Biologically variable ventilation improves gas exchange and respiratory mechanics in a model of severe bronchospasm
OBJECTIVE:Mechanical ventilation can be lifesaving for status asthmaticus, but how best to accomplish mechanical ventilation is unclear. Biologically variable ventilation (mechanical ventilation that emulates healthy variation) and conventional control mode ventilation (monotonously regular) were co...
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| Veröffentlicht in: | Critical care medicine 2007-07, Vol.35 (7), p.1749-1755 |
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| creator | Mutch, W Alan C Buchman, Timothy G Girling, Linda G Walker, Elizabeth K-Y McManus, Bruce M Graham, M Ruth |
| description | OBJECTIVE:Mechanical ventilation can be lifesaving for status asthmaticus, but how best to accomplish mechanical ventilation is unclear. Biologically variable ventilation (mechanical ventilation that emulates healthy variation) and conventional control mode ventilation (monotonously regular) were compared in an animal model of bronchospasm to determine which approach yields better gas exchange and respiratory mechanics.
DESIGN:A randomized prospective trial of biologically variable ventilation vs. control mode ventilation in swine.
SETTING:University research laboratory.
SUBJECTS:Eighteen farm-raised pigs.
INTERVENTIONS:Methacholine was administered as a nebulized aerosol to initiate bronchospasm, defined as doubling of peak inspiratory pressure and respiratory system resistance, and then randomized (n = 9 each group) to either continue control mode ventilation or switch to biologically variable ventilation at the same minute ventilation. Over the next 4 hrs, hemodynamics, blood gases, respiratory mechanics, and carbon dioxide expirograms were recorded hourly. At end-experiment, tracheobronchial lavage was undertaken to determine interleukin-6 and -10 concentrations.
MEASUREMENTS AND MAIN RESULTS:Measurements of physiologic variables and inflammatory cytokines showed that biologically variable ventilation significantly improved gas exchange, with greater arterial oxygen tensions (p = .006; group × time interaction), lower arterial carbon dioxide tensions (p = .0003; group effect), lower peak inspiratory pressures (p = .0001; group × time), greater static compliance (p = .0001; group × time), greater dynamic compliance (p = .0001; group × time), and lower total respiratory system resistance (p = .028; group × time), compared with conventional ventilation. The appearance of inflammatory cytokines in bronchoalveolar lavage fluid (interleukin-6 and -10) was not affected by mode of ventilation.
CONCLUSIONS:In this experimental model, biologically variable ventilation was superior to control mode ventilation in terms of gas exchange and respiratory mechanics during severe bronchospasm. |
| doi_str_mv | 10.1097/01.CCM.0000269039.61615.A1 |
| format | Article |
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DESIGN:A randomized prospective trial of biologically variable ventilation vs. control mode ventilation in swine.
SETTING:University research laboratory.
SUBJECTS:Eighteen farm-raised pigs.
INTERVENTIONS:Methacholine was administered as a nebulized aerosol to initiate bronchospasm, defined as doubling of peak inspiratory pressure and respiratory system resistance, and then randomized (n = 9 each group) to either continue control mode ventilation or switch to biologically variable ventilation at the same minute ventilation. Over the next 4 hrs, hemodynamics, blood gases, respiratory mechanics, and carbon dioxide expirograms were recorded hourly. At end-experiment, tracheobronchial lavage was undertaken to determine interleukin-6 and -10 concentrations.
MEASUREMENTS AND MAIN RESULTS:Measurements of physiologic variables and inflammatory cytokines showed that biologically variable ventilation significantly improved gas exchange, with greater arterial oxygen tensions (p = .006; group × time interaction), lower arterial carbon dioxide tensions (p = .0003; group effect), lower peak inspiratory pressures (p = .0001; group × time), greater static compliance (p = .0001; group × time), greater dynamic compliance (p = .0001; group × time), and lower total respiratory system resistance (p = .028; group × time), compared with conventional ventilation. The appearance of inflammatory cytokines in bronchoalveolar lavage fluid (interleukin-6 and -10) was not affected by mode of ventilation.
