), leak-corrected VT (proximal) and inspiratory V (at ventilator) measurements, respectively to guide PIP adjustment. After 20 min, ABG, pressure rate product, VT and pressures were recorded at each condition. RESULTS: When an ET Tube leak was not present, the AVEA had lower PEEP than the VN500 and Servo I (P<0.05) and lower PIP and Vr than the Servo-I (P<0.05). There were no other differences in the other physiologic parameters. When a mpderate tube leak was implemented, the AVEA and VN500 ventilators modes increased PIP; whereas the Servo 1 reduced PIP by -4 cmHTO. V, and pH were greater with the AVEA and VN500 and pressure rate product lower with the VNS00 than the Servo-I (P<0.05) with an ET Tube leak. DISCUSSION/CONCLUSION: A major finding from this study is that all subjects were able to be supported similarly without an ET tube leak. Modes that allow VT monitoring using a proximal flow sensor placed at the airway to guide PIP adjustments during volume-targeted ventilation may be more effective in providing ventilation when ET Tube leaks exist. Studies in human infants need to be conducted to validate these findings and guide development in future ventilator mode designs. Sponsored Research - Draeger provided the research funding but had no input into study design, equipment, lab space, or writing of this abstract.
- Publication
Respiratory Care, 2016, Vol 61, Issue 10, pOF45
- ISSN
0020-1324
- Publication type
Academic Journal