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Continuous tracheal gas insufflation during protective mechanical ventilation in juvenile piglets with acute lung
Zhong-Liang Guo1, Tao Ren1, Ying-Yun Cai1
1Department of Respiratory Medicine, East Hospital, Tongji University School of Medicine, Shanghai 200120, China (Guo ZL, Ren T, Liang YJ); Pediatric Department, Zhongshan Hospital, Fudan University, Shanghai 200032, China (Cai YY); Pediatric ICU, Pediatrics Hospital, Fudan University, Shanghai 200032, China (Lu GP, Gong JY).
Insights
Continuous tracheal gas insufflation (TGI) improves gas exchange and ventilation in acute lung injury (ALI) models. This method enhances lung function and reduces inflammation during mechanical ventilation (MV).
Area of Science:
- Pulmonary Medicine
- Critical Care Medicine
- Respiratory Physiology
Background:
- Low tidal volume mechanical ventilation (MV) struggles to correct hypoxemia.
- Prolonged high oxygen inhalation risks oxygen toxicity.
- Protective MV strategies are crucial for acute lung injury (ALI).
Purpose of the Study:
- To evaluate the efficacy of continuous tracheal gas insufflation (TGI) during protective MV.
- To assess TGI's impact on cardiopulmonary function in an ALI model.
Main Methods:
- 12 piglets were mechanically ventilated and challenged with lipopolysaccharide.
- Two groups were formed: MV alone and TGI with continuous airway flow.
- Fraction of inspired oxygen (FIO2) was maintained at 0.4 to prevent oxygen toxicity.
Main Results:
- TGI significantly improved tidal volume, ventilation efficacy, and airway pressure.
- Gas exchange improved with TGI, showing better pH, lower PaCO2, and increased PaO2/FIO2.
- Histological analysis revealed reduced lung inflammation and hemorrhage in the TGI group.
Conclusions:
- Continuous TGI during MV significantly enhances gas exchange and ventilation efficacy.
- TGI shows promise as an improved treatment strategy for acute lung injury.
- This technique may mitigate some risks associated with conventional MV in ALI.
Background:
Low tidal volume mechanical ventilation is difficult to correct hypoxemia, and prolonged inhalation of pure oxygen can lead to oxygen poisoning. We suggest that continuous tracheal gas insufflation (TGI) during protective mechanical ventilation could improve cardiopulmonary function in acute lung injury.
Methods:
Totally 12 healthy juvenile piglets were anesthetized and mechanically ventilated at PEEP of 2 cmH2O with a peak inspiratory pressure of 10 cmH2O. The piglets were challenged with lipopolysaccharide and randomly assigned into two groups (n=6 each group): mechanical ventilation (MV) alone and TGI with continuous airway flow 2 l/min. FIO2 was set at 0.4 to avoid oxygen toxicity and continuously monitored with an oxygen analyzer.
Results:
Tidal volume, ventilation efficacy index and mean airway resistant pressure were significantly improved in the TGI group (P<0.01 or P<0.05). At 4 hours post ALI, pH decreased to below 7.20 in the MV group, and improved in the TGI group (P<0.01). Similarly, PaCO2 was stable and was significantly lower in the TGI group than in the MV group (P<0.01). PaO2 and PaO2/FIO2 increased also in the TGI group (P<0.05). There was no significant difference in heart rate, respiratory rate, mean artery pressure, central venous pressure, dynamic lung compliance and mean resistance of airway between the two groups. Lung histological examination showed reduced inflammation, reduced intra-alveolar and interstitial patchy hemorrhage, and homogenously expanded lungs in the TGI group.
Conclusion:
Continuous TGI during MV can significantly improve gas exchange and ventilation efficacy and may provide a better treatment for acute lung injury.
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