The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment–Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome
BackgroundWhether spontaneous breathing (SB) should be used in early acute respiratory distress syndrome (ARDS) is questioned because it may cause ventilator-induced lung injury (VILI) by tidal high strain/stress and recruitment/derecruitment (R/D). However, SB has shown beneficial effects when used...
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doaj-888a8ae894894a8b98a22b251b1b4e2a2020-11-25T02:07:52ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2019-11-011010.3389/fphys.2019.01392486078The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment–Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress SyndromeCarl Hannes Widing0Carl Hannes Widing1Mariangela Pellegrini2Mariangela Pellegrini3Anders Larsson4Anders Larsson5Gaetano Perchiazzi6Gaetano Perchiazzi7Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, SwedenNU-Hospital Organization, Trollhättan, SwedenHedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, SwedenDepartment of Anaesthesia and Intensive Care Medicine, Uppsala University Hospital, Uppsala, SwedenHedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, SwedenDepartment of Anaesthesia and Intensive Care Medicine, Uppsala University Hospital, Uppsala, SwedenHedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, SwedenDepartment of Anaesthesia and Intensive Care Medicine, Uppsala University Hospital, Uppsala, SwedenBackgroundWhether spontaneous breathing (SB) should be used in early acute respiratory distress syndrome (ARDS) is questioned because it may cause ventilator-induced lung injury (VILI) by tidal high strain/stress and recruitment/derecruitment (R/D). However, SB has shown beneficial effects when used appropriately. We hypothesized that high levels of positive end-expiratory pressure (PEEP), during assisted SB, would prevent tidal R/D, reducing ventilatory variation and respiratory rate while potentially increasing transpulmonary pressure (PTP). The aim was to test this hypothesis in experimental mild ARDS during continuous SB using neurally adjusted ventilator assist (NAVA) and uninterrupted computed tomography (CT) exposure.MethodsMild experimental ARDS (PaO2/FiO2-ratio of 250) was induced in anesthetized pigs (n = 5), ventilated using uninterrupted NAVA. PEEP was changed in steps of 3 cmH2O, from 0 to 15 and back to 0 cmH2O. Dynamic CT scans, ventilatory parameters, and esophageal pressure were acquired simultaneously. PTP and R/D were calculated and compared among PEEP levels.ResultsWhen increasing PEEP from 0 to 15 cmH2O, tidal R/D decreased from 4.3 ± 5.9 to 1.1 ± 0.7% (p < 0.01), breath-to-breath variability decreased, and PTP increased from 11.4 ± 3.7 to 29.7 ± 14.1 cmH2O (R2 = 0.96).ConclusionThis study shows that injurious phenomena like R/D and high PTP are present in NAVA at the two extremes of the PEEP spectrum. Willing to titrate PEEP to limit these phenomena, the physician must choose the best compromise between restraining the R/D or PTP.https://www.frontiersin.org/article/10.3389/fphys.2019.01392/fullARDSmechanical ventilationVILINAVArespiratory failurePEEP |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Carl Hannes Widing Carl Hannes Widing Mariangela Pellegrini Mariangela Pellegrini Anders Larsson Anders Larsson Gaetano Perchiazzi Gaetano Perchiazzi |
spellingShingle |
Carl Hannes Widing Carl Hannes Widing Mariangela Pellegrini Mariangela Pellegrini Anders Larsson Anders Larsson Gaetano Perchiazzi Gaetano Perchiazzi The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment–Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome Frontiers in Physiology ARDS mechanical ventilation VILI NAVA respiratory failure PEEP |
author_facet |
Carl Hannes Widing Carl Hannes Widing Mariangela Pellegrini Mariangela Pellegrini Anders Larsson Anders Larsson Gaetano Perchiazzi Gaetano Perchiazzi |
author_sort |
Carl Hannes Widing |
title |
The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment–Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome |
title_short |
The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment–Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome |
title_full |
The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment–Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome |
title_fullStr |
The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment–Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome |
title_full_unstemmed |
The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment–Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome |
title_sort |
effects of positive end-expiratory pressure on transpulmonary pressure and recruitment–derecruitment during neurally adjusted ventilator assist: a continuous computed tomography study in an animal model of acute respiratory distress syndrome |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Physiology |
issn |
1664-042X |
publishDate |
2019-11-01 |
description |
BackgroundWhether spontaneous breathing (SB) should be used in early acute respiratory distress syndrome (ARDS) is questioned because it may cause ventilator-induced lung injury (VILI) by tidal high strain/stress and recruitment/derecruitment (R/D). However, SB has shown beneficial effects when used appropriately. We hypothesized that high levels of positive end-expiratory pressure (PEEP), during assisted SB, would prevent tidal R/D, reducing ventilatory variation and respiratory rate while potentially increasing transpulmonary pressure (PTP). The aim was to test this hypothesis in experimental mild ARDS during continuous SB using neurally adjusted ventilator assist (NAVA) and uninterrupted computed tomography (CT) exposure.MethodsMild experimental ARDS (PaO2/FiO2-ratio of 250) was induced in anesthetized pigs (n = 5), ventilated using uninterrupted NAVA. PEEP was changed in steps of 3 cmH2O, from 0 to 15 and back to 0 cmH2O. Dynamic CT scans, ventilatory parameters, and esophageal pressure were acquired simultaneously. PTP and R/D were calculated and compared among PEEP levels.ResultsWhen increasing PEEP from 0 to 15 cmH2O, tidal R/D decreased from 4.3 ± 5.9 to 1.1 ± 0.7% (p < 0.01), breath-to-breath variability decreased, and PTP increased from 11.4 ± 3.7 to 29.7 ± 14.1 cmH2O (R2 = 0.96).ConclusionThis study shows that injurious phenomena like R/D and high PTP are present in NAVA at the two extremes of the PEEP spectrum. Willing to titrate PEEP to limit these phenomena, the physician must choose the best compromise between restraining the R/D or PTP. |
topic |
ARDS mechanical ventilation VILI NAVA respiratory failure PEEP |
url |
https://www.frontiersin.org/article/10.3389/fphys.2019.01392/full |
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