Lung volume recruitment in a preterm pig model of lung immaturity

Esmond L. Arrindell, Ramesh Krishnan, Marie Van Der Merwe, Frank Caminita, Scott Howard, Jie Zhang, Randal Buddington

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

A translational preterm pig model analogous to infants born at 28 wk of gestation revealed that continuous positive airway pressure results in limited lung recruitment but does not prevent respiratory distress syndrome, whereas assist-control + volume guarantee (AC+VG) ventilation improves recruitment but can cause injury, highlighting the need for improved ventilation strategies. We determined whether airway pressure release ventilation (APRV) can be used to recruit the immature lungs of preterm pigs without injury. Spontaneously breathing pigs delivered at 89% of term (model for 28-wk infants) were randomized to 24 h of APRV (n = 9) vs. AC+VG with a tidal volume of 5 ml/kg (n = 10). Control pigs (n = 36) were provided with supplemental oxygen by an open mask. Nutrition and fluid support was provided throughout the 24-h period. All pigs supported with APRV and AC+VG survived 24 h, compared with 62% of control pigs. APRV resulted in improved lung volume recruitment compared with AC+VG based on radiographs, lower PCO2 levels (44 ± 2.9 vs. 53 ± 2.7 mmHg, P ≤ 0.009) and lower inspired oxygen fraction requirements (36 ± 6 vs. 44 ± 11%, P ≤ 0.001), and higher oxygenation index (5.1 ± 1.5 vs. 2.9 ± 1.1, P ≤ 0.001). There were no differences between APRV and AC+VG pigs for heart rate, ratio of wet to dry lung mass, proinflammatory cytokines, or histopathological markers of lung injury. Lung protective ventilation with APRV improved recruitment of alveoli of preterm lungs, enhanced development and maintenance of functional residual capacity without injury, and improved clinical outcomes relative to AC+VG. Long-term consequences of lung volume recruitment by using APRV should be evaluated.

Original languageEnglish (US)
Pages (from-to)L1088-L1092
JournalAmerican Journal of Physiology - Lung Cellular and Molecular Physiology
Volume309
Issue number10
DOIs
StatePublished - Jan 1 2015

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Continuous Positive Airway Pressure
Swine
Lung
Ventilation
Wounds and Injuries
Oxygen
Functional Residual Capacity
Tidal Volume
Lung Injury
Masks
Respiration
Heart Rate
Maintenance
Cytokines
Pregnancy

All Science Journal Classification (ASJC) codes

  • Physiology
  • Pulmonary and Respiratory Medicine
  • Physiology (medical)
  • Cell Biology

Cite this

Lung volume recruitment in a preterm pig model of lung immaturity. / Arrindell, Esmond L.; Krishnan, Ramesh; Van Der Merwe, Marie; Caminita, Frank; Howard, Scott; Zhang, Jie; Buddington, Randal.

In: American Journal of Physiology - Lung Cellular and Molecular Physiology, Vol. 309, No. 10, 01.01.2015, p. L1088-L1092.

Research output: Contribution to journalArticle

Arrindell, Esmond L. ; Krishnan, Ramesh ; Van Der Merwe, Marie ; Caminita, Frank ; Howard, Scott ; Zhang, Jie ; Buddington, Randal. / Lung volume recruitment in a preterm pig model of lung immaturity. In: American Journal of Physiology - Lung Cellular and Molecular Physiology. 2015 ; Vol. 309, No. 10. pp. L1088-L1092.
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