High-frequency percussive ventilation with systemic heparin improves short-term survival in a LD100 sheep model of acute respiratory distress syndrome

Dongfang Wang, Joseph B. Zwischenberger, Clare Savage, Lucinda Miller, Donald J. Deyo, Scott Alpard, Victor J. Cardenas

    Research output: Contribution to journalArticle

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    Abstract

    We undertook an assessment of high-frequency percussive ventilation (HFPV) and systemic heparin on survival in our LD100 sheep model of smoke/burn-induced acute respiratory distress syndrome (ARDS). This was a prospective controlled outcomes study in a large animal critical care laboratory. ARDS was induced in 13 sheep by a combination of 48 cotton smoke breaths and 40% full-thickness cutaneous burn (LD100) followed by mechanical ventilation (15 ml/kg tidal volume). After meeting ARDS criteria (PaO2/FiO2 < 200), the sheep were divided into high-frequency percussive ventilation (HFPV; n = 7) or volume-controlled mechanical ventilation (VCMV; n = 6) groups. Both groups received systemic heparin to achieve an ACT 180-300 seconds. HFPV was managed with the Volumetric Diffusive Respiration Ventilator (Percussionaire Corp., Sandpoint, ID). The VCMV group was managed with up to 10 ml/kg tidal volume. Arterial blood gases and ventilator settings were monitored every 6 hours after onset of ARDS. HFPV did not affect sheep hemodynamics. Survival 84 hours after smoke and burn injury was significantly greater in the HFPV (7/7, 100%) compared with the VCMV group (3/6, 50%, P < .05). PaCO2 was significantly greater in VCMV group at 36, 48, and 72 hours after smoke and burn injury. PaO2/FiO2 after 36 hours of smoke and burn injury in the HFPV group was improved compared with the VCMV group, but no statistical difference was found. In the VCMV group, peak airway pressure was decreased to 19.7 ± 2.2 cm H2O at 36 hours from 29 ± 2.8 at 24 hours as the tidal volume changed from 15 ml/kg to 10 ml/kg and then gradually increased to 39 ± 5.6 cm H2O at 72 hours. In the HFPV group, peak inspiratory pressure kept constant at a level of 30 cmH2O. In our smoke/burn-induced LD100 sheep model of ARDS, volume-controlled mechanical ventilation with systemic heparin achieved a 50% survival whereas HFPV with systemic heparin achieved 100% survival at 60 hours after the onset of ARDS.

    Original languageEnglish (US)
    Pages (from-to)463-471
    Number of pages9
    JournalJournal of Burn Care and Research
    Volume27
    Issue number4
    DOIs
    StatePublished - Jul 2006

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    High-Frequency Ventilation
    Adult Respiratory Distress Syndrome
    Heparin
    Sheep
    Smoke
    Tidal Volume
    Artificial Respiration
    Mechanical Ventilators
    Burns
    Wounds and Injuries
    Pressure
    Critical Care
    Respiration
    Gases
    Hemodynamics
    Outcome Assessment (Health Care)
    Skin

    ASJC Scopus subject areas

    • Emergency Medicine
    • Rehabilitation
    • Surgery

    Cite this

    High-frequency percussive ventilation with systemic heparin improves short-term survival in a LD100 sheep model of acute respiratory distress syndrome. / Wang, Dongfang; Zwischenberger, Joseph B.; Savage, Clare; Miller, Lucinda; Deyo, Donald J.; Alpard, Scott; Cardenas, Victor J.

    In: Journal of Burn Care and Research, Vol. 27, No. 4, 07.2006, p. 463-471.

    Research output: Contribution to journalArticle

    Wang, Dongfang ; Zwischenberger, Joseph B. ; Savage, Clare ; Miller, Lucinda ; Deyo, Donald J. ; Alpard, Scott ; Cardenas, Victor J. / High-frequency percussive ventilation with systemic heparin improves short-term survival in a LD100 sheep model of acute respiratory distress syndrome. In: Journal of Burn Care and Research. 2006 ; Vol. 27, No. 4. pp. 463-471.
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    abstract = "We undertook an assessment of high-frequency percussive ventilation (HFPV) and systemic heparin on survival in our LD100 sheep model of smoke/burn-induced acute respiratory distress syndrome (ARDS). This was a prospective controlled outcomes study in a large animal critical care laboratory. ARDS was induced in 13 sheep by a combination of 48 cotton smoke breaths and 40{\%} full-thickness cutaneous burn (LD100) followed by mechanical ventilation (15 ml/kg tidal volume). After meeting ARDS criteria (PaO2/FiO2 < 200), the sheep were divided into high-frequency percussive ventilation (HFPV; n = 7) or volume-controlled mechanical ventilation (VCMV; n = 6) groups. Both groups received systemic heparin to achieve an ACT 180-300 seconds. HFPV was managed with the Volumetric Diffusive Respiration Ventilator (Percussionaire Corp., Sandpoint, ID). The VCMV group was managed with up to 10 ml/kg tidal volume. Arterial blood gases and ventilator settings were monitored every 6 hours after onset of ARDS. HFPV did not affect sheep hemodynamics. Survival 84 hours after smoke and burn injury was significantly greater in the HFPV (7/7, 100{\%}) compared with the VCMV group (3/6, 50{\%}, P < .05). PaCO2 was significantly greater in VCMV group at 36, 48, and 72 hours after smoke and burn injury. PaO2/FiO2 after 36 hours of smoke and burn injury in the HFPV group was improved compared with the VCMV group, but no statistical difference was found. In the VCMV group, peak airway pressure was decreased to 19.7 ± 2.2 cm H2O at 36 hours from 29 ± 2.8 at 24 hours as the tidal volume changed from 15 ml/kg to 10 ml/kg and then gradually increased to 39 ± 5.6 cm H2O at 72 hours. In the HFPV group, peak inspiratory pressure kept constant at a level of 30 cmH2O. In our smoke/burn-induced LD100 sheep model of ARDS, volume-controlled mechanical ventilation with systemic heparin achieved a 50{\%} survival whereas HFPV with systemic heparin achieved 100{\%} survival at 60 hours after the onset of ARDS.",
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