Biologically variable ventilation improves gas exchange and respiratory mechanics in a model of severe bronchospasm

W. Alan C. Mutch*, Timothy G. Buchman, Linda G. Girling, Elizabeth K.Y. Walker, Bruce M. McManus, M. Ruth Graham

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

Abstract

OBJECTIVE: Mechanical ventilation can be lifesaving for status asthmaticus, but how best to accomplish mechanical ventilation is unclear. Biologically variable ventilation (mechanical ventilation that emulates healthy variation) and conventional control mode ventilation (monotonously regular) were compared in an animal model of bronchospasm to determine which approach yields better gas exchange and respiratory mechanics. DESIGN: A randomized prospective trial of biologically variable ventilation vs. control mode ventilation in swine. SETTING: University research laboratory. SUBJECTS: Eighteen farm-raised pigs. INTERVENTIONS: Methacholine was administered as a nebulized aerosol to initiate bronchospasm, defined as doubling of peak inspiratory pressure and respiratory system resistance, and then randomized (n = 9 each group) to either continue control mode ventilation or switch to biologically variable ventilation at the same minute ventilation. Over the next 4 hrs, hemodynamics, blood gases, respiratory mechanics, and carbon dioxide expirograms were recorded hourly. At end-experiment, tracheobronchial lavage was undertaken to determine interleukin-6 and -10 concentrations. MEASUREMENTS AND MAIN RESULTS: Measurements of physiologic variables and inflammatory cytokines showed that biologically variable ventilation significantly improved gas exchange, with greater arterial oxygen tensions (p = .006; group × time interaction), lower arterial carbon dioxide tensions (p = .0003; group effect), lower peak inspiratory pressures (p = .0001; group × time), greater static compliance (p = .0001; group × time), greater dynamic compliance (p = .0001; group × time), and lower total respiratory system resistance (p = .028; group × time), compared with conventional ventilation. The appearance of inflammatory cytokines in bronchoalveolar lavage fluid (interleukin-6 and -10) was not affected by mode of ventilation. CONCLUSIONS: In this experimental model, biologically variable ventilation was superior to control mode ventilation in terms of gas exchange and respiratory mechanics during severe bronchospasm.

Original languageEnglish
Pages (from-to)1749-1755
Number of pages7
JournalCritical Care Medicine
Volume35
Issue number7
DOIs
StatePublished - Jul 2007
Externally publishedYes

Keywords

  • Asthma
  • Bronchial spasm
  • Mechanical
  • Ventilators

Fingerprint

Dive into the research topics of 'Biologically variable ventilation improves gas exchange and respiratory mechanics in a model of severe bronchospasm'. Together they form a unique fingerprint.

Cite this