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Pediatr Res. 2014 Apr;75(4):493-9. doi: 10.1038/pr.2013.251. Epub 2013 Dec 27.

Optimal mean airway pressure during high-frequency oscillatory ventilation determined by measurement of respiratory system reactance.

Author information

  • 1Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano University, Milano, Italy.
  • 2Neonatology and Neonatal Intensive Care Unit, Fondazione MBBM - Ospedale San Gerardo, Monza, Italy.
  • 31] Neonatal Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia [2] Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia.
  • 4Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia.
  • 5Neonatal Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
  • 61] Neonatal Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia [2] Department of Paediatrics, Royal Hobart Hospital and University of Tasmania, Hobart, Tasmania, Australia [3] Neonatal Respiratory Group, Menzies Research Institute, Hobart, Tasmania, Australia.
  • 71] Neonatal Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia [2] Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia [3] Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.

Abstract

BACKGROUND:

The aims of the present study were (i) to characterize the relationship between mean airway pressure (PAW) and reactance measured at 5 Hz (reactance of the respiratory system (X RS), forced oscillation technique) and (ii) to compare optimal PAW (P opt) defined by X RS, oxygenation, lung volume (VL), and tidal volume (VT) in preterm lambs receiving high-frequency oscillatory ventilation (HFOV).

METHODS:

Nine 132-d gestation lambs were commenced on HFOV at PAW of 14 cmH2O (P start). PAW was increased stepwise to a maximum pressure (P max) and subsequently sequentially decreased to the closing pressure (Pcl, oxygenation deteriorated) or a minimum of 6 cmH2O, using an oxygenation-based recruitment maneuver. X RS, regional V L (electrical impedance tomography), and V T were measured immediately after (t 0 min) and 2 min after (t 2 min) each PAW decrement. P opt defined by oxygenation, X RS, V L, and V T were determined.

RESULTS:

The PAW-X RS and PAW-VT relationships were dome shaped with a maximum at Pcl+6 cmH2O, the same point as P opt defined by VL. Below Pcl+6 cmH2O, X RS became unstable between t 0 min and t 2 min and was associated with derecruitment in the dependent lung. P opt, as defined by oxygenation, was lower than the P opt defined by X RS, V L, or V T.

CONCLUSION:

X RS has the potential as a bedside tool for optimizing PAW during HFOV.

PMID:
24375086
[PubMed - indexed for MEDLINE]
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