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Navarrete-Calvo R, Parra P, Rodríguez-Gómez IM, Morgaz J, Domínguez JM, Gómez-Villamandos RJ, Quirós-Carmona S, Pineda C, Granados MDM. Comparison of the efficacy of two alveolar recruitment manoeuvres in improving the lung mechanics and the degree of atelectasis in anaesthetized healthy sheep. Res Vet Sci 2022; 150:164-169. [PMID: 35841725 DOI: 10.1016/j.rvsc.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/03/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022]
Abstract
The aim of the present study was to evaluate whether the application of two types of alveolar recruitment manoeuvres (ARMs) followed by a positive end-expiratory pressure (PEEP) improved lung mechanics and the degree of atelectasis caused by general anaesthesia. Twenty-one female Merino sheep were divided into three groups: sustained inflation ARM (ARMsust), stepwise ARM (AMRstep), and control (without ARM). Sheep received detomidine-morphine for premedication, propofol for induction, and isoflurane during general anaesthesia in a volume-controlled mode with 100% oxygen during the first 15 min of anaesthesia and 40% the rest of the study. The right jugular vein and metacarpal artery were catheterised for mixed venous and arterial blood sample collection, respectively. The quasistatic compliance (Cqst), oxygenation parameters, and shunt fraction (Qs/Qt) were monitored before ARM application (TpreARM), and at 10 (T10) and 60 min (T60) after ARM application. A pulmonary histopathological study was conducted on five animals from each group. A significant increase in Cqst was observed in both ARM groups at T10 compared to TpreARM (ARMsust: P = 0.001; ARMstep: P = 0.002), although only the ARMsust group showed significant differences compared to the control group. The ARMstep group presented a significant improvement in oxygenation parameters and Qs/Qt fraction (T10: 4.84 (3.26-16.48)%, P = 0.048; T60: 4.40 (4.31-14.16)%, P = 0.004) compared with TpreARM (21.48 (20.61-28.32)%). The ARMstep group had the highest percentage of alveolar area and the most homogeneous values. In conclusion, the application of a stepwise ARM followed by PEEP improved atelectasis caused by isoflurane anaesthesia in healthy sheep.
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Affiliation(s)
- Rocío Navarrete-Calvo
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
| | - Pablo Parra
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
| | - Irene Magdalena Rodríguez-Gómez
- Department of Anatomy and Comparative Pathology and Toxicology, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain..
| | - Juan Morgaz
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
| | - Juan Manuel Domínguez
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
| | - Rafael Jesús Gómez-Villamandos
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
| | - Setefilla Quirós-Carmona
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
| | - Carmen Pineda
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
| | - María Del Mar Granados
- Department of Animal Medicine and Surgery, University of Córdoba, Rabanales University Campus, National Road IV-A, km 396, Córdoba, Spain
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Viscasillas J, Alonso-Iñigo J, Gutierrez-Bautista A, Casañ Pallardó M, Redondo J. Description of ovine model for testing ventilator prototypes in the COVID-19 pandemic. REVISTA ESPAÑOLA DE ANESTESIOLOGÍA Y REANIMACIÓN (ENGLISH EDITION) 2021; 68:592-596. [PMID: 34802971 PMCID: PMC8585596 DOI: 10.1016/j.redare.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/04/2020] [Indexed: 12/04/2022]
Abstract
The COVID-19 pandemic has revealed a ventilator deficit in the global health system for this scenario. For this reason, several national and international projects have been developed to get done prototypes of ventilators which could be easy and fast to manufacture. One of the requirements of the AEMPS for conducting clinical studies with new prototypes is through the validation of these new prototypes in an animal model. Therefore, it is important to achieve an animal model which allows us to easily reproduce different clinical scenarios. In this article, we describe the use of a sheep as a research model to assess a prototype ventilator. The animal was anesthetized for 10 h in which the prototype was tested in up to 6 different scenarios. This model is effective and easy to reproduce, making it an excellent choice for this kind of research.
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Viscasillas J, Alonso-Iñigo JM, Gutierrez-Bautista A, Casañ Pallardó M, Redondo JI. Description of ovine model for testing ventilator prototypes in the COVID-19 pandemic. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2020; 68:S0034-9356(20)30263-2. [PMID: 33858680 PMCID: PMC7584440 DOI: 10.1016/j.redar.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/17/2020] [Accepted: 10/04/2020] [Indexed: 11/05/2022]
Abstract
The COVID-19 pandemic has revealed a ventilator deficit in the global health system for this scenario. For this reason, several national and international projects have been developed to get done prototypes of ventilators which could be easy and fast to manufacture. One of the requirements of the AEMPS for conducting clinical studies with new prototypes is through the validation of these new prototypes in an animal model. Therefore, it is important to achieve an animal model which allows us to easily reproduce different clinical scenarios. In this article, we describe the use of a sheep as a research model to assess a prototype ventilator. The animal was anesthetized for 10hours in which the prototype was tested in up to 6different scenarios. This model is effective and easy to reproduce, making it an excellent choice for this kind of research.
