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Inspiratory Limb Carbon Dioxide Entrainment During High-Frequency Oscillatory Ventilation: Characterization in a Mechanical Test Lung and Swine Model
High-frequency oscillatory ventilation (HFOV) has been utilized as a rescue oxygenation therapy in adults with ARDS over the last decade. The HFOV oscillating piston can generate negative pressure during the exhalation cycle, which has been termed active exhalation. We hypothesized that this charact...
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| Published in: | Respiratory care 2012-11, Vol.57 (11), p.1865-1872 |
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| creator | BOSTICK, Adam W NAWOROL, Gregory A BRITTON, Tyler J ORI, Timothy R FRENCH, Shawn K DERDAK, Stephen |
| description | High-frequency oscillatory ventilation (HFOV) has been utilized as a rescue oxygenation therapy in adults with ARDS over the last decade. The HFOV oscillating piston can generate negative pressure during the exhalation cycle, which has been termed active exhalation. We hypothesized that this characteristic of HFOV entrains CO(2) into the inspiratory limb of the circuit and increases the total dead space. The purpose of this study was to determine if retrograde CO(2) entrainment occurs and how it is altered by HFOV parameter settings.
An HFOV was interfaced to a cuffed endotracheal tube and connected to a mechanical test lung. Negative pressure changes within the circuit's inspiratory limb were measured while HFOV settings were manipulated. Retrograde CO(2) entrainment was evaluated by insufflating CO(2) into the test lung to achieve 40 mm Hg at the carina. Inspiratory limb CO(2) entrainment was measured at incremental distances from the Y-piece. HFOV settings and cuff leak were varied to assess their effect on CO(2) entrainment. Control experiments were conducted using a conventional ventilator. Test lung results were validated on a large hypercapnic swine.
Negative pressure was detectable within the inspiratory limb of the HFOV circuit and varied inversely with mean airway pressure (P(-)(aw)) and directly with oscillatory pressure amplitude (ΔP). CO(2) was readily detectable within the inspiratory limb and was proportional to the negative pressure that was generated. Factors that decreased CO(2) entrainment in both the test lung and swine included low ΔP, high mean airway pressure, high oscillatory frequency (Hz), high bias flow, and endotracheal tube cuff leak placement. CO(2) entrainment was also reduced by utilizing a higher bias flow strategy at any targeted mean airway pressure.
Retrograde CO(2) entrainment occurs during HFOV use and can be manipulated with the ventilator settings. This phenomenon may have clinical implications on the development or persistence of hypercapnia. |
| doi_str_mv | 10.4187/respcare.01563 |
| format | article |
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An HFOV was interfaced to a cuffed endotracheal tube and connected to a mechanical test lung. Negative pressure changes within the circuit's inspiratory limb were measured while HFOV settings were manipulated. Retrograde CO(2) entrainment was evaluated by insufflating CO(2) into the test lung to achieve 40 mm Hg at the carina. Inspiratory limb CO(2) entrainment was measured at incremental distances from the Y-piece. HFOV settings and cuff leak were varied to assess their effect on CO(2) entrainment. Control experiments were conducted using a conventional ventilator. Test lung results were validated on a large hypercapnic swine.
Negative pressure was detectable within the inspiratory limb of the HFOV circuit and varied inversely with mean airway pressure (P(-)(aw)) and directly with oscillatory pressure amplitude (ΔP). CO(2) was readily detectable within the inspiratory limb and was proportional to the negative pressure that was generated. Factors that decreased CO(2) entrainment in both the test lung and swine included low ΔP, high mean airway pressure, high oscillatory frequency (Hz), high bias flow, and endotracheal tube cuff leak placement. CO(2) entrainment was also reduced by utilizing a higher bias flow strategy at any targeted mean airway pressure.
