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Atelectasis, Shunt, and Worsening Oxygenation Following Reduction of Respiratory Rate in Healthy Pigs Undergoing ECMO: An Experimental Lung Imaging Study

Rationale: Reducing the respiratory rate during extracorporeal membrane oxygenation (ECMO) decreases the mechanical power, but it might induce alveolar de-recruitment. Dissecting de-recruitment due to lung edema vs. the fraction due to hypoventilation may be challenging in injured lungs. Objectives:...

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Autores principales: Spinelli, Elena, Colussi, Giulia, Dal Santo, Gaia, Scotti, Eleonora, Marongiu, Ines, Garbelli, Erica, Mazzucco, Alessandra, Dondossola, Daniele, Maia, Raquel, Battistin, Michele, Biancolilli, Osvaldo, Rosso, Lorenzo, Gatti, Stefano, Mauri, Tommaso
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063114/
https://www.ncbi.nlm.nih.gov/pubmed/33897471
http://dx.doi.org/10.3389/fphys.2021.663313
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author Spinelli, Elena
Colussi, Giulia
Dal Santo, Gaia
Scotti, Eleonora
Marongiu, Ines
Garbelli, Erica
Mazzucco, Alessandra
Dondossola, Daniele
Maia, Raquel
Battistin, Michele
Biancolilli, Osvaldo
Rosso, Lorenzo
Gatti, Stefano
Mauri, Tommaso
author_facet Spinelli, Elena
Colussi, Giulia
Dal Santo, Gaia
Scotti, Eleonora
Marongiu, Ines
Garbelli, Erica
Mazzucco, Alessandra
Dondossola, Daniele
Maia, Raquel
Battistin, Michele
Biancolilli, Osvaldo
Rosso, Lorenzo
Gatti, Stefano
Mauri, Tommaso
author_sort Spinelli, Elena
collection PubMed
description Rationale: Reducing the respiratory rate during extracorporeal membrane oxygenation (ECMO) decreases the mechanical power, but it might induce alveolar de-recruitment. Dissecting de-recruitment due to lung edema vs. the fraction due to hypoventilation may be challenging in injured lungs. Objectives: We characterized changes in lung physiology (primary endpoint: development of atelectasis) associated with progressive reduction of the respiratory rate in healthy animals on ECMO. Methods: Six female pigs underwent general anesthesia and volume control ventilation (Baseline: PEEP 5 cmH(2)O, Vt 10 ml/kg, I:E = 1:2, FiO(2) 0.5, rate 24 bpm). Veno-venous ECMO was started and respiratory rate was progressively reduced to 18, 12, and 6 breaths per minute (6-h steps), while all other settings remained unchanged. ECMO blood flow was kept constant while gas flow was increased to maintain stable PaCO(2). Measurements and Main Results: At Baseline (without ECMO) and toward the end of each step, data from quantitative CT scan, electrical impedance tomography, and gas exchange were collected. Increasing ECMO gas flow while lowering the respiratory rate was associated with an increase in the fraction of non-aerated tissue (i.e., atelectasis) and with a decrease of tidal ventilation reaching the gravitationally dependent lung regions (p = 0.009 and p = 0.018). Intrapulmonary shunt increased (p < 0.001) and arterial PaO(2) decreased (p < 0.001) at lower rates. The fraction of non-aerated lung was correlated with longer expiratory time spent at zero flow (r = 0.555, p = 0.011). Conclusions: Progressive decrease of respiratory rate coupled with increasing CO(2) removal in mechanically ventilated healthy pigs is associated with development of lung atelectasis, higher shunt, and poorer oxygenation.
