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Physiologically variable ventilation reduces regional lung inflammation in a pediatric model of acute respiratory

Andre Dos Santos Rocha1, Gergely H Fodor2,3, Miklos Kassai2

  • 1Unit for Anaesthesiological Investigations, Department of Acute Medicine, University Hospitals of Geneva and University of Geneva, rue Willy Donzé 6, 1205, Geneva, Switzerland. Andre.DosSantosRocha@unige.ch.

Respiratory Research
|November 1, 2020
PubMed

Insights

Physiological variable ventilation (PVV) reduced lung inflammation in juvenile rabbits compared to conventional pressure-controlled ventilation (PCV). This study highlights PVV's potential benefits for pediatric respiratory support.

Area of Science:

  • Pediatric critical care medicine
  • Respiratory physiology
  • Inflammation research

Background:

  • Variable mechanical ventilation (VMV) offers benefits for lung health, but its effects in pediatric models and on regional inflammation are not well-established.
  • Previous studies suggest VMV may improve outcomes, yet its impact on regional lung inflammation requires further investigation, particularly in young patients.

Purpose of the Study:

  • To compare the effects of physiological variable ventilation (PVV) versus conventional pressure-controlled ventilation (PCV) on regional lung inflammation.
  • To evaluate structural, molecular, and functional outcomes related to inflammation in a pediatric model of healthy lungs and acute respiratory distress syndrome (ARDS).

Main Methods:

  • Utilized 36 New-Zealand White rabbit pups with healthy lungs or induced ARDS, randomized to 5 hours of PCV or PVV.
  • Assessed regional lung aeration, inflammation (using [18F]fluorodeoxyglucose uptake), and perfusion via CT, PET, and SPECT scans.
  • Monitored ventilation parameters, blood gases, and respiratory tissue elastance hourly.

Main Results:

  • PVV improved respiratory elastance in both healthy and ARDS rabbit pups compared to PCV.
  • PVV significantly reduced lung inflammation, indicated by lower normalized [18F]fluorodeoxyglucose uptake, especially in well and poorly aerated zones.
  • No significant benefits of PVV were observed for regional blood perfusion or blood gas parameters.

Conclusions:

  • Physiological variable ventilation (PVV) effectively reduces both global and regional lung inflammation in juvenile rabbits.
  • PVV demonstrates a potential advantage over conventional pressure-controlled ventilation (PCV) in managing lung inflammation in pediatric patients.
  • These findings support further research into PVV for pediatric respiratory support, particularly in ARDS cases.
Abstract

Keywords:
ARDSMechanical ventilationPositron emission tomographyRegional ventilationVariable ventilation

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