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Regional lung volume changes during high-frequency oscillatory ventilation. 2010

Gerhard K Wolf, and Bartłomiej Grychtol, and Inez Frerichs, and David Zurakowski, and John H Arnold
Division of Critical Care Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA. gerhard.wolf@childrens.harvard.edu

OBJECTIVE To investigate regional lung volume changes occurring during an inflation-deflation maneuver using high-frequency oscillatory ventilation. METHODS Prospective animal trial. METHODS Animal research laboratory. METHODS Six Yorkshire swine. METHODS Electrical impedance tomography was used to quantify regional ventilation during high-frequency oscillatory ventilation. The electrical impedance tomography-derived center of ventilation was used to describe the distribution of regional ventilation, whereas spectral analysis was used to describe regional ventilation-induced impedance changes. Lung injury was induced using surfactant lavage. Animals were transitioned to high-frequency oscillatory ventilation and a slow inflation-deflation maneuver was performed by changing mean airway pressure by 5 cm H2O every 15 mins to a maximum mean airway pressure of 40 cm H2O. RESULTS The induction of lung injury was associated with a significant shift of the center of ventilation toward nondependent areas and an increase in shunt fraction (p < .001). During the following inflation-deflation maneuver using high-frequency oscillatory ventilation, inflation was associated with a shift of the center of ventilation from nondependent to dependent areas. Center of ventilation was significantly correlated with the shunt fraction (p < .001). Analyzing different lung layers along the gravitational axis separately, nondependent lung areas showed significantly decreased regional ventilation-induced impedance changes at higher pressures, suggesting overdistension, whereas dependent lung areas showed increased impedance changes, suggesting recruitment. The reverse was observed during deflation (all p < .05). CONCLUSIONS The center of ventilation during high-frequency oscillatory ventilation correlated with oxygenating efficiency as measured by the shunt fraction. Lung recruitment during high-frequency oscillatory ventilation produced a significant shift of regional ventilation toward dependent areas of the lung and led to overdistension of nondependent areas.

UI MeSH Term Description Entries
D008176 Lung Volume Measurements Measurement of the amount of air that the lungs may contain at various points in the respiratory cycle. Lung Capacities,Lung Volumes,Capacity, Lung,Lung Capacity,Lung Volume,Lung Volume Measurement,Measurement, Lung Volume,Volume, Lung
D004195 Disease Models, Animal Naturally-occurring or experimentally-induced animal diseases with pathological processes analogous to human diseases. Animal Disease Model,Animal Disease Models,Disease Model, Animal
D006612 High-Frequency Ventilation Ventilatory support system using frequencies from 60-900 cycles/min or more. Three types of systems have been distinguished on the basis of rates, volumes, and the system used. They are high frequency positive-pressure ventilation (HFPPV); HIGH-FREQUENCY JET VENTILATION; (HFJV); and high-frequency oscillation (HFO). High-Frequency Oscillation Ventilation,High-Frequency Positive Pressure Ventilation,Ventilation, High-Frequency,High Frequency Oscillation Ventilation,High Frequency Positive Pressure Ventilation,High Frequency Ventilation,Ventilation, High Frequency,High Frequency Ventilations,High-Frequency Oscillation Ventilations,High-Frequency Ventilations,Oscillation Ventilation, High-Frequency,Oscillation Ventilations, High-Frequency,Ventilation, High-Frequency Oscillation,Ventilations, High Frequency,Ventilations, High-Frequency,Ventilations, High-Frequency Oscillation
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
D013552 Swine Any of various animals that constitute the family Suidae and comprise stout-bodied, short-legged omnivorous mammals with thick skin, usually covered with coarse bristles, a rather long mobile snout, and small tail. Included are the genera Babyrousa, Phacochoerus (wart hogs), and Sus, the latter containing the domestic pig (see SUS SCROFA). Phacochoerus,Pigs,Suidae,Warthogs,Wart Hogs,Hog, Wart,Hogs, Wart,Wart Hog
D014054 Tomography Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. Tomographies
D017097 Electric Impedance The resistance to the flow of either alternating or direct electrical current. Bioelectrical Impedance,Electric Resistance,Impedance,Ohmic Resistance,Biolectric Impedance,Electrical Impedance,Electrical Resistance,Impedance, Bioelectrical,Impedance, Biolectric,Impedance, Electric,Impedance, Electrical,Ohmic Resistances,Resistance, Electric,Resistance, Electrical,Resistance, Ohmic,Resistances, Ohmic
D055397 Ventilator-Induced Lung Injury Lung damage that is caused by the adverse effects of PULMONARY VENTILATOR usage. The high frequency and tidal volumes produced by a mechanical ventilator can cause alveolar disruption and PULMONARY EDEMA. Lung Injury, Ventilator-Induced,Lung Injuries, Ventilator-Induced,Lung Injury, Ventilator Induced,Ventilator Induced Lung Injury,Ventilator-Induced Lung Injuries

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