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Titolo:
Oxygenation and lung morphology in a rabbit pediatric ARDS- model under high peak pressure ventilation plus nitric oxide and surfactant compared withveno-venous ECMO
Autore:
Moller, JC; Reiss, I; Schaible, TF; Kohl, M; Gopel, W; Fischer, T; Nitsche, EM; Kruger, S;
Indirizzi:
Univ Lubeck, PICU, Inst Pathol, Dept Pediat, D-23538 Lubeck, Germany Univ Lubeck Lubeck Germany D-23538 Dept Pediat, D-23538 Lubeck, Germany Univ Lubeck, Dept Anaesthesiol, Inst Pathol, D-23538 Lubeck, Germany Univ Lubeck Lubeck Germany D-23538 Inst Pathol, D-23538 Lubeck, Germany
Titolo Testata:
INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS
fascicolo: 11, volume: 22, anno: 1999,
pagine: 747 - 753
SICI:
0391-3988(199911)22:11<747:OALMIA>2.0.ZU;2-Q
Fonte:
ISI
Lingua:
ENG
Soggetto:
RESPIRATORY-DISTRESS-SYNDROME; END-EXPIRATORY PRESSURE; MECHANICAL VENTILATION; EXOGENOUS SURFACTANT; CHILDREN; IMPAIRMENT; MORTALITY; FAILURE; VOLUME; INJURY;
Keywords:
permissive hypercapnia; surfactant; nitric oxide; baro/ergotrauma;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
31
Recensione:
Indirizzi per estratti:
Indirizzo: Moller, JC Univ Lubeck, PICU, Inst Pathol, Dept Pediat, Ratzeburger Allee 160, D-23538 Lubeck, Germany Univ Lubeck Ratzeburger Allee 160 Lubeck Germany D-23538 rmany
Citazione:
J.C. Moller et al., "Oxygenation and lung morphology in a rabbit pediatric ARDS- model under high peak pressure ventilation plus nitric oxide and surfactant compared withveno-venous ECMO", INT J ARTIF, 22(11), 1999, pp. 747-753

Abstract

The aim of the study is to investigate which of two treatment options of saline lavage induced ARDS in rabbits is better in terms of oxygenation and prevention of barotrauma: combined high peak pressure ventilation with surfactant administration and inhaled nitric oxide or veno-venous ECMO combinedwith low peak inspiratory pressure ventilation. Materials and Methods: After saline lavage (10 cc/kg repeated as long as foamy retrieval was observed) two combined therapeutic strategies were examined: ventilation with high inspiratory pressures (35 cm H2O) with additional exogenous surfactant administration (100 mg/kg) and inhaled nitric oxide (10 PPM) (n=5, group 1) and low inspiratory pressure (20 cm H2O) ventilation under veno-venous ECMO support (n=5, group 2). The FiO(2) was maintained at 1.0 in both groups. The paO(2)/FiO(2) ratio was calculated in 30 minute intervals for 4 hours. After that the animals were sacrificed and the lungsexamined macro- and microscopically. Aeration was described in a semiquantitative method using the alveolar expansion index. Oxygenation in group I was significantly better than in group 2 if increased significantly after surfactant but not after additional nitric oxide administration. However, thelungs in group I showed severe signs of baro/ergotrauma (Hyaline membranes, air leaks, infiltration of polymorphonuclear (PMN) granulocytes and macrophages, break down of alveolar capillary membranes) after 4 hrs of combinedtherapy whereas the lungs in group 2 appeared normal. Adding surfactant and NO to a high tidal volume ventilation improved oxygenation, but did not prevent baro/ergotrauma. Ventilation with low inspiratory pressures combinedwith ECMO caused little baro/ergotrauma but adequate oxygenation could notbe achieved, probably due to anatomical features of the rabbit which do not allow appropriate blood flow within the ECMO-circuit.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/04/20 alle ore 03:34:46