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Affiliation(s)
- J Viscasillas
- Departamento de Medicina y Cirugía Animal, Hospital Clínico Veterinario. Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - J M Alonso-Iñigo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitari i Politécnic La Fe de Valencia, España
| | - A Gutierrez-Bautista
- Departamento de Medicina y Cirugía Animal, Hospital Clínico Veterinario. Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - M Casañ Pallardó
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario de Castellón, España
| | - J I Redondo
- Departamento de Medicina y Cirugía Animal, Hospital Clínico Veterinario. Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
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Engel M, Nowacki RME, Jonker EM, Ophelders D, Nikiforou M, Kloosterboer N, Zimmermann LJI, van Waardenburg DA, Kramer BW. A comparison of four different models of acute respiratory distress syndrome in sheep. Respir Res 2020; 21:209. [PMID: 32771010 PMCID: PMC7414721 DOI: 10.1186/s12931-020-01475-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) can have various causes. The study objective was to investigate whether different pathophysiologic models of ARDS would show different respiratory, cardiovascular and inflammatory outcomes. METHODS We performed a prospective, randomized study in 27 ventilated ewes inducing ARDS using three different techniques to mimic the pulmonary causes of ARDS (ARDSp): warm saline lavage (n = 6), intratracheal hydrochloric acid (HCl; n = 6), intratracheal albumin (n = 10), and one technique to mimic an extrapulmonary cause of ARDS (ARDSexp): intravenous lipopolysaccharide (LPS iv; n = 5). ARDS was defined when PaO2 was < 15 kPa (112 mmHg) when ventilated with PEEP 10 cm H2O and FiO2 = 1.0. The effects on gas exchange were investigated by calculating the oxygenation index (OI) and the ventilation efficacy index (VEI) every 30 min for a period of 4 h. Post mortem lung lavage was performed to obtain broncho-alveolar lavage fluid (BALF) to assess lung injury and inflammation. Lung injury and inflammation were assessed by measuring the total number and differentiation of leukocytes, the concentration of protein and disaturated phospholipids, and interleukine-6 and -8 in the BALF. Histology of the lung was evaluated by measuring the mean alveolar size, alveolar wall thickness and the lung injury score system by Matute-Bello et al., as markers of lung injury. The concentration of interleukin-6 was determined in plasma, as a marker of systematic inflammation. RESULTS The OI and VEI were most affected in the LPS iv group and thereafter the HCl group, after meeting the ARDS criteria. Diastolic blood pressure was lowest in the LPS iv group. There were no significant differences found in the total number and differentiation of leukocytes, the concentration of protein and disaturated phospholipids, or interleukin-8 in the BALF, histology of the lung and the lung injury score. IL-6 in BALF and plasma was highest in the LPS iv group, but no significant differences were found between the other groups. It took a significantly longer period of time to meet the ARDS criteria in the LPS iv group. CONCLUSIONS The LPS model caused the most severe pulmonary and cardiovascular insufficiency. Surprisingly, there were limited significant differences in lung injury and inflammatory markers, despite the different pathophysiological models, when the clinical definition of ARDS was applied.
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Affiliation(s)
- Monique Engel
- Department of Pediatrics, School for Oncology and Developmental Biology - GROW, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, PO Box 5800, NL-6202, AZ, Maastricht, The Netherlands.
