Bubble bilevel ventilation facilitates gas exchange in anesthetized rabbits

Background Bubble continuous positive airway pressure is an established therapy for infants in respiratory distress. In resource-limited settings, few treatment options exist for infants requiring further respiratory support. A bubble bilevel device has been developed to provide nonelectric, time-cy...

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Published inPediatric research Vol. 89; no. 3; pp. 622 - 627
Main Authors John, Stephen C., Mohammed, Azmath, Church, Joseph T., John, Anna V., Perkins, Elena M., McLeod, Jennifer S., Carr, Benjamin D., Smith, Sue, Barnett, J. Hudson, Gustafson, Peter A., Dick, Macdonald, John, Sunil P.
Format Journal Article
LanguageEnglish
Published New York Nature Publishing Group US 01.02.2021
Nature Publishing Group
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Summary:Background Bubble continuous positive airway pressure is an established therapy for infants in respiratory distress. In resource-limited settings, few treatment options exist for infants requiring further respiratory support. A bubble bilevel device has been developed to provide nonelectric, time-cycled, pressure-limited respiratory support. We compared the efficacy of bubble bilevel ventilation with conventional mechanical ventilation in sedated rabbits. Methods Six adult rabbits under inhaled isoflurane general anesthesia were ventilated by alternating intervals of conventional and bubble bilevel ventilation for three 10−15-min periods. During each period, interval arterial blood gas (ABG) measurements were obtained after at least 10 min on the respective mode of ventilation. Results The bubble bilevel system was able to deliver the following pressures: 20/7, 15/5, 12/5, 8/5 cm H 2 O. The estimated differences in arterial blood gas values on bubble bilevel vs. ventilator were as follows (normalized values): pH 7.41 vs. 7.40, pCO 2 37.7 vs. 40, pO 2 97.6 vs. 80. In addition, the bubble bilevel ventilation delivered consistent pressure waveforms without interruption for over 60 min on two rabbits. Conclusion This study demonstrates promising in vivo results on the efficacy of a novel bubble bilevel device, which may prove useful for infants in respiratory distress. Impact Given the lack of personnel, funds or infrastructure to provide neonatal mechanical ventilation in resource-limited settings, additional low-cost, low-tech treatments are necessary to save infant lives. Bubble bilevel ventilation reliably delivers two levels of airway pressure to anesthetized rabbits resulting in normalization of blood gases comparable to those achieved on a traditional ventilator. If proven effective, simple technologies like this device have the potential to significantly impact neonatal mortality due to respiratory distress globally.
ISSN:0031-3998
1530-0447
DOI:10.1038/s41390-020-0928-0