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DCO2/PaCO2 correlation on high-frequency oscillatory ventilation combined with volume guarantee using increasing frequencies in an animal model

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European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

To examine the correlation DCO2/PaCO2 on high-frequency oscillatory ventilation (HFOV) combined with volume guarantee (VG) throughout increasing frequencies in two different respiratory conditions, physiological and low compliance. Neonatal animal model was used, before and after a bronchoalveolar lavage (BAL). HFOV combined with VG was used. The frequency was increased from 10 to 20 Hz, and high-frequency tidal volume (VThf) was gradually decreased maintaining a constant DCO2. Arterial partial pressure of carbon dioxide (PaCO2) was evaluated after each frequency and VThf change. Six 2-day-old piglets were studied. A linear decrease in PaCO2 was observed throughout increasing frequencies in both respiratory conditions while maintaining a constant DCO2, showing a significant difference between the initial PaCO2 (at 10 Hz) and the PaCO2 obtained at 18 and 20 Hz. A new DCO2 equation (corrected DCO2) was calculated in order to better define the correlation between DCO2 and the observed PaCO2.

Conclusion: The correlation DCO2/PaCO2 throughout increasing frequencies is not linear, showing a greater CO2 elimination efficiency at higher frequencies, in spite of maintaining a constant DCO2. So, using frequencies close to the resonant frequency of the respiratory system on HFOV combined with VG, optimizes the efficiency of gas exchange.

What is Known:

• The efficacy of CO2removal during high-frequency oscillatory ventilation (HFOV), described as the diffusion coefficient of CO2(DCO2) is related to the square of the high-frequency tidal volume (VThf) and the frequency (f), expressed as DCO2= VThf2× f.

What is New:

• The correlation between DCO2and PaCO2throughout increasing frequencies is not linear, showing a greater CO2elimination efficiency at higher frequencies. So, using very high frequencies on HFOV combined with volume guarantee optimizes the efficiency of gas exchange allowing to minimize lung injury.

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Abbreviations

BAL:

Bronchoalveolar lavage

Cdyn:

Lung dynamic compliance

CMV:

Conventional mechanical ventilation

DCO2 :

Diffusion coefficient of CO2

FiO2 :

Inspired oxygen fraction

Hz:

Hertz

HFOV:

High-frequency oscillatory ventilation

mPaw:

Mean airway pressure

PaCO2 :

Arterial partial pressure of carbon dioxide

PaO2 :

Arterial partial pressure of oxygen

PEEP:

Positive end-expiratory pressure

RDS:

Respiratory distress syndrome

SatO2 :

Arterial oxyhemoglobin saturation

SD:

Standard deviation

VG:

Volume guarantee

VILI:

Ventilator-induced lung injury

VThf:

High-frequency tidal volume

ΔPhf:

Oscillation pressure amplitude

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Acknowledgments

The authors thank Dräger Medical GmbH for providing the Babylog VN500 for the present study and Grupo de patología RESPIratoria y SURFactante de la SENeo (RESPIRUF) for funding the study.

Funding

This study was funded by “Grupo de patología RESPIratoria y SURFactante de la SENeo” (Ayuda a la Investigación Respisurf/Adolfo-Valls).

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Authors and Affiliations

  1. Neonatology Division, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Hospital General Universitario “Gregorio Marañón”, C/Dr. Esquerdo, 46, 28007, Madrid, Spain

    Noelia González-Pacheco & Manuel Sánchez-Luna

  2. Neonatology Division, Clínica Universidad de Navarra, C/Marquesado de Sta. Marta, 1, 28027, Madrid, Spain

    Cristina Arribas-Sánchez

  3. Medical and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Majadahonda, Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Spain

    Martín Santos-González, Cristina Orden-Quinto & Francisco Tendillo-Cortijo

Authors
  1. Noelia González-Pacheco
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  2. Manuel Sánchez-Luna
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  3. Cristina Arribas-Sánchez
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  4. Martín Santos-González
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  5. Cristina Orden-Quinto
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  6. Francisco Tendillo-Cortijo
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Contributions

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

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

Cristina Arribas-Sánchez: development and data management.

Martín Santos-González: design, development, data management and statistical analysis.

Cristina Orden-Quinto: development and data management.

Francisco Tendillo-Cortijo: design, development and data management.

Corresponding author

Correspondence to Noelia González-Pacheco.

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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 competing interests.

Ethical approval

All applicable international, national, and institutional guidelines for the care and use of animals were followed (2010/63/UE and RD 53/2013). 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 (Ethics committee for animal research, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid; CEEA: 004P/2017).

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Communicated by Patrick Van Reempts

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González-Pacheco, N., Sánchez-Luna, M., Arribas-Sánchez, C. et al. DCO2/PaCO2 correlation on high-frequency oscillatory ventilation combined with volume guarantee using increasing frequencies in an animal model. Eur J Pediatr 179, 499–506 (2020). https://doi.org/10.1007/s00431-019-03503-8

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  • DOI: https://doi.org/10.1007/s00431-019-03503-8

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