Retrograde CO(2) entrainment occurs during HFOV use and can be manipulated with the ventilator settings. This phenomenon may have clinical implications on the development or persistence of hypercapnia.</description><identifier>ISSN: 0020-1324</identifier><identifier>EISSN: 1943-3654</identifier><identifier>DOI: 10.4187/respcare.01563</identifier><identifier>PMID: 22613503</identifier><identifier>CODEN: RECACP</identifier><language>eng</language><publisher>Irving, TX: Daedalus</publisher><subject>Acute respiratory distress syndrome ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Animal models in research ; Animals ; Artificial respiration ; Biological and medical sciences ; Carbon dioxide ; Carbon Dioxide - metabolism ; Care and treatment ; Disease Models, Animal ; Emergency and intensive respiratory care ; Health aspects ; High-Frequency Ventilation - methods ; Intensive care medicine ; Intubation, Intratracheal ; Medical sciences ; Oxygen therapy ; Physiological aspects ; Respiratory Distress Syndrome, Adult - physiopathology ; Respiratory Distress Syndrome, Adult - therapy ; Respiratory Function Tests ; Swine</subject><ispartof>Respiratory care, 2012-11, Vol.57 (11), p.1865-1872</ispartof><rights>2015 INIST-CNRS</rights><rights>COPYRIGHT 2012 Daedalus Enterprises, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c423t-3b449371d0f7a792dffb40278e933865554d25894b7c50f0cc3d57c832e96c9f3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26598817$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22613503$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>BOSTICK, Adam W</creatorcontrib><creatorcontrib>NAWOROL, Gregory A</creatorcontrib><creatorcontrib>BRITTON, Tyler J</creatorcontrib><creatorcontrib>ORI, Timothy R</creatorcontrib><creatorcontrib>FRENCH, Shawn K</creatorcontrib><creatorcontrib>DERDAK, Stephen</creatorcontrib><title>Inspiratory Limb Carbon Dioxide Entrainment During High-Frequency Oscillatory Ventilation: Characterization in a Mechanical Test Lung and Swine Model</title><title>Respiratory care</title><addtitle>Respir Care</addtitle><description>High-frequency oscillatory ventilation (HFOV) has been utilized as a rescue oxygenation therapy in adults with ARDS over the last decade. The HFOV oscillating piston can generate negative pressure during the exhalation cycle, which has been termed active exhalation. We hypothesized that this characteristic of HFOV entrains CO(2) into the inspiratory limb of the circuit and increases the total dead space. The purpose of this study was to determine if retrograde CO(2) entrainment occurs and how it is altered by HFOV parameter settings.
An HFOV was interfaced to a cuffed endotracheal tube and connected to a mechanical test lung. Negative pressure changes within the circuit's inspiratory limb were measured while HFOV settings were manipulated. Retrograde CO(2) entrainment was evaluated by insufflating CO(2) into the test lung to achieve 40 mm Hg at the carina. Inspiratory limb CO(2) entrainment was measured at incremental distances from the Y-piece. HFOV settings and cuff leak were varied to assess their effect on CO(2) entrainment. Control experiments were conducted using a conventional ventilator. Test lung results were validated on a large hypercapnic swine.
Negative pressure was detectable within the inspiratory limb of the HFOV circuit and varied inversely with mean airway pressure (P(-)(aw)) and directly with oscillatory pressure amplitude (ΔP). CO(2) was readily detectable within the inspiratory limb and was proportional to the negative pressure that was generated. Factors that decreased CO(2) entrainment in both the test lung and swine included low ΔP, high mean airway pressure, high oscillatory frequency (Hz), high bias flow, and endotracheal tube cuff leak placement. CO(2) entrainment was also reduced by utilizing a higher bias flow strategy at any targeted mean airway pressure.
