Benefit of Physiologically Variable Over Pressure-Controlled Ventilation in a Model of Chronic Obstructive Pulmonary Disease: A Randomized Study

The advantages of physiologically variable ventilation (PVV) based on a spontaneous breathing pattern have been demonstrated in several respiratory conditions. However, its potential benefits in chronic obstructive pulmonary disease (COPD) have not yet been characterized. We used an experimental mod...

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Published inFrontiers in physiology Vol. 11; p. 625777
Main Authors Dos Santos Rocha, Andre, Südy, Roberta, Bizzotto, Davide, Kassai, Miklos, Carvalho, Tania, Dellacà, Raffaele L, Peták, Ferenc, Habre, Walid
Format Journal Article
LanguageEnglish
Published Switzerland Frontiers Media S.A 13.01.2021
Subjects
animal model
COPD
gas exchange
lung mechanics
Physiology
variable ventilation
variable ventilation
animal model
gas exchange
lung mechanics
COPD
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Abstract The advantages of physiologically variable ventilation (PVV) based on a spontaneous breathing pattern have been demonstrated in several respiratory conditions. However, its potential benefits in chronic obstructive pulmonary disease (COPD) have not yet been characterized. We used an experimental model of COPD to compare respiratory function outcomes after 6 h of PVV versus conventional pressure-controlled ventilation (PCV). Rabbits received nebulized elastase and lipopolysaccharide throughout 4 weeks. After 30 days, animals were anesthetized, tracheotomized, and randomized to receive 6 h of physiologically variable ( = 8) or conventional PCV ( = 7). Blood gases, respiratory mechanics, and chest fluoroscopy were assessed hourly. After 6 h of ventilation, animals receiving variable ventilation demonstrated significantly higher oxygenation index (PaO /FiO 441 ± 37 (mean ± standard deviation) 354 ± 61 mmHg, < 0.001) and lower respiratory elastance (359 ± 36 463 ± 81 cmH O/L, < 0.01) than animals receiving PCV. Animals ventilated with the variable mode also presented less lung derecruitment (decrease in lung aerated area, -3.4 ± 9.9 -17.9 ± 6.7%, < 0.01) and intrapulmonary shunt fraction (9.6 ± 4.1 17.0 ± 5.8%, < 0.01). PVV applied to a model of COPD improved oxygenation, respiratory mechanics, lung aeration, and intrapulmonary shunt fraction compared to conventional ventilation. A reduction in alveolar derecruitment and lung tissue stress leading to better aeration and gas exchange may explain the benefits of PVV.
AbstractList INTRODUCTIONThe advantages of physiologically variable ventilation (PVV) based on a spontaneous breathing pattern have been demonstrated in several respiratory conditions. However, its potential benefits in chronic obstructive pulmonary disease (COPD) have not yet been characterized. We used an experimental model of COPD to compare respiratory function outcomes after 6 h of PVV versus conventional pressure-controlled ventilation (PCV). MATERIALS AND METHODSRabbits received nebulized elastase and lipopolysaccharide throughout 4 weeks. After 30 days, animals were anesthetized, tracheotomized, and randomized to receive 6 h of physiologically variable (n = 8) or conventional PCV (n = 7). Blood gases, respiratory mechanics, and chest fluoroscopy were assessed hourly. RESULTSAfter 6 h of ventilation, animals receiving variable ventilation demonstrated significantly higher oxygenation index (PaO2/FiO2 441 ± 37 (mean ± standard deviation) versus 354 ± 61 mmHg, p < 0.001) and lower respiratory elastance (359 ± 36 versus 463 ± 81 cmH2O/L, p < 0.01) than animals receiving PCV. Animals ventilated with the variable mode also presented less lung derecruitment (decrease in lung aerated area, -3.4 ± 9.9 versus -17.9 ± 6.7%, p < 0.01) and intrapulmonary shunt fraction (9.6 ± 4.1 versus 17.0 ± 5.8%, p < 0.01). CONCLUSIONPVV applied to a model of COPD improved oxygenation, respiratory mechanics, lung aeration, and intrapulmonary shunt fraction compared to conventional ventilation. A reduction in alveolar derecruitment and lung tissue stress leading to better aeration and gas exchange may explain the benefits of PVV.