CONCLUSIONS:In this experimental model, biologically variable ventilation was superior to control mode ventilation in terms of gas exchange and respiratory mechanics during severe bronchospasm.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/01.CCM.0000269039.61615.A1</identifier><identifier>PMID: 17522581</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Animals ; Biological and medical sciences ; Bronchial Spasm - therapy ; Cytokines - metabolism ; Emergency and intensive respiratory care ; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation ; Intensive care medicine ; Least-Squares Analysis ; Medical sciences ; Methacholine Chloride ; Pulmonary Gas Exchange ; Random Allocation ; Respiration, Artificial - methods ; Respiratory Mechanics ; Status Asthmaticus - therapy ; Swine</subject><ispartof>Critical care medicine, 2007-07, Vol.35 (7), p.1749-1755</ispartof><rights>2007 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4591-fdb1a76301ba6aad38af7247a95cd716f21d8ae2e7610a17a5cb47dacefe3fb3</citedby><cites>FETCH-LOGICAL-c4591-fdb1a76301ba6aad38af7247a95cd716f21d8ae2e7610a17a5cb47dacefe3fb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18870318$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17522581$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mutch, W Alan C</creatorcontrib><creatorcontrib>Buchman, Timothy G</creatorcontrib><creatorcontrib>Girling, Linda G</creatorcontrib><creatorcontrib>Walker, Elizabeth K-Y</creatorcontrib><creatorcontrib>McManus, Bruce M</creatorcontrib><creatorcontrib>Graham, M Ruth</creatorcontrib><title>Biologically variable ventilation improves gas exchange and respiratory mechanics in a model of severe bronchospasm</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:Mechanical ventilation can be lifesaving for status asthmaticus, but how best to accomplish mechanical ventilation is unclear. Biologically variable ventilation (mechanical ventilation that emulates healthy variation) and conventional control mode ventilation (monotonously regular) were compared in an animal model of bronchospasm to determine which approach yields better gas exchange and respiratory mechanics.
DESIGN:A randomized prospective trial of biologically variable ventilation vs. control mode ventilation in swine.
SETTING:University research laboratory.
SUBJECTS:Eighteen farm-raised pigs.
INTERVENTIONS:Methacholine was administered as a nebulized aerosol to initiate bronchospasm, defined as doubling of peak inspiratory pressure and respiratory system resistance, and then randomized (n = 9 each group) to either continue control mode ventilation or switch to biologically variable ventilation at the same minute ventilation. Over the next 4 hrs, hemodynamics, blood gases, respiratory mechanics, and carbon dioxide expirograms were recorded hourly. At end-experiment, tracheobronchial lavage was undertaken to determine interleukin-6 and -10 concentrations.
MEASUREMENTS AND MAIN RESULTS:Measurements of physiologic variables and inflammatory cytokines showed that biologically variable ventilation significantly improved gas exchange, with greater arterial oxygen tensions (p = .006; group × time interaction), lower arterial carbon dioxide tensions (p = .0003; group effect), lower peak inspiratory pressures (p = .0001; group × time), greater static compliance (p = .0001; group × time), greater dynamic compliance (p = .0001; group × time), and lower total respiratory system resistance (p = .028; group × time), compared with conventional ventilation. The appearance of inflammatory cytokines in bronchoalveolar lavage fluid (interleukin-6 and -10) was not affected by mode of ventilation.
CONCLUSIONS:In this experimental model, biologically variable ventilation was superior to control mode ventilation in terms of gas exchange and respiratory mechanics during severe bronchospasm.</description><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Animals</subject><subject>Biological and medical sciences</subject><subject>Bronchial Spasm - therapy</subject><subject>Cytokines - metabolism</subject><subject>Emergency and intensive respiratory care</subject><subject>General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation</subject><subject>Intensive care medicine</subject><subject>Least-Squares Analysis</subject><subject>Medical sciences</subject><subject>Methacholine Chloride</subject><subject>Pulmonary Gas Exchange</subject><subject>Random Allocation</subject><subject>Respiration, Artificial - methods</subject><subject>Respiratory Mechanics</subject><subject>Status Asthmaticus - therapy</subject><subject>Swine</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkMFu1DAQhi1ERbctr4AsJLgleOI4TjggbVcUkFr10rs1cSa7Bide7OyWfXtSdqW9Mpc5zDczvz7G3oPIQTT6k4B8tXrIxVxF1QjZ5BVUoPIlvGILUFJkomjka7YQohGZLBt5ya5S-ikElErLN-wStCoKVcOCpVsXfFg7i94f-B6jw9YT39M4OY-TCyN3wzaGPSW-xsTpj93guCaOY8cjpa2LOIV44AO9DJxN3I0c-RA68jz0PNGeIvE2htFuQtpiGm7YRY8-0dtTv2ZPd1-fVt-z-8dvP1bL-8yWqoGs71pAXUkBLVaInayx10WpsVG201D1BXQ1UkG6AoGgUdm21B1a6kn2rbxmH49n5_i_d5QmM7hkyXscKeyS0aJSRaXVDH4-gjaGlCL1ZhvdgPFgQJgX40aAmY2bs3Hzz7hZwrz87vRl1w7UnVdPimfgwwnANFvuI47WpTNX11pIqGfuy5F7Dn6imH753TNFsyH00-Z_kvwFObigIw</recordid><startdate>200707</startdate><enddate>200707</enddate><creator>Mutch, W Alan C</creator><creator>Buchman, Timothy