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Intensive Care Medicine

, Volume 28, Issue 8, pp 1151–1156 | Cite as

Oxygenation index, an indicator of optimal distending pressure during high-frequency oscillatory ventilation?

  • Huibert R. van Genderingen
  • Johannus A. van Vught
  • Jos R. Jansen
  • Elisabeth L. Duval
  • Dick G. Markhorst
  • Adrian Versprille
Experimental

Abstract

Objective. To test the hypothesis that, during high-frequency oscillatory ventilation (HFOV) of pigs with acute lung injury, the oxygenation index (OI = Paw*FIO2*100/PaO2) is minimal at the lowest continuous distending pressure (Paw), where the physiological shunt fraction is below 0.1 (Pawoptimal).

Design and setting. Prospective, observational study in a university research laboratory.

Subjects. Eight Yorkshire pigs weighing 12.0±0.5 kg, with lung injury induced by lung lavage.

Interventions. After initiation of HFOV, the pigs were subjected to a stepwise increase of Paw to obtain under-inflation, optimal inflation and over-distension of the lungs (inflation) in series, followed by a similar decrease of Paw (deflation).

Measurements and results. At each Paw level, the OI and physiological shunt fraction were determined. The OI reached a minimum of 6.2±1.4 at Paw 30±4 cmH2O during inflation and a minimum of 2.4±0.3 at Paw 13±2 cmH2O during deflation. Pawoptimal was 32±6 cmH2O on the inflation limb and 14±2 cmH2O on the deflation limb. The difference between the Paw at minimal OI and Pawoptimal was –1.9±4.2 cmH2O (NS) during inflation and –1.5±1.6 cmH2O (p<0.05) during deflation. In 15 out of the 16 comparisons, the difference in Paw was within one step (±3 cmH2O).

Conclusion. The minimal OI is indicative for the Paw where oxygenation is optimal during HFOV in surfactant-depleted pigs.

Acute lung injury High-frequency oscillatory ventilation Oxygenation index Gas exchange 

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Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • Huibert R. van Genderingen
    • 1
  • Johannus A. van Vught
    • 2
  • Jos R. Jansen
    • 3
  • Elisabeth L. Duval
    • 4
  • Dick G. Markhorst
    • 2
  • Adrian Versprille
    • 2
  1. 1.Department of Clinical Physics & Informatics, Vrije Universiteit Medical Center, PO Box 7057,1007 MB Amsterdam, The NetherlandsThe Netherlands
  2. 2.Pediatric Intensive Care Unit, Department of Pediatrics, Wilhelmina Children's Hospital, PO Box 80590, 3508 AB Utrecht, The NetherlandsThe Netherlands
  3. 3.Department of Intensive Care, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsThe Netherlands
  4. 4.Pediatric Intensive Care Unit, Department of Pediatrics, Paola Children's Hospital, Lindendreef 1, 2020 Antwerp, BelgiumThe Netherlands

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