| | - Relana M E Nowacki
- Department of Pediatrics, School for Oncology and Developmental Biology - GROW, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, PO Box 5800, NL-6202, AZ, Maastricht, The Netherlands
| | - Elly M Jonker
- Department of Pediatrics, School for Oncology and Developmental Biology - GROW, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, PO Box 5800, NL-6202, AZ, Maastricht, The Netherlands
| | - Daan Ophelders
- Department of Pediatrics, School for Oncology and Developmental Biology - GROW, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, PO Box 5800, NL-6202, AZ, Maastricht, The Netherlands
| | - Maria Nikiforou
- Department of Pediatrics, School for Oncology and Developmental Biology - GROW, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, PO Box 5800, NL-6202, AZ, Maastricht, The Netherlands
| | - Nico Kloosterboer
- Department of Pediatrics, School for Oncology and Developmental Biology - GROW, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, PO Box 5800, NL-6202, AZ, Maastricht, The Netherlands
| | - Luc J I Zimmermann
- Department of Pediatrics, School for Oncology and Developmental Biology - GROW, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, PO Box 5800, NL-6202, AZ, Maastricht, The Netherlands
| | - Dick A van Waardenburg
- Department of Pediatrics, School of Nutrition and Translational Research in Metabolism - NUTRIM, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Boris W Kramer
- Department of Pediatrics, School for Oncology and Developmental Biology - GROW, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, PO Box 5800, NL-6202, AZ, Maastricht, The Netherlands
- Department of Pediatrics, School of Mental Health and Neuroscience, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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Driving-pressure-independent protective effects of open lung approach against experimental acute respiratory distress syndrome. Crit Care 2018; 22:228. [PMID: 30243301 PMCID: PMC6151188 DOI: 10.1186/s13054-018-2154-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 08/08/2018] [Indexed: 12/16/2022] Open
Abstract
Background The open lung approach (OLA) reportedly has lung-protective effects against acute respiratory distress syndrome (ARDS). Recently, lowering of the driving pressure (ΔP), rather than improvement in lung aeration per se, has come to be considered as the primary lung-protective mechanism of OLA. However, the driving pressure-independent protective effects of OLA have never been evaluated in experimental studies. We here evaluated whether OLA shows protective effects against experimental ARDS even when the ΔP is not lowered. Methods Lipopolysaccharide was intratracheally administered to rats to establish experimental ARDS. After 24 h, rats were mechanically ventilated and randomly allocated to the OLA or control group. In the OLA group, 5 cmH2O positive end-expiratory pressure (PEEP) and recruitment maneuver (RM) were applied. Neither PEEP nor RM was applied to the rats in the control group. Dynamic ΔP was kept at 15 cmH2O in both groups. After 6 h of mechanical ventilation, rats in both groups received RM to inflate reversible atelectasis of the lungs. Arterial blood gas analysis, lung computed tomography, histological evaluation, and comprehensive biochemical analysis were performed. Results OLA significantly improved lung aeration, arterial oxygenation, and gas exchange. Even after RM in both groups, the differences in these parameters between the two groups persisted, indicating that the atelectasis-induced respiratory dysfunction observed in the control group is not an easily reversible functional problem. Lung histological damage was severe in the dorsal dependent area in both groups, but was attenuated by OLA. White blood cell counts, protein concentrations, and tissue injury markers in the broncho-alveolar lavage fluid (BALF) were higher in the control than in the OLA group. Furthermore, levels of CXCL-7, a platelet-derived chemokine, were higher in the BALF from the control group, indicating that OLA protects the lungs by suppressing platelet activation. Conclusions OLA shows protective effects against experimental ARDS, even when the ΔP is not decreased. In addition to reducing ΔP, maintaining lung aeration seems to be important for lung protection in ARDS. Electronic supplementary material The online version of this article (10.1186/s13054-018-2154-2) contains supplementary material, which is available to authorized users.
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Effect of Repeated Recruitment Manoeuvres on Patients with Severe Acute Respiratory Distress Syndrome. W INDIAN MED J 2015; 64:362-6. [PMID: 26624588 DOI: 10.7727/wimj.2014.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 06/23/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The study aimed to evaluate the influence of repeated recruitment manoeuvres (RRMs) on lung injury in patients with acute respiratory distress syndrome (ARDS). METHODS Forty-one ventilated patients with severe ARDS were selected for this study. Recruitment manoeuvres (RMs) were conducted with continuous positive airway pressure (CPAP; 30 cm H2O for 40 seconds). Recruitment manoeuvres were repeated every two hours for all three groups. Changes in haemodynamics, pulmonary compliance, gas exchange and extravascular lung water index (EVLWI) were monitored before RM (pre-RM), 10 minutes after each RM, and four hours after RM3 (4 hours post-RRM). Pulmonary inflammatory factors (tumour necrosis factor-alpha [TNF-α] and interleukin [IL]-6 and -10) were also analysed. RESULTS Compared with those in pre-RM, pulmonary compliance, oxygenation index (ratio of partial pressure of arterial oxygen to fraction of inspired oxygen [PaO2/FiO2]) and EVLWI remarkably improved in RM1, RM2, RM3 and 4 hours post-RRM (p < 0.05). The PaO2/FiO2 ratio increased significantly in RM1 and RM3 (p < 0.05). Extravascular lung water index decreased significantly in RM1 compared with that in RM3 and 4 hours post-RRM (p < 0.05). There was no significant difference in cytokines. CONCLUSION Repeated recruitment manoeuvres during lung-protected ventilation can improve pulmonary compliance and oxygenation and significantly decrease extravascular lung water in ARDS patients. Lung injury was not worsened by RRMs in patients with severe ARDS.
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Engel M, Nowacki RME, Boden P, Reiss LK, Uhlig S, Reynaert NL, Gopal P, Wouters EFM, Willems CHMP, Kloosterboer N, Wolfs TGAM, Zimmermann LJI, Vos GD, Kramer BW. The Effects of Dexamethasone and Oxygen in Ventilated Adult Sheep with Early Phase Acute Respiratory Distress Syndrome. Lung 2014; 193:97-103. [DOI: 10.1007/s00408-014-9670-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023]
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