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Effect of the I/E ratio on CO2 removal during high-frequency oscillatory ventilation with volume guarantee in a neonatal animal model of RDS

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Abstract

The objective of this study was to analyze the effect of I/E ratio on carbon dioxide (CO2) elimination during high-frequency oscillatory ventilation (HFOV) combined with volume guarantee (VG). Five 2-day-old piglets were studied before and after a bronchoalveolar lavage (BAL). The effect of an I/E ratio of 1:1 and 1:2 with (VG-ON) and without VG (VG-OFF) on PaCO2, as well as delta and mean airway pressures at the airway opening (∆Phf-ao, mPaw-ao) and at the tracheal level (∆Phf-t, mPaw-t) were evaluated at frequencies of 5, 8, 11, and 14 Hz. With the VG-ON, PaCO2 was significant lower with the I/E ratio of 1:2 at 5 Hz compared with the 1:1. mPaw-t was higher than mPaw-ao, with 1:1 I/E ratio, and on VG-ON, this difference was statistically significant.

Conclusion: “In this animal study and with this ventilator, the I/E ratio of 1:1 compared to 1:2 in HFOV and VG-ON did not produce a higher CO2 lavage as when HFOV was used without the VG modality. Even more, a lower PaCO2 was found when using the lower frequency and 1:2 ratio compared to 1:1. So in contrast to non-VG HFOV mode, using a fixed tidal volume, no significant changes on CO2 elimination are observed during HFOV when the I/E ratios of 1:1 and 1:2 are compared at different frequencies.”

What is Known:

•The tidal volume on HFOV is determinant in CO 2 removal, and this is generated by delta pressure and the length of the inspiratory time.

What is New:

•HFOV combined with VG, an I/E ratio of 1:2 is more effective to remove CO 2 , and this is not related to the tidal volume.

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Abbreviations

BAL:

Bronchoalveolar lavage

Cdyn:

Dynamic compliance

CMV:

Conventional mechanical ventilation

CO2 :

Carbon dioxide

DCO2 :

carbon dioxide diffusion coefficient

FiO2 :

Inspired oxygen fraction

f R :

Frequency

HFOV:

High-frequency oscillatory ventilation

mPaw-ao:

Mean airway pressure at the airway opening

mPaw-t:

Mean airway pressure at the trachea

mPaw:

Mean airway pressure

PaCO2 :

Partial carbon dioxide pressure

PaO2 :

Partial arterial oxygen pressure

PEEP:

Positive end-expiratory pressure

SaO2 :

Arterial oxyhemoglobin saturation

SD:

Standard deviation

VG:

Volume guarantee

VT:

Tidal volume

VThf:

High-frequency expired tidal volume

ΔPhf-ao:

High-frequency delta pressure at the airway opening

ΔPhf-t:

High-frequency delta pressure at the trachea

ΔPhf:

High-frequency delta pressure

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Acknowledgments

The authors thank Dräger Medical GmbH for providing the Babylog VN500 for the present study.

Authors’ contributions

Manuel Sánchez-Luna: design, development, data interpretation, statistical analysis, and preparation of manuscript.

Noelia González-Pacheco: design, development, data management, data interpretation, and preparation of manuscript.

Martín Santos: design, development, data management, statistical analysis, and preparation of manuscript.

Ángel Blanco: development and data management.

Cristina Orden: development and data management.

Jaques Belik: data interpretation and preparation of manuscript.

Francisco J. Tendillo: design, development, and data management.

Author information

Authors and Affiliations

  1. Neonatology Division, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, University Complutense of Madrid, Madrid, Spain

    Manuel Sánchez-Luna & Noelia González-Pacheco

  2. Medical and Surgical Research Unit, Instituto de Investigación Sanitatia Puerta de Hierro-Majadahonda, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain

    Martín Santos, Cristina Orden & Francisco J. Tendillo

  3. Anaesthesia and Critical Care Department, Instituto de Investigación Sanitatia Puerta de Hierro-Majadahonda, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain

    Ángel Blanco

  4. Division of Neonatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Jaques Belik

Authors
  1. Manuel Sánchez-Luna
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  2. Noelia González-Pacheco
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  3. Martín Santos
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  4. Ángel Blanco
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  5. Cristina Orden
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  6. Jaques Belik
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  7. Francisco J. Tendillo
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Corresponding author

Correspondence to Manuel Sánchez-Luna.

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Conflict of interest

Manuel Sánchez-Luna declares receiving advisory board consulting fees from Dräger. The remaining authors declare that they have no conflict of interest.

Ethical approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted. This article does not contain any studies with human participants performed by any of the authors. The ethical approval number for the study was CEEA 005/2013.

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Communicated by Patrick Van Reempts

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Sánchez-Luna, M., González-Pacheco, N., Santos, M. et al. Effect of the I/E ratio on CO2 removal during high-frequency oscillatory ventilation with volume guarantee in a neonatal animal model of RDS. Eur J Pediatr 175, 1343–1351 (2016). https://doi.org/10.1007/s00431-016-2770-2

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  • DOI: https://doi.org/10.1007/s00431-016-2770-2

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