Lung recruitment and lung volume maintenance: a strategy for improving oxygenation and preventing lung injury during both conventional mechanical ventilation and high-frequency oscillation

• Published in: Intensive care medicine 2000-06, Vol.26 (6), p.745-755
• Main Authors: RIMENSBERGER, P. C, PACHE, J.-C, MCKERLIE, C, FRNDOVA, H, COX, P. N
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Biological and medical sciences; Critical care; Emergency and intensive respiratory care; High-Frequency Ventilation - adverse effects; High-Frequency Ventilation - methods; Intensive care; Intensive care medicine; Intermittent Positive-Pressure Ventilation - adverse effects; Intermittent Positive-Pressure Ventilation - methods; Lavage; Lung - pathology; Medical sciences; Peroxidase - metabolism; Pulmonary Gas Exchange; Rabbits; Random Allocation; Respiratory Distress Syndrome, Adult - physiopathology; Respiratory Distress Syndrome, Adult - prevention & control; Respiratory Mechanics; Tidal Volume; Ventilators
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s001340051242

To determine whether using a small tidal volume (5 ml/kg) ventilation following sustained inflation with positive endexpiratory pressure (PEEP) set above the critical closing pressure (CCP) allows oxygenation equally well and induces as little lung damage as high-frequency oscillation following sustained inflation with a continuous distending pressure (CDP) slightly above the CCP of the lung. Twelve surfactant-depleted adult New Zealand rabbits were ventilated for 4 h after being randomly assigned to one of two groups: group 1, conventional mechanical ventilation, tidal volume 5 ml/kg, sustained inflation followed by PEEP > CCP; group 2, high-frequency oscillation, sustained inflation followed by CDP > CCP. In both groups oxygenation improved substantially after sustained inflation (P < 0.05) and remained stable over 4 h of ventilation without any differences between the groups. Histologically, both groups showed only little airway injury to bronchioles, alveolar ducts, and alveolar airspace, with no difference between the two groups. Myeloperoxidase content in homogenized lung tissue, as a marker of leukocyte infiltration, was equivalent in the two groups. We conclude that a volume recruitment strategy during small tidal volume ventilation and maintaining lung volumes above lung closing is as protective as that of high-frequency oscillation at similar lung volumes in this model of lung injury