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Research article
Yingzi Huang
Southeast University Zhongda Hospital
Corresponding Author
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Background: In acute respiratory distress syndrome (ARDS), lung recruitment maneuvers can recruit collapsed alveoli in gravity-dependent lung regions, improving the homogeneity of ventilation distribution. This study used electrical impedance tomography (EIT) to investigate the physiological effects of different recruitment maneuvers for alveolar recruitment in a pig model of ARDS.
Methods: ARDS was induced in ten healthy male pigs with repeated bronchoalveolar lavage until the arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) (P/F ratio) was < 100 mmHg and remained stable for 30 minutes (TARDS). ARDS pigs underwent three sequential recruitment maneuvers, including sustained inflation (SI), increments of positive end-expiratory pressure (PEEP) (IP), and pressure-controlled ventilation (PCV) applied in random order, with 30 mins at a PEEP of 5 cmH2O between maneuvers. Respiratory mechanics, hemodynamics, arterial blood gas, and EIT were recorded at baseline, TARDS, and before and after each recruitment maneuver.
Results: In all ten pigs, ARDS was successfully induced with a mean 2.8±1.03L (2800±1032.80ml) bronchoalveolar lavages. PaO2, SO2, P/F, and compliance were significantly improved after recruitment with SI, IP or PCV (all p<0.05), and there were no significant differences between maneuvers. Global inhomogeneity (GI) was significantly decreased after recruitment with SI, IP, or PCV. There were no significant differences in GI before or after recruitment with the different maneuvers. The decrease in GI (ΔGI) was significantly greater after recruitment with IP compared to SI (p=0.023), but there was no significant difference in ΔGI between IP and PCV.
Conclusion: SI, IP, and PCV increased oxygenation, and regional and global compliance of the respiratory system, and decreased inhomogeneous gas distribution in ARDS pigs. IP significantly improved inhomogeneity of the lung compared to SI.
Keywords
electrical impedance tomography, global inhomogeneity, acute respiratory distress syndrome.
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CURRENT STATUS: Published
View the published article at BMC Anesthesiology.
Version 3
Posted 02 Jun, 2020
No community comments so far
Editor assigned
On 26 May, 2020
Submission checks complete
On 25 May, 2020
Editor invited
On 25 May, 2020
No comments provided
Editorial decision: Major revision
On 07 May, 2020
Review #2 received
Received 22 Apr, 2020
Review #1 received
Received 22 Apr, 2020
Reviewer #2 agreed
On 16 Apr, 2020
Reviewers invited
Invitations sent on 16 Apr, 2020
Reviewer #1 agreed
On 16 Apr, 2020
Editor assigned
On 08 Apr, 2020
Submission checks complete
On 07 Apr, 2020
Editor invited
On 07 Apr, 2020
No comments provided
Editorial decision: Major revision
On 11 Feb, 2020
Review #1 received
Received 29 Jan, 2020
Review #2 received
Received 29 Jan, 2020
Reviewer #2 agreed
On 21 Jan, 2020
Reviewer #1 agreed
On 19 Jan, 2020
Reviewers invited
Invitations sent on 17 Jan, 2020
Editor assigned
On 10 Jan, 2020
Submission checks complete
On 09 Jan, 2020
Editor invited
On 09 Jan, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
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See the published version of this preprint at BMC Anesthesiology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Yingzi Huang
Southeast University Zhongda Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Anesthesiology.
Version 3
Posted 02 Jun, 2020
No community comments so far
Editor assigned
On 26 May, 2020
Submission checks complete
On 25 May, 2020
Editor invited
On 25 May, 2020
No comments provided
Editorial decision: Major revision
On 07 May, 2020
Review #2 received
Received 22 Apr, 2020
Review #1 received
Received 22 Apr, 2020
Reviewer #2 agreed
On 16 Apr, 2020
Reviewers invited
Invitations sent on 16 Apr, 2020
Reviewer #1 agreed
On 16 Apr, 2020
Editor assigned
On 08 Apr, 2020
Submission checks complete
On 07 Apr, 2020
Editor invited
On 07 Apr, 2020
No comments provided
Editorial decision: Major revision
On 11 Feb, 2020
Review #1 received
Received 29 Jan, 2020
Review #2 received
Received 29 Jan, 2020
Reviewer #2 agreed
On 21 Jan, 2020
Reviewer #1 agreed
On 19 Jan, 2020
Reviewers invited
Invitations sent on 17 Jan, 2020
Editor assigned
On 10 Jan, 2020
Submission checks complete
On 09 Jan, 2020
Editor invited
On 09 Jan, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Anesthesiology.
Background: In acute respiratory distress syndrome (ARDS), lung recruitment maneuvers can recruit collapsed alveoli in gravity-dependent lung regions, improving the homogeneity of ventilation distribution. This study used electrical impedance tomography (EIT) to investigate the physiological effects of different recruitment maneuvers for alveolar recruitment in a pig model of ARDS.
Methods: ARDS was induced in ten healthy male pigs with repeated bronchoalveolar lavage until the arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) (P/F ratio) was < 100 mmHg and remained stable for 30 minutes (TARDS). ARDS pigs underwent three sequential recruitment maneuvers, including sustained inflation (SI), increments of positive end-expiratory pressure (PEEP) (IP), and pressure-controlled ventilation (PCV) applied in random order, with 30 mins at a PEEP of 5 cmH2O between maneuvers. Respiratory mechanics, hemodynamics, arterial blood gas, and EIT were recorded at baseline, TARDS, and before and after each recruitment maneuver.
Results: In all ten pigs, ARDS was successfully induced with a mean 2.8±1.03L (2800±1032.80ml) bronchoalveolar lavages. PaO2, SO2, P/F, and compliance were significantly improved after recruitment with SI, IP or PCV (all p<0.05), and there were no significant differences between maneuvers. Global inhomogeneity (GI) was significantly decreased after recruitment with SI, IP, or PCV. There were no significant differences in GI before or after recruitment with the different maneuvers. The decrease in GI (ΔGI) was significantly greater after recruitment with IP compared to SI (p=0.023), but there was no significant difference in ΔGI between IP and PCV.
Conclusion: SI, IP, and PCV increased oxygenation, and regional and global compliance of the respiratory system, and decreased inhomogeneous gas distribution in ARDS pigs. IP significantly improved inhomogeneity of the lung compared to SI.
Figure 1
Figure 2
Figure 3
Figure 4
This is a list of supplementary files associated with this preprint. Click to download.
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