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Expiratory high-frequency percussive ventilation: a novel concept for improving gas exchange
Background: Although high-frequency percussive ventilation (HFPV) improves gas exchange, concerns remain about tissue overdistension caused by the oscillations and consequent lung damage. We compared a modified percussive ventilation modality created by superimposing high-frequency oscillations to the conventional ventilation waveform during expiration only (eHFPV) with conventional mechanical ventilation (CMV) and standard HFPV. Methods: Hypoxia and hypercapnia were induced by decreasing the frequency of CMV in New Zealand White rabbits (n = 10). Following steady-state CMV periods, percussive modalities with oscillations randomly introduced to the entire breathing cycle (HFPV) or to the expiratory phase alone (eHFPV) with varying amplitudes (2 or 4 cmH 2 O) and frequencies were used (5 or 10 Hz). The arterial partial pressures of oxygen (PaO 2 ) and carbon dioxide (PaCO 2 ) were determined. Volumetric capnography was used to evaluate the ventilation dead space fraction, phase 2 slope, and minute elimination of CO 2 . Respiratory mechanics were characterized by forced oscillations. Results: The use of eHFPV with 5 Hz superimposed oscillation frequency and an amplitude of 4 cmH 2 O enhanced gas exchange similar to those observed after HFPV. These improvements in PaO 2 (47.3 ± 5.5 vs. 58.6 ± 7.2 mmHg) and PaCO 2 (54.7 ± 2.3 vs. 50.1 ± 2.9 mmHg) were associated with lower ventilation dead space and capnogram phase 2 slope, as well as enhanced minute CO 2 elimination without altering respiratory mechanics. Conclusions: These findings demonstrated improved gas exchange using eHFPV as a novel mechanical ventilation modality that combines the benefits of conventional and small-amplitude high-frequency oscillatory ventilation, owing to improved longitudinal gas transport rather than increased lung surface area available for gas exchange.
Expiratory high-frequency percussive ventilation: a novel concept for improving gas exchange
Background: Although high-frequency percussive ventilation (HFPV) improves gas exchange, concerns remain about tissue overdistension caused by the oscillations and consequent lung damage. We compared a modified percussive ventilation modality created by superimposing high-frequency oscillations to the conventional ventilation waveform during expiration only (eHFPV) with conventional mechanical ventilation (CMV) and standard HFPV. Methods: Hypoxia and hypercapnia were induced by decreasing the frequency of CMV in New Zealand White rabbits (n = 10). Following steady-state CMV periods, percussive modalities with oscillations randomly introduced to the entire breathing cycle (HFPV) or to the expiratory phase alone (eHFPV) with varying amplitudes (2 or 4 cmH 2 O) and frequencies were used (5 or 10 Hz). The arterial partial pressures of oxygen (PaO 2 ) and carbon dioxide (PaCO 2 ) were determined. Volumetric capnography was used to evaluate the ventilation dead space fraction, phase 2 slope, and minute elimination of CO 2 . Respiratory mechanics were characterized by forced oscillations. Results: The use of eHFPV with 5 Hz superimposed oscillation frequency and an amplitude of 4 cmH 2 O enhanced gas exchange similar to those observed after HFPV. These improvements in PaO 2 (47.3 ± 5.5 vs. 58.6 ± 7.2 mmHg) and PaCO 2 (54.7 ± 2.3 vs. 50.1 ± 2.9 mmHg) were associated with lower ventilation dead space and capnogram phase 2 slope, as well as enhanced minute CO 2 elimination without altering respiratory mechanics. Conclusions: These findings demonstrated improved gas exchange using eHFPV as a novel mechanical ventilation modality that combines the benefits of conventional and small-amplitude high-frequency oscillatory ventilation, owing to improved longitudinal gas transport rather than increased lung surface area available for gas exchange.
Expiratory high-frequency percussive ventilation: a novel concept for improving gas exchange
Petak, Ferenc (author) / Fodor, Gergely H. (author) / Schranc, Almos (author) / Sudy, Roberta (author) / Balogh, Adam Laszlo (author) / Babik, Barna (author) / Dos Santos Rocha, André Alexandre (author) / Bayat, Sam (author) / Bizzotto, Davide (author) / Dellacà, Raffaele L. (author)
2022-01-01
unige:168816
ISSN: 1465-9921 ; Respiratory research, vol. 23, no. 1 (2022) 283
Article (Journal)
Electronic Resource
English
DDC:
690
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