Retrograde CO(2) entrainment occurs during HFOV use and can be manipulated with the ventilator settings. This phenomenon may have clinical implications on the development or persistence of hypercapnia.</description><subject>Acute respiratory distress syndrome</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Animal models in research</subject><subject>Animals</subject><subject>Artificial respiration</subject><subject>Biological and medical sciences</subject><subject>Carbon dioxide</subject><subject>Carbon Dioxide - metabolism</subject><subject>Care and treatment</subject><subject>Disease Models, Animal</subject><subject>Emergency and intensive respiratory care</subject><subject>Health aspects</subject><subject>High-Frequency Ventilation - methods</subject><subject>Intensive care medicine</subject><subject>Intubation, Intratracheal</subject><subject>Medical sciences</subject><subject>Oxygen therapy</subject><subject>Physiological aspects</subject><subject>Respiratory Distress Syndrome, Adult - physiopathology</subject><subject>Respiratory Distress Syndrome, Adult - therapy</subject><subject>Respiratory Function Tests</subject><subject>Swine</subject><issn>0020-1324</issn><issn>1943-3654</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNptkk9v1DAQxS1ERZfClSOyhEBcsvhvHHOrti2ttFUPFK6R40x2jRJ7sRPB8j34vni72wJS5YPt0W-e9GYeQq8omQtaqQ8R0saaCHNCZcmfoBnVghe8lOIpmhHCSEE5E8foeUrf8rcUUj9Dx4yVlEvCZ-j3lU8bF80Y4hYv3dDghYlN8PjMhZ-uBXzux2icH8CP-GyKzq_wpVuti4sI3yfwdotvknV9v1f4mjGX3y74j3ixNtHYEaL7dVfBzmODr8GujXfW9PgW0oiXU5Y0vsWffzgP-Dq00L9AR53pE7w83Cfoy8X57eKyWN58ulqcLgsrGB8L3gihuaIt6ZRRmrVd1wjCVAWa86qUUoqWyUqLRllJOmItb6WyFWegS6s7foLe73U3MWQ3aawHlyxkNx7ClGpKmVCSSUUy-maPrkwPtfNdyHOxO7w-5aSiTLNSZWr-CJVPC4OzwUPncv2_hnf_NKzB9OM6hX7azSs9qmxjSClCV2-iG0zc1pTUuyjU91Go76KQG14fvE3NAO0Dfr_7DLw9ACblbXTReOvSX66Uuqqo4n8AFVm9Fw</recordid><startdate>20121101</startdate><enddate>20121101</enddate><creator>BOSTICK, Adam W</creator><creator>NAWOROL, Gregory A</creator><creator>BRITTON, Tyler J</creator><creator>ORI, Timothy R</creator><creator>FRENCH, Shawn K</creator><creator>DERDAK, Stephen</creator><general>Daedalus</general><general>Daedalus Enterprises, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20121101</creationdate><title>Inspiratory Limb Carbon Dioxide Entrainment During High-Frequency Oscillatory Ventilation: Characterization in a Mechanical Test Lung and Swine Model</title><author>BOSTICK, Adam W ; NAWOROL, Gregory A ; BRITTON, Tyler J ; ORI, Timothy R ; FRENCH, Shawn K ; DERDAK, Stephen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c423t-3b449371d0f7a792dffb40278e933865554d25894b7c50f0cc3d57c832e96c9f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Acute respiratory distress syndrome</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Animal models in research</topic><topic>Animals</topic><topic>Artificial respiration</topic><topic>Biological and medical sciences</topic><topic>Carbon dioxide</topic><topic>Carbon Dioxide - metabolism</topic><topic>Care and treatment</topic><topic>Disease Models, Animal</topic><topic>Emergency and intensive respiratory care</topic><topic>Health aspects</topic><topic>High-Frequency Ventilation - methods</topic><topic>Intensive care medicine</topic><topic>Intubation, Intratracheal</topic><topic>Medical sciences</topic><topic>Oxygen therapy</topic><topic>Physiological aspects</topic><topic>Respiratory Distress Syndrome, Adult - physiopathology</topic><topic>Respiratory Distress Syndrome, Adult - therapy</topic><topic>Respiratory Function Tests</topic><topic>Swine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>BOSTICK, Adam W</creatorcontrib><creatorcontrib>NAWOROL, Gregory A</creatorcontrib><creatorcontrib>BRITTON, Tyler J</creatorcontrib><creatorcontrib>ORI, Timothy R</creatorcontrib><creatorcontrib>FRENCH, Shawn