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Tidal changes in PaO2 and their relationship to cyclical lung recruitment/derecruitment in a porcine lung injury model
Univ Oxford, Nuffield Div Anaesthet, Oxford, England.
Kings Coll London, Ctr Human & Appl Physiol Sci, London, England.
Univ Oxford, Nuffield Div Anaesthet, Oxford, England;Columbia Univ, Vagelos Coll Phys & Surg, New York, NY USA.
Univ Oxford, Nuffield Div Anaesthet, Oxford, England.
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2019 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 122, no 2, p. 277-285Article in journal (Refereed) Published
Abstract [en]

Background: Tidal recruitment/derecruitment (R/D) of collapsed regions in lung injury has been presumed to cause respiratory oscillations in the partial pressure of arterial oxygen (PaO2). These phenomena have not yet been studied simultaneously. We examined the relationship between R/D and PaO2 oscillations by contemporaneous measurement of lung-density changes and PaO2. Methods: Five anaesthetised pigs were studied after surfactant depletion via a saline-lavage model of R/D. The animals were ventilated with a mean fraction of inspired O-2 (FiO(2)) of 0.7 and a tidal volume of 10 ml kg(-1) Protocolised changes in pressure-and volume-controlled modes, inspiratory: expiratory ratio (I:E), and three types of breath-hold manoeuvres were undertaken. Lung collapse and PaO2 were recorded using dynamic computed tomography (dCT) and a rapid PaO2 sensor. Results: During tidal ventilation, the expiratory lung collapse increased when I: E <1 [mean (standard deviation) lung collapse = .7 (8.7)%; P<0.05], but the amplitude of respiratory PaO2 oscillations [ 2.2 (0.8) kPa] did not change during the respiratory cycle. The expected relationship between respiratory PaO2 oscillation amplitude and R/D was therefore not clear. Lung collapse increased during breath-hold manoeuvres at end-expiration and end-inspiration (14% vs 0.9-2.1%; P<0.0001). The mean change in PaO2 from beginning to end of breath-hold manoeuvres was significantly different with each type of breath-hold manoeuvre (P<0.0001). Conclusions: This study in a porcine model of collapse-prone lungs did not demonstrate the expected association between PaO2 oscillation amplitude and the degree of recruitment/derecruitment. The results suggest that changes in pulmonary ventilation are not the sole determinant of changes in PaO2 during mechanical ventilation in lung injury.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD , 2019. Vol. 122, no 2, p. 277-285
Keywords [en]
diagnostic imaging, dynamic computed tomorgraphy, lung injury, pulmonary atelectasis, respiration, ventilation
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-377219DOI: 10.1016/j.bja.2018.09.011ISI: 000456793300025PubMedID: 30686314OAI: oai:DiVA.org:uu-377219DiVA, id: diva2:1289215
Funder
Swedish Research Council, K2015-99X-2273101-4Available from: 2019-02-15 Created: 2019-02-15 Last updated: 2019-02-15Bibliographically approved

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Hedenstierna, GöranLarsson, Anders

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