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Continuous external negative pressure improves oxygenation and respiratory mechanics in Experimental Lung Injury in Pigs – A pilot proof-of-concept trial
BACKGROUND: Continuous external negative pressure (CENP) during positive pressure ventilation can recruit dependent lung regions. We hypothesised that CENP applied regionally to the thorax or the abdomen only, increases the caudal end-expiratory transpulmonary pressure depending on positive end-expi...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746426/ https://www.ncbi.nlm.nih.gov/pubmed/33336263 http://dx.doi.org/10.1186/s40635-020-00315-1 |
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author | Scharffenberg, Martin Wittenstein, Jakob Herzog, Moritz Tauer, Sebastian Vivona, Luigi Theilen, Raphael Bluth, Thomas Kiss, Thomas Koch, Thea Fiorentino, Giuseppe de Abreu, Marcelo Gama Huhle, Robert |
author_facet | Scharffenberg, Martin Wittenstein, Jakob Herzog, Moritz Tauer, Sebastian Vivona, Luigi Theilen, Raphael Bluth, Thomas Kiss, Thomas Koch, Thea Fiorentino, Giuseppe de Abreu, Marcelo Gama Huhle, Robert |
author_sort | Scharffenberg, Martin |
collection | PubMed |
description | BACKGROUND: Continuous external negative pressure (CENP) during positive pressure ventilation can recruit dependent lung regions. We hypothesised that CENP applied regionally to the thorax or the abdomen only, increases the caudal end-expiratory transpulmonary pressure depending on positive end-expiratory pressure (PEEP) in lung-injured pigs. Eight pigs were anesthetised and mechanically ventilated in the supine position. Pressure sensors were placed in the left pleural space, and a lung injury was induced by saline lung lavages. A CENP shell was placed at the abdomen and thorax (randomised order), and animals were ventilated with PEEP 15, 7 and zero cmH(2)O (15 min each). On each PEEP level, CENP of − 40, − 30, − 20, − 10 and 0 cmH(2)O was applied (3 min each). Respiratory and haemodynamic variables were recorded. Electrical impedance tomography allowed assessment of centre of ventilation. RESULTS: Compared to positive pressure ventilation alone, the caudal transpulmonary pressure was significantly increased by CENP of ≤ 20 cmH(2)O at all PEEP levels. CENP of – 20 cmH(2)O reduced the mean airway pressure at zero PEEP (P = 0.025). The driving pressure decreased at CENP of ≤ 10 at PEEP of 0 and 7 cmH(2)O (P < 0.001 each) but increased at CENP of – 30 cmH(2)O during the highest PEEP (P = 0.001). CENP of – 30 cmH(2)O reduced the mechanical power during zero PEEP (P < 0.001). Both elastance (P < 0.001) and resistance (P < 0.001) were decreased at CENP ≤ 30 at PEEP of 0 and 7 cmH(2)O. Oxygenation increased at CENP of ≤ 20 at PEEP of 0 and 7 cmH(2)O (P < 0.001 each). Applying external negative pressure significantly shifted the centre of aeration towards dorsal lung regions irrespectively of the PEEP level. Cardiac output decreased significantly at CENP -20 cmH(2)O at all PEEP levels (P < 0.001). Effects on caudal transpulmonary pressure, elastance and cardiac output were more pronounced when CENP was applied to the abdomen compared with the thorax. CONCLUSIONS: In this lung injury model in pigs, CENP increased the end-expiratory caudal transpulmonary pressure. This lead to a shift of lung aeration towards dependent zones as well as improved respiratory mechanics and oxygenation, especially when CENP was applied to the abdomen as compared to the thorax. CENP values ≤ 20 cmH(2)O impaired the haemodynamics. |
format | Online Article Text |
