Limiting ventilator-associated lung injury in a preterm porcine neonatal model

Michaela Kollisch-Singule; Sumeet V Jain; Joshua Satalin; Penny Andrews; Quinn Searles; Zhiyong Liu; Yan Zhou; Guirong Wang; Andreas H Meier; Louis A Gatto; Gary F Nieman; Nader M Habashi

doi:10.1016/j.jpedsurg.2016.10.020

Limiting ventilator-associated lung injury in a preterm porcine neonatal model

J Pediatr Surg. 2017 Jan;52(1):50-55. doi: 10.1016/j.jpedsurg.2016.10.020. Epub 2016 Oct 27.

Authors

Affiliations

¹ Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: KolliscM@upstate.edu.
² Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: JainSu@upstate.edu.
³ Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: SatalinJ@upstate.edu.
⁴ Department of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, 21201, USA. Electronic address: plandrews@intensivecareonline.com.
⁵ Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: SearlesQ@upstate.edu.
⁶ Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: LiuZh@upstate.edu.
⁷ Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: ZhouYa@upstate.edu.
⁸ Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: WangG@upstate.edu.
⁹ Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: MeierAn@upstate.edu.
¹⁰ Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA; Department of Biological Sciences, SUNY Cortland, 22 Graham Ave, Cortland, NY, 13045, USA. Electronic address: Louis.Gatto@cortland.edu.
¹¹ Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA. Electronic address: NiemanG@upstate.edu.
¹² Department of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, 21201, USA. Electronic address: nmh@xmxmail.com.

PMID: 27837992
DOI: 10.1016/j.jpedsurg.2016.10.020

Abstract

Purpose: Preterm infants are prone to respiratory distress syndrome (RDS), with severe cases requiring mechanical ventilation for support. However, there are no clear guidelines regarding the optimal ventilation strategy. We hypothesized that airway pressure release ventilation (APRV) would mitigate lung injury in a preterm porcine neonatal model.

Methods: Preterm piglets were delivered on gestational day 98 (85% of 115day term), instrumented, and randomized to volume guarantee (VG; n=10) with low tidal volumes (5.5cm³kg^-1) and PEEP 4cmH₂O or APRV (n=10) with initial ventilator settings: P_High 18cmH₂O, P_Low 0cmH₂O, T_High 1.30s, T_Low 0.15s. Ventilator setting changes were made in response to clinical parameters in both groups. Animals were monitored continuously for 24hours.

Results: The mortality rates between the two groups were not significantly different (p>0.05). The VG group had relatively increased oxygen requirements (F_iO₂ 50%±9%) compared with the APRV group (F_iO₂ 28%±5%; p>0.05) and a decrease in PaO₂/FiO₂ ratio (VG 162±33mmHg; APRV 251±45mmHg; p<0.05). The compliance of the VG group (0.51±0.07L·cmH₂O^-1) was significantly less than the APRV group (0.90±0.06L·cmH₂O^-1; p<0.05).

Conclusion: This study demonstrates that APRV improves oxygenation and compliance as compared with VG. This preliminary work suggests further study into the clinical uses of APRV in the neonate is warranted.

Level of evidence: Not Applicable (Basic Science Animal Study).

Keywords: Airway pressure release ventilation; Respiratory distress syndrome; Ventilator-induced injury.

MeSH terms

Animals
Animals, Newborn
Continuous Positive Airway Pressure / adverse effects*
Disease Models, Animal
Female
Humans
Infant, Newborn
Lung Injury / etiology
Lung Injury / prevention & control*
Random Allocation
Respiratory Distress Syndrome, Newborn / therapy*
Swine
Tidal Volume