The advantages of physiologically variable ventilation (PVV) based on a spontaneous breathing pattern have been demonstrated in several respiratory conditions. However, its potential benefits in chronic obstructive pulmonary disease (COPD) have not yet been characterized. We used an experimental model of COPD to compare respiratory function outcomes after 6 h of PVV versus conventional pressure-controlled ventilation (PCV). Rabbits received nebulized elastase and lipopolysaccharide throughout 4 weeks. After 30 days, animals were anesthetized, tracheotomized, and randomized to receive 6 h of physiologically variable ( = 8) or conventional PCV ( = 7). Blood gases, respiratory mechanics, and chest fluoroscopy were assessed hourly. After 6 h of ventilation, animals receiving variable ventilation demonstrated significantly higher oxygenation index (PaO /FiO 441 ± 37 (mean ± standard deviation) 354 ± 61 mmHg, < 0.001) and lower respiratory elastance (359 ± 36 463 ± 81 cmH O/L, < 0.01) than animals receiving PCV. Animals ventilated with the variable mode also presented less lung derecruitment (decrease in lung aerated area, -3.4 ± 9.9 -17.9 ± 6.7%, < 0.01) and intrapulmonary shunt fraction (9.6 ± 4.1 17.0 ± 5.8%, < 0.01). PVV applied to a model of COPD improved oxygenation, respiratory mechanics, lung aeration, and intrapulmonary shunt fraction compared to conventional ventilation. A reduction in alveolar derecruitment and lung tissue stress leading to better aeration and gas exchange may explain the benefits of PVV.
Introduction The advantages of physiologically variable ventilation (PVV) based on a spontaneous breathing pattern have been demonstrated in several respiratory conditions. However, its potential benefits in chronic obstructive pulmonary disease (COPD) have not yet been characterized. We used an experimental model of COPD to compare respiratory function outcomes after 6 h of PVV versus conventional pressure-controlled ventilation (PCV). Materials and Methods Rabbits received nebulized elastase and lipopolysaccharide throughout 4 weeks. After 30 days, animals were anesthetized, tracheotomized, and randomized to receive 6 h of physiologically variable ( n = 8) or conventional PCV ( n = 7). Blood gases, respiratory mechanics, and chest fluoroscopy were assessed hourly. Results After 6 h of ventilation, animals receiving variable ventilation demonstrated significantly higher oxygenation index (PaO 2 /FiO 2 441 ± 37 (mean ± standard deviation) versus 354 ± 61 mmHg, p < 0.001) and lower respiratory elastance (359 ± 36 versus 463 ± 81 cmH 2 O/L, p < 0.01) than animals receiving PCV. Animals ventilated with the variable mode also presented less lung derecruitment (decrease in lung aerated area, –3.4 ± 9.9 versus –17.9 ± 6.7%, p < 0.01) and intrapulmonary shunt fraction (9.6 ± 4.1 versus 17.0 ± 5.8%, p < 0.01). Conclusion PVV applied to a model of COPD improved oxygenation, respiratory mechanics, lung aeration, and intrapulmonary shunt fraction compared to conventional ventilation. A reduction in alveolar derecruitment and lung tissue stress leading to better aeration and gas exchange may explain the benefits of PVV.
Author Südy, Roberta
Dos Santos Rocha, Andre
Bizzotto, Davide
Dellacà, Raffaele L
Peták, Ferenc
Kassai, Miklos
Habre, Walid
Carvalho, Tania
AuthorAffiliation 4 Department of Medical Physics and Informatics, Faculty of Medicine, University of Szeged , Szeged , Hungary
1 Unit for Anaesthesiological Investigations, Department of Acute Medicine, University Hospitals of Geneva, University of Geneva , Geneva , Switzerland
2 Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano , Milan , Italy
3 Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa , Lisbon , Portugal
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Keywords variable ventilation
animal model
gas exchange
lung mechanics
COPD
Language English
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Snippet The advantages of physiologically variable ventilation (PVV) based on a spontaneous breathing pattern have been demonstrated in several respiratory conditions....
Introduction The advantages of physiologically variable ventilation (PVV) based on a spontaneous breathing pattern have been demonstrated in several...
INTRODUCTIONThe advantages of physiologically variable ventilation (PVV) based on a spontaneous breathing pattern have been demonstrated in several respiratory...
IntroductionThe advantages of physiologically variable ventilation (PVV) based on a spontaneous breathing pattern have been demonstrated in several respiratory...
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StartPage 625777
SubjectTerms animal model
COPD
gas exchange
lung mechanics
Physiology
variable ventilation
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Title Benefit of Physiologically Variable Over Pressure-Controlled Ventilation in a Model of Chronic Obstructive Pulmonary Disease: A Randomized Study
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