Protective ventilation strategies in the management of phosgene-induced acute lung injury. 2007

Duncan A Parkhouse, and Roger F Brown, and Bronwen J Jugg, and Fraser M Harban, and Jan Platt, and Christopher E Kenward, and John Jenner, and Paul Rice, and Adam J Smith
Biomedical Sciences Department, Defence Science and Technology Laboratory, Porton Down, Salisbury, SP4 OJQ, UK.

Phosgene is a chemical widely used in the plastics industry and has been used in warfare. It produces a life-threatening pulmonary edema within hours of exposure, to which no specific antidote exists. This study aims to examine the pathophysiological changes seen with low tidal volume ventilation (protective ventilation (PV)) strategies compared to conventional ventilation (CV), in a model of phosgene-induced acute lung injury. Anesthetized pigs were instrumented and exposed to phosgene (concentration x time (Ct), 2,350 mg x min x m(-3)) and then ventilated with intermittent positive pressure ventilation (tidal volume (TV) = 10 ml x kg(-1); positive end expiratory pressure, 3 cm H2O; frequency, 20 breaths x min(-1); fractional concentration of inspired oxygen, 0.24), monitored for 6 hours after exposure, and then randomized into treatment groups: CV, PV (A) or (B) (TV, 8 or 6 ml x kg(-1); positive end expiratory pressure, 8 cm H2O; frequency, 20 or 25 breaths x min(-1); fractional concentration of inspired oxygen, 0.4). Pathophysiological parameters were measured for up to 24 hours. The results show that PV resulted in improved oxygenation, decreased shunt fraction, and mortality, with all animals surviving to 24 hours compared to only three of the CV animals. Microscopy confirmed reduced hemorrhage, neutrophilic infiltration, and intra-alveolar edema.

UI MeSH Term Description Entries
D007385 Intermittent Positive-Pressure Ventilation Application of positive pressure to the inspiratory phase when the patient has an artificial airway in place and is connected to a ventilator. BIPAP Biphasic Intermittent Positive Airway Pressure,IPPV,Inspiratory Positive-Pressure Ventilation,Ventilation, Intermittent Positive-Pressure,Biphasic Intermittent Positive Airway Pressure,Inspiratory Positive Pressure Ventilation,Intermittent Positive Pressure Ventilation,Positive-Pressure Ventilation, Inspiratory,Positive-Pressure Ventilation, Intermittent,Ventilation, Inspiratory Positive-Pressure,Ventilation, Intermittent Positive Pressure
D010705 Phosgene A highly toxic gas that has been used as a chemical warfare agent. It is an insidious poison as it is not irritating immediately, even when fatal concentrations are inhaled. (From The Merck Index, 11th ed, p7304)
D011175 Positive-Pressure Respiration A method of mechanical ventilation in which pressure is maintained to increase the volume of gas remaining in the lungs at the end of expiration, thus reducing the shunting of blood through the lungs and improving gas exchange. Positive End-Expiratory Pressure,Positive-Pressure Ventilation,End-Expiratory Pressure, Positive,End-Expiratory Pressures, Positive,Positive End Expiratory Pressure,Positive End-Expiratory Pressures,Positive Pressure Respiration,Positive Pressure Ventilation,Positive-Pressure Respirations,Positive-Pressure Ventilations,Pressure, Positive End-Expiratory,Pressures, Positive End-Expiratory,Respiration, Positive-Pressure,Respirations, Positive-Pressure,Ventilation, Positive-Pressure,Ventilations, Positive-Pressure
D011897 Random Allocation A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. Randomization,Allocation, Random
D012121 Respiration, Artificial Any method of artificial breathing that employs mechanical or non-mechanical means to force the air into and out of the lungs. Artificial respiration or ventilation is used in individuals who have stopped breathing or have RESPIRATORY INSUFFICIENCY to increase their intake of oxygen (O2) and excretion of carbon dioxide (CO2). Ventilation, Mechanical,Mechanical Ventilation,Artificial Respiration,Artificial Respirations,Mechanical Ventilations,Respirations, Artificial,Ventilations, Mechanical
D012123 Pulmonary Ventilation The total volume of gas inspired or expired per unit of time, usually measured in liters per minute. Respiratory Airflow,Ventilation Tests,Ventilation, Pulmonary,Expiratory Airflow,Airflow, Expiratory,Airflow, Respiratory,Test, Ventilation,Tests, Ventilation,Ventilation Test
D012128 Respiratory Distress Syndrome A syndrome characterized by progressive life-threatening RESPIRATORY INSUFFICIENCY in the absence of known LUNG DISEASES, usually following a systemic insult such as surgery or major TRAUMA. ARDS, Human,Acute Respiratory Distress Syndrome,Adult Respiratory Distress Syndrome,Pediatric Respiratory Distress Syndrome,Respiratory Distress Syndrome, Acute,Respiratory Distress Syndrome, Adult,Respiratory Distress Syndrome, Pediatric,Shock Lung,Distress Syndrome, Respiratory,Distress Syndromes, Respiratory,Human ARDS,Lung, Shock,Respiratory Distress Syndromes,Syndrome, Respiratory Distress
D002619 Chemical Warfare Agents Chemicals that are used to cause the disturbance, disease, or death of humans during WARFARE. Agents, Chemical Warfare,Warfare Agents, Chemical,Agent, Chemical Warfare,Chemical Warfare Agent,Warfare Agent, Chemical
D005260 Female Females
D000818 Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA. Animal,Metazoa,Animalia