G</creator><creator>Girling, Linda G</creator><creator>Walker, Elizabeth K-Y</creator><creator>McManus, Bruce M</creator><creator>Graham, M Ruth</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200707</creationdate><title>Biologically variable ventilation improves gas exchange and respiratory mechanics in a model of severe bronchospasm</title><author>Mutch, W Alan C ; Buchman, Timothy G ; Girling, Linda G ; Walker, Elizabeth K-Y ; McManus, Bruce M ; Graham, M Ruth</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4591-fdb1a76301ba6aad38af7247a95cd716f21d8ae2e7610a17a5cb47dacefe3fb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Animals</topic><topic>Biological and medical sciences</topic><topic>Bronchial Spasm - therapy</topic><topic>Cytokines - metabolism</topic><topic>Emergency and intensive respiratory care</topic><topic>General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation</topic><topic>Intensive care medicine</topic><topic>Least-Squares Analysis</topic><topic>Medical sciences</topic><topic>Methacholine Chloride</topic><topic>Pulmonary Gas Exchange</topic><topic>Random Allocation</topic><topic>Respiration, Artificial - methods</topic><topic>Respiratory Mechanics</topic><topic>Status Asthmaticus - therapy</topic><topic>Swine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mutch, W Alan C</creatorcontrib><creatorcontrib>Buchman, Timothy G</creatorcontrib><creatorcontrib>Girling, Linda G</creatorcontrib><creatorcontrib>Walker, Elizabeth K-Y</creatorcontrib><creatorcontrib>McManus, Bruce M</creatorcontrib><creatorcontrib>Graham, M Ruth</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mutch, W Alan C</au><au>Buchman, Timothy G</au><au>Girling, Linda G</au><au>Walker, Elizabeth K-Y</au><au>McManus, Bruce M</au><au>Graham, M Ruth</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Biologically variable ventilation improves gas exchange and respiratory mechanics in a model of severe bronchospasm</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2007-07</date><risdate>2007</risdate><volume>35</volume><issue>7</issue><spage>1749</spage><epage>1755</epage><pages>1749-1755</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE:Mechanical ventilation can be lifesaving for status asthmaticus, but how best to accomplish mechanical ventilation is unclear. Biologically variable ventilation (mechanical ventilation that emulates healthy variation) and conventional control mode ventilation (monotonously regular) were compared in an animal model of bronchospasm to determine which approach yields better gas exchange and respiratory mechanics.
DESIGN:A randomized prospective trial of biologically variable ventilation vs. control mode ventilation in swine.
SETTING:University research laboratory.
SUBJECTS:Eighteen farm-raised pigs.
INTERVENTIONS:Methacholine was administered as a nebulized aerosol to initiate bronchospasm, defined as doubling of peak inspiratory pressure and respiratory system resistance, and then randomized (n = 9 each group) to either continue control mode ventilation or switch to biologically variable ventilation at the same minute ventilation. Over the next 4 hrs, hemodynamics, blood gases, respiratory mechanics, and carbon dioxide expirograms were recorded hourly. At end-experiment, tracheobronchial lavage was undertaken to determine interleukin-6 and -10 concentrations.
MEASUREMENTS AND MAIN RESULTS:Measurements of physiologic variables and inflammatory cytokines showed that biologically variable ventilation significantly improved gas exchange, with greater arterial oxygen tensions (p = .006; group × time interaction), lower arterial carbon dioxide tensions (p = .0003; group effect), lower peak inspiratory pressures (p = .0001; group × time), greater static compliance (p = .0001; group × time), greater dynamic compliance (p = .0001; group × time), and lower total respiratory system resistance (p = .028; group × time), compared with conventional ventilation. The appearance of inflammatory cytokines in bronchoalveolar lavage fluid (interleukin-6 and -10) was not affected by mode of ventilation.
CONCLUSIONS:In this experimental model, biologically variable ventilation was superior to control mode ventilation in terms of gas exchange and respiratory mechanics during severe bronchospasm.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>17522581</pmid><doi>10.1097/01.CCM.0000269039.61615.A1</doi><tpages>7</tpages></addata></record> |
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| ispartof | Critical care medicine, 2007-07, Vol.35 (7), p.1749-1755 |
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| subjects | Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Animals Biological and medical sciences Bronchial Spasm - therapy Cytokines - metabolism Emergency and intensive respiratory care General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation Intensive care medicine Least-Squares Analysis Medical sciences Methacholine Chloride Pulmonary Gas Exchange Random Allocation Respiration, Artificial - methods Respiratory Mechanics Status Asthmaticus - therapy Swine |
| title | Biologically variable ventilation improves gas exchange and respiratory mechanics in a model of severe bronchospasm |
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