SUSTAINED INFLATIONS IMPROVE RESPIRATORY COMPLIANCE DURING HIGH-FREQUENCY OSCILLATORY VENTILATION BUT NOT DURING LARGE TIDAL VOLUME POSITIVE-PRESSURE VENTILATION IN RABBITS
Dm. Bond et al., SUSTAINED INFLATIONS IMPROVE RESPIRATORY COMPLIANCE DURING HIGH-FREQUENCY OSCILLATORY VENTILATION BUT NOT DURING LARGE TIDAL VOLUME POSITIVE-PRESSURE VENTILATION IN RABBITS, Critical care medicine, 22(8), 1994, pp. 1269-1277
Objective: To determine whether volume recruitment maneuvers that indu
ce significant lung reexpansion during high-frequency oscillatory vent
ilation are also of value during conventional positive-pressure ventil
ation. Design: Crossover comparison of volume recruitment maneuvers ad
ministered during high-frequency oscillatory ventilation and positive-
pressure ventilation in normal and surfactant-deficient adult rabbits.
Setting: Laboratory. Subjects: Nineteen adult New Zealand white rabbi
ts (weight 2.3 to 3.3 kg). Methods: Respiratory system compliance was
measured plethysmographically before and after sustained inflations in
six normal and five saline-lavaged anesthetized rabbits, using both v
entilators over a range of mean and end-expiratory pressures. Results:
Under conditions where sustained inflations during high-frequency osc
illatory ventilation at 15 Hz increased respiratory system compliance
50 +/- 28%, sustained inflations during conventional positive-pressure
ventilation at a rate of 30 to 40 breaths/min and tidal volumes of 14
to 17 mL/kg did not change respiratory system compliance (mean change
3 +/- 9%). Sustained inflations during conventional positive-pressure
ventilation could not be made effective by increasing the positive en
d-expiratory pressure level to equal the mean pressure during high-fre
quency oscillatory ventilation. Sustained inflations on conventional p
ositive-pressure ventilation remained ineffective up to positive end-e
xpiratory pressure levels of 17.5 cm H2O. In lavaged rabbits, sustaine
d inflations increased respiratory system compliance 49 +/- 14% during
high-frequency oscillatory ventilation and 0 +/- 3% during convention
al positive-pressure ventilation. Sustained inflations increased compl
iance significantly during conventional positive-pressure ventilation
only when ventilating with tidal volumes of 7 mL/kg and low end-expira
tory pressure. Conclusions: Active recruitment of lung volume during h
igh-frequency oscillatory ventilation appears necessary, because small
pressure/volume cycles adequate to support high-frequency gas transpo
rt are not able to reexpand atelectatic lung units without the aid of
a sustained inflation. We conclude that volume recruitment maneuvers i
mprove respiratory system compliance substantially during high-frequen
cy oscillatory ventilation at 15 Hz, but these maneuvers offer potenti
al risk and no benefit during conventional positive-pressure ventilati
on with large tidal volumes or when using smaller tidal volumes and hi
gh levels of positive end-expiratory pressure.