Differential effect of recruitment maneuvres on pulmonary blood flow and oxygenation during HFOV in preterm lambs
Differential effect of recruitment maneuvres on pulmonary blood flow and oxygenation during HFOV in preterm lambs
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DOI：
10.1152/japplphysiol.00041.2008
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发表时间：
2008-08-01
影响因子：
3.3
通讯作者：
Hooper, Stuart B.
中科院分区：
文献类型：
--
作者：
Polglase, Graeme R.;Moss, Timothy J. M.;Hooper, Stuart B.
首先，高频振荡通气（HFOV）时肺容量复张对早产儿肺血流（PBF）的影响尚不清楚。由于气道压力增加会对PBF产生不利影响，因此我们比较了两种HFOV募集策略对PBF和氧合指数（OI）的影响。对早产羔羊（妊娠128 +/- 1天;足月与150天相似）进行麻醉，并使用HFOV（10 Hz，33% t（I））进行通气，平均气道压（Pao）为15 cmH（2）O。通过将Pao增加至25 cmH（2）O持续1 min，以5 min的间隔重复5次，增加至30 cmH（2）O，然后减少至15 cmH（2）O（Ramp组; n = 6）来恢复肺容量。对照组（n = 5）接受15 cmH 2 O的恒定HFOV。在HFOV期间，对照组中PBF逐渐降低（45 +/- 4%），OI增加（15 +/-6%，表明氧合减少），这与在Sigh组羔羊中观察到的变化相似。在Ramp组中，PBF随着气道压力增加而下降（54 ± 10%）（r（2）= 0.99），尽管PBF没有再次增加，因为Pao随后降低。OI降低（47 +/- 9%），反映了Ramp组在HFOV期间高Pao水平下氧合改善。然而，高Pao恢复了6只羔羊中4只的逆行PBF，表明通过动脉导管的右向左分流恢复。因此，血容量复张率的选择会影响HFOV期间OI和PBF的变化幅度。尽管显著改善了OI，但斜坡招募方法导致PBF持续变化。
First The effects of lung volume recruitment manouvres on pulmonary blood flow (PBF) during high-frequency oscillatory ventilation (HFOV) in preterm neonates are unknown. Since increased airway pressure adversely affects PBF, we compared the effects of two HFOV recruitment strategies on PBF and oxygenation index (OI). Preterm lambs (128 +/- 1 day gestation; term similar to 150 days) were anesthetized and ventilated using HFOV (10 Hz, 33% t(I)) with a mean airway pressure (Pao) of 15 cmH(2)O. Lung volume was recruited by either increasing Pao to 25 cmH(2)O for 1 min, repeated five times at 5-min intervals incrementing up to 30 cmH(2)O then decrementing back to 15 cmH(2)O ( Ramp group; n = 6). Controls (n = 5) received constant HFOV at 15 cmH2O. PBF progressively decreased (by 45 +/- 4%) and OI increased (by 15 +/- 6%, indicating reduced oxygenation) in controls during HFOV, which was similar to the changes observed in the Sigh group of lambs. In the Ramp group, PBF fell (by 54 +/- 10%) as airway pressure increased (r(2) = 0.99), although the PBF did not increase again as the Pao was subsequently reduced. The OI decreased (by 47 +/- 9%), reflecting improved oxygenation at high Pao levels during HFOV in the Ramp group. However, high Pao restored retrograde PBF during diastole in four of six lambs, indicating the restoration of right-to-left shunting through the ductus arteriosus. Thus the choice of volume recruitment maneuvre influences the magnitude of change in OI and PBF that occurs during HFOV. Despite significantly improving OI, the ramp recruitment approach causes sustained changes in PBF.