Related Publications

Duncan A Parkhouse, and Roger F Brown, and Bronwen J Jugg, and Fraser M Harban, and Jan Platt, and Christopher E Kenward, and John Jenner, and Paul Rice, and Adam J Smith
July 2010, Clinical toxicology (Philadelphia, Pa.),
Duncan A Parkhouse, and Roger F Brown, and Bronwen J Jugg, and Fraser M Harban, and Jan Platt, and Christopher E Kenward, and John Jenner, and Paul Rice, and Adam J Smith
April 2003, Critical care medicine,
Duncan A Parkhouse, and Roger F Brown, and Bronwen J Jugg, and Fraser M Harban, and Jan Platt, and Christopher E Kenward, and John Jenner, and Paul Rice, and Adam J Smith
January 2022, Frontiers in immunology,
Duncan A Parkhouse, and Roger F Brown, and Bronwen J Jugg, and Fraser M Harban, and Jan Platt, and Christopher E Kenward, and John Jenner, and Paul Rice, and Adam J Smith
February 2015, Experimental and toxicologic pathology : official journal of the Gesellschaft fur Toxikologische Pathologie,
Duncan A Parkhouse, and Roger F Brown, and Bronwen J Jugg, and Fraser M Harban, and Jan Platt, and Christopher E Kenward, and John Jenner, and Paul Rice, and Adam J Smith
November 2001, Critical care medicine,
Duncan A Parkhouse, and Roger F Brown, and Bronwen J Jugg, and Fraser M Harban, and Jan Platt, and Christopher E Kenward, and John Jenner, and Paul Rice, and Adam J Smith
December 2010, Journal of the Royal Army Medical Corps,
Duncan A Parkhouse, and Roger F Brown, and Bronwen J Jugg, and Fraser M Harban, and Jan Platt, and Christopher E Kenward, and John Jenner, and Paul Rice, and Adam J Smith
November 2012, Zhonghua lao dong wei sheng zhi ye bing za zhi = Zhonghua laodong weisheng zhiyebing zazhi = Chinese journal of industrial hygiene and occupational diseases,
Duncan A Parkhouse, and Roger F Brown, and Bronwen J Jugg, and Fraser M Harban, and Jan Platt, and Christopher E Kenward, and John Jenner, and Paul Rice, and Adam J Smith
July 2011, Anesthesiology,
Duncan A Parkhouse, and Roger F Brown, and Bronwen J Jugg, and Fraser M Harban, and Jan Platt, and Christopher E Kenward, and John Jenner, and Paul Rice, and Adam J Smith
July 2015, Toxicological sciences : an official journal of the Society of Toxicology,
Duncan A Parkhouse, and Roger F Brown, and Bronwen J Jugg, and Fraser M Harban, and Jan Platt, and Christopher E Kenward, and John Jenner, and Paul Rice, and Adam J Smith
November 2012, Medizinische Klinik, Intensivmedizin und Notfallmedizin,
Copied contents to your clipboard!