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spelling pubmed-80631142021-04-24 Atelectasis, Shunt, and Worsening Oxygenation Following Reduction of Respiratory Rate in Healthy Pigs Undergoing ECMO: An Experimental Lung Imaging Study Spinelli, Elena Colussi, Giulia Dal Santo, Gaia Scotti, Eleonora Marongiu, Ines Garbelli, Erica Mazzucco, Alessandra Dondossola, Daniele Maia, Raquel Battistin, Michele Biancolilli, Osvaldo Rosso, Lorenzo Gatti, Stefano Mauri, Tommaso Front Physiol Physiology Rationale: Reducing the respiratory rate during extracorporeal membrane oxygenation (ECMO) decreases the mechanical power, but it might induce alveolar de-recruitment. Dissecting de-recruitment due to lung edema vs. the fraction due to hypoventilation may be challenging in injured lungs. Objectives: We characterized changes in lung physiology (primary endpoint: development of atelectasis) associated with progressive reduction of the respiratory rate in healthy animals on ECMO. Methods: Six female pigs underwent general anesthesia and volume control ventilation (Baseline: PEEP 5 cmH(2)O, Vt 10 ml/kg, I:E = 1:2, FiO(2) 0.5, rate 24 bpm). Veno-venous ECMO was started and respiratory rate was progressively reduced to 18, 12, and 6 breaths per minute (6-h steps), while all other settings remained unchanged. ECMO blood flow was kept constant while gas flow was increased to maintain stable PaCO(2). Measurements and Main Results: At Baseline (without ECMO) and toward the end of each step, data from quantitative CT scan, electrical impedance tomography, and gas exchange were collected. Increasing ECMO gas flow while lowering the respiratory rate was associated with an increase in the fraction of non-aerated tissue (i.e., atelectasis) and with a decrease of tidal ventilation reaching the gravitationally dependent lung regions (p = 0.009 and p = 0.018). Intrapulmonary shunt increased (p < 0.001) and arterial PaO(2) decreased (p < 0.001) at lower rates. The fraction of non-aerated lung was correlated with longer expiratory time spent at zero flow (r = 0.555, p = 0.011). Conclusions: Progressive decrease of respiratory rate coupled with increasing CO(2) removal in mechanically ventilated healthy pigs is associated with development of lung atelectasis, higher shunt, and poorer oxygenation. Frontiers Media S.A. 2021-04-09 /pmc/articles/PMC8063114/ /pubmed/33897471 http://dx.doi.org/10.3389/fphys.2021.663313 Text en Copyright © 2021 Spinelli, Colussi, Dal Santo, Scotti, Marongiu, Garbelli, Mazzucco, Dondossola, Maia, Battistin, Biancolilli, Rosso, Gatti and Mauri. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Physiology
Spinelli, Elena
Colussi, Giulia
Dal Santo, Gaia
Scotti, Eleonora
Marongiu, Ines
Garbelli, Erica
Mazzucco, Alessandra
Dondossola, Daniele
Maia, Raquel
Battistin, Michele
Biancolilli, Osvaldo
Rosso, Lorenzo
Gatti, Stefano
Mauri, Tommaso
Atelectasis, Shunt, and Worsening Oxygenation Following Reduction of Respiratory Rate in Healthy Pigs Undergoing ECMO: An Experimental Lung Imaging Study
title Atelectasis, Shunt, and Worsening Oxygenation Following Reduction of Respiratory Rate in Healthy Pigs Undergoing ECMO: An Experimental Lung Imaging Study
title_full Atelectasis, Shunt, and Worsening Oxygenation Following Reduction of Respiratory Rate in Healthy Pigs Undergoing ECMO: An Experimental Lung Imaging Study
title_fullStr Atelectasis, Shunt, and Worsening Oxygenation Following Reduction of Respiratory Rate in Healthy Pigs Undergoing ECMO: An Experimental Lung Imaging Study
title_full_unstemmed Atelectasis, Shunt, and Worsening Oxygenation Following Reduction of Respiratory Rate in Healthy Pigs Undergoing ECMO: An Experimental Lung Imaging Study
title_short Atelectasis, Shunt, and Worsening Oxygenation Following Reduction of Respiratory Rate in Healthy Pigs Undergoing ECMO: An Experimental Lung Imaging Study
title_sort atelectasis, shunt, and worsening oxygenation following reduction of respiratory rate in healthy pigs undergoing ecmo: an experimental lung imaging study
topic Physiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063114/
https://www.ncbi.nlm.nih.gov/pubmed/33897471
http://dx.doi.org/10.3389/fphys.2021.663313
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