id | pubmed-7746426 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-77464262020-12-18 Continuous external negative pressure improves oxygenation and respiratory mechanics in Experimental Lung Injury in Pigs – A pilot proof-of-concept trial Scharffenberg, Martin Wittenstein, Jakob Herzog, Moritz Tauer, Sebastian Vivona, Luigi Theilen, Raphael Bluth, Thomas Kiss, Thomas Koch, Thea Fiorentino, Giuseppe de Abreu, Marcelo Gama Huhle, Robert Intensive Care Med Exp Research BACKGROUND: Continuous external negative pressure (CENP) during positive pressure ventilation can recruit dependent lung regions. We hypothesised that CENP applied regionally to the thorax or the abdomen only, increases the caudal end-expiratory transpulmonary pressure depending on positive end-expiratory pressure (PEEP) in lung-injured pigs. Eight pigs were anesthetised and mechanically ventilated in the supine position. Pressure sensors were placed in the left pleural space, and a lung injury was induced by saline lung lavages. A CENP shell was placed at the abdomen and thorax (randomised order), and animals were ventilated with PEEP 15, 7 and zero cmH(2)O (15 min each). On each PEEP level, CENP of − 40, − 30, − 20, − 10 and 0 cmH(2)O was applied (3 min each). Respiratory and haemodynamic variables were recorded. Electrical impedance tomography allowed assessment of centre of ventilation. RESULTS: Compared to positive pressure ventilation alone, the caudal transpulmonary pressure was significantly increased by CENP of ≤ 20 cmH(2)O at all PEEP levels. CENP of – 20 cmH(2)O reduced the mean airway pressure at zero PEEP (P = 0.025). The driving pressure decreased at CENP of ≤ 10 at PEEP of 0 and 7 cmH(2)O (P < 0.001 each) but increased at CENP of – 30 cmH(2)O during the highest PEEP (P = 0.001). CENP of – 30 cmH(2)O reduced the mechanical power during zero PEEP (P < 0.001). Both elastance (P < 0.001) and resistance (P < 0.001) were decreased at CENP ≤ 30 at PEEP of 0 and 7 cmH(2)O. Oxygenation increased at CENP of ≤ 20 at PEEP of 0 and 7 cmH(2)O (P < 0.001 each). Applying external negative pressure significantly shifted the centre of aeration towards dorsal lung regions irrespectively of the PEEP level. Cardiac output decreased significantly at CENP -20 cmH(2)O at all PEEP levels (P < 0.001). Effects on caudal transpulmonary pressure, elastance and cardiac output were more pronounced when CENP was applied to the abdomen compared with the thorax. CONCLUSIONS: In this lung injury model in pigs, CENP increased the end-expiratory caudal transpulmonary pressure. This lead to a shift of lung aeration towards dependent zones as well as improved respiratory mechanics and oxygenation, especially when CENP was applied to the abdomen as compared to the thorax. CENP values ≤ 20 cmH(2)O impaired the haemodynamics. Springer International Publishing 2020-12-18 /pmc/articles/PMC7746426/ /pubmed/33336263 http://dx.doi.org/10.1186/s40635-020-00315-1 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Research Scharffenberg, Martin Wittenstein, Jakob Herzog, Moritz Tauer, Sebastian Vivona, Luigi Theilen, Raphael Bluth, Thomas Kiss, Thomas Koch, Thea Fiorentino, Giuseppe de Abreu, Marcelo Gama Huhle, Robert Continuous external negative pressure improves oxygenation and respiratory mechanics in Experimental Lung Injury in Pigs – A pilot proof-of-concept trial |
title | Continuous external negative pressure improves oxygenation and respiratory mechanics in Experimental Lung Injury in Pigs – A pilot proof-of-concept trial |
title_full | Continuous external negative pressure improves oxygenation and respiratory mechanics in Experimental Lung Injury in Pigs – A pilot proof-of-concept trial |
title_fullStr | Continuous external negative pressure improves oxygenation and respiratory mechanics in Experimental Lung Injury in Pigs – A pilot proof-of-concept trial |
title_full_unstemmed | Continuous external negative pressure improves oxygenation and respiratory mechanics in Experimental Lung Injury in Pigs – A pilot proof-of-concept trial |
title_short | Continuous external negative pressure improves oxygenation and respiratory mechanics in Experimental Lung Injury in Pigs – A pilot proof-of-concept trial |
title_sort | continuous external negative pressure improves oxygenation and respiratory mechanics in experimental lung injury in pigs – a pilot proof-of-concept trial |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746426/ https://www.ncbi.nlm.nih.gov/pubmed/33336263 http://dx.doi.org/10.1186/s40635-020-00315-1 |
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