High-frequency ventilation in rabbits with respiratory insufficiency

Treatment of respiratory insufficiency using continuous positive pressure ventilation (CPPV) with positive end-expiratory pressure (PEEP) is often associated with high airway pressures and large tidal volumes resulting in parenchymal damage and an exacerbation of ventilation/perfusion mismatch. High-frequency jet ventilation and high-frequency oscillation purportedly provide adequate ventilation and might preclude these harmful side effects. Few data exist comparing these methods in a model of respiratory insufficiency. Respiratory insufficiency was produced in three groups of six rabbits by 15 pulmonary lavages with saline (35 ml kg −1) to remove surfactant, following which ventilation for the subsequent 5 hr was as follows: group I, CPPV with a frequency of 60 bpm, and a minute volume of 400 ml min −1 kg −1; group II, oscillatory ventilation with a loudspeaker system delivering a tidal volume of 6–8 ml at a frequency of 5 Hz; and group III, jet ventilation with volumes of 6–8 ml at a frequency of 5 Hz. All groups were ventilated with a PEEP of 10 cm H 2O and a F iO 2 of 1.0. Arterial blood samples were taken every hour. All three methods provided adequate oxygenation without important differences. The arterial pCO 2 rose in all three groups owing to the seriousness of the respiratory insufficiency created. This rise was the highest with oscillatory ventilation. Three of the six rabbits deteriorated after 3 hr of jet ventilation and died with elevated pCO 2s and low pO 2s with bloody edema coming out of the trachea. Because of this apparent damaging effect of jet ventilation and because oscillatory ventilation achieved the same gas exchange but at lower airway pressures as compared to jet ventilation and CPPV, it is thought that oscillatory ventilation is superior over both jet ventilation and CPPV for application in respiratory insufficiency.