K</creatorcontrib><creatorcontrib>DERDAK, Stephen</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Respiratory care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>BOSTICK, Adam W</au><au>NAWOROL, Gregory A</au><au>BRITTON, Tyler J</au><au>ORI, Timothy R</au><au>FRENCH, Shawn K</au><au>DERDAK, Stephen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inspiratory Limb Carbon Dioxide Entrainment During High-Frequency Oscillatory Ventilation: Characterization in a Mechanical Test Lung and Swine Model</atitle><jtitle>Respiratory care</jtitle><addtitle>Respir Care</addtitle><date>2012-11-01</date><risdate>2012</risdate><volume>57</volume><issue>11</issue><spage>1865</spage><epage>1872</epage><pages>1865-1872</pages><issn>0020-1324</issn><eissn>1943-3654</eissn><coden>RECACP</coden><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>High-frequency oscillatory ventilation (HFOV) has been utilized as a rescue oxygenation therapy in adults with ARDS over the last decade. The HFOV oscillating piston can generate negative pressure during the exhalation cycle, which has been termed active exhalation. We hypothesized that this characteristic of HFOV entrains CO(2) into the inspiratory limb of the circuit and increases the total dead space. The purpose of this study was to determine if retrograde CO(2) entrainment occurs and how it is altered by HFOV parameter settings.
An HFOV was interfaced to a cuffed endotracheal tube and connected to a mechanical test lung. Negative pressure changes within the circuit's inspiratory limb were measured while HFOV settings were manipulated. Retrograde CO(2) entrainment was evaluated by insufflating CO(2) into the test lung to achieve 40 mm Hg at the carina. Inspiratory limb CO(2) entrainment was measured at incremental distances from the Y-piece. HFOV settings and cuff leak were varied to assess their effect on CO(2) entrainment. Control experiments were conducted using a conventional ventilator. Test lung results were validated on a large hypercapnic swine.
Negative pressure was detectable within the inspiratory limb of the HFOV circuit and varied inversely with mean airway pressure (P(-)(aw)) and directly with oscillatory pressure amplitude (ΔP). CO(2) was readily detectable within the inspiratory limb and was proportional to the negative pressure that was generated. Factors that decreased CO(2) entrainment in both the test lung and swine included low ΔP, high mean airway pressure, high oscillatory frequency (Hz), high bias flow, and endotracheal tube cuff leak placement. CO(2) entrainment was also reduced by utilizing a higher bias flow strategy at any targeted mean airway pressure.
Retrograde CO(2) entrainment occurs during HFOV use and can be manipulated with the ventilator settings. This phenomenon may have clinical implications on the development or persistence of hypercapnia.</abstract><cop>Irving, TX</cop><pub>Daedalus</pub><pmid>22613503</pmid><doi>10.4187/respcare.01563</doi><tpages>8</tpages></addata></record> |
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| subjects | Acute respiratory distress syndrome Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Animal models in research Animals Artificial respiration Biological and medical sciences Carbon dioxide Carbon Dioxide - metabolism Care and treatment Disease Models, Animal Emergency and intensive respiratory care Health aspects High-Frequency Ventilation - methods Intensive care medicine Intubation, Intratracheal Medical sciences Oxygen therapy Physiological aspects Respiratory Distress Syndrome, Adult - physiopathology Respiratory Distress Syndrome, Adult - therapy Respiratory Function Tests Swine |
| title | Inspiratory Limb Carbon Dioxide Entrainment During High-Frequency Oscillatory Ventilation: Characterization in a Mechanical Test Lung and Swine Model |
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