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Peták F, Südy R, Diaper J, Fontao F, Bizzotto D, Dellacà RL, Habre W, Schranc Á. Benefits of intratracheal and extrathoracic high-frequency percussive ventilation in a model of capnoperitoneum. J Appl Physiol (1985) 2024; 136:928-937. [PMID: 38420682 DOI: 10.1152/japplphysiol.00881.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/29/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
Abdominal inflation with CO2 is used to facilitate laparoscopic surgeries, however, providing adequate mechanical ventilation in this scenario is of major importance during anesthesia management. We characterized high-frequency percussive ventilation (HFPV) in protecting from the gas exchange and respiratory mechanical impairments during capnoperitoneum. In addition, we aimed to assess the difference between conventional pressure-controlled mechanical ventilation (CMV) and HFPV modalities generating the high-frequency signal intratracheally (HFPVi) or extrathoracally (HFPVe). Anesthetized rabbits (n = 16) were mechanically ventilated by random sequences of CMV, HFPVi, and HFPVe. The ventilator superimposed the conventional waveform with two high-frequency signals (5 Hz and 10 Hz) during intratracheal HFPV (HFPVi) and HFPV with extrathoracic application of oscillatory signals through a sealed chest cuirass (HFPVe). Lung oxygenation index ([Formula: see text]/[Formula: see text]), arterial partial pressure of carbon dioxide ([Formula: see text]), intrapulmonary shunt (Qs/Qt), and respiratory mechanics were assessed before abdominal inflation, during capnoperitoneum, and after abdominal deflation. Compared with CMV, HFPVi with additional 5-Hz oscillations during capnoperitoneum resulted in higher [Formula: see text]/[Formula: see text], lower [Formula: see text], and decreased Qs/Qt. These improvements were smaller but remained significant during HFPVi with 10 Hz and HFPVe with either 5 or 10 Hz. The ventilation modes did not protect against capnoperitoneum-induced deteriorations in respiratory tissue mechanics. These findings suggest that high-frequency oscillations combined with conventional pressure-controlled ventilation improved lung oxygenation and CO2 removal in a model of capnoperitoneum. Compared with extrathoracic pressure oscillations, intratracheal generation of oscillatory pressure bursts appeared more effective. These findings may contribute to the optimization of mechanical ventilation during laparoscopic surgery.NEW & NOTEWORTHY The present study examines an alternative and innovative mechanical ventilation modality in improving oxygen delivery, CO2 clearance, and respiratory mechanical abnormalities in a clinically relevant experimental model of capnoperitoneum. Our data reveal that high-frequency oscillations combined with conventional ventilation improve gas exchange, with intratracheal oscillations being more effective than extrathoracic oscillations in this clinically relevant translational model.
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Affiliation(s)
- Ferenc Peták
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Roberta Südy
- Unit for Anesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
| | - John Diaper
- Unit for Anesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
| | - Fabienne Fontao
- Unit for Anesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
| | - Davide Bizzotto
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Walid Habre
- Unit for Anesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
| | - Álmos Schranc
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
- Unit for Anesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
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2
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Garofalo E, Rovida S, Cammarota G, Biamonte E, Troisi L, Cosenza L, Pelaia C, Navalesi P, Longhini F, Bruni A. Benefits of secretion clearance with high frequency percussive ventilation in tracheostomized critically ill patients: a pilot study. J Clin Monit Comput 2023; 37:911-918. [PMID: 36607533 PMCID: PMC10175357 DOI: 10.1007/s10877-022-00970-7] [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: 07/11/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
Clearance of secretions remains a challenge in ventilated patients. Despite high-frequency percussive ventilation (HFPV) showing benefits in patients with cystic fibrosis and neuromuscular disorders, very little is known about its effects on other patient categories. Therefore, we designed a physiological pilot study investigating the effects on lung aeration and gas exchange of short HFPV cycles in tracheostomized patients undergoing mechanical ventilation. Electrical impedance tomography (EIT) was recorded at baseline (T0) by a belt wrapped around the patient's chest, followed by the HFPV cycle lasting 10 min. EIT data was collected again after the HFPV cycle (T1) as well as after 1 h (T2) and 3 h (T3) from T0. Variation from baseline of end-expiratory lung impedance (∆EELI), tidal variation (TIV) and global inhomogeneity index (GI) were computed. Arterial blood was also taken for gas analysis. HFPV cycle significantly improved the ∆EELI at T1, T2 and T3 when compared to baseline (p < 0.05 for all comparisons). The ratio between arterial partial pressure and inspired fraction of oxygen (PaO2/FiO2) also increased after the treatment (p < 0.001 for all comparison) whereas TIV (p = 0.132) and GI (p = 0.114) remained unchanged. Short cycles of HFPV superimposed to mechanical ventilation promoted alveolar recruitment, as suggested by improved ∆EELI, and improved oxygenation in tracheostomized patients with high load of secretion.Trial Registration Prospectively registered on www.clinicaltrials.gov (NCT05200507; dated 6th January 2022).
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Affiliation(s)
- Eugenio Garofalo
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Serena Rovida
- Department of Intensive Care Medicine, St George's University Hospital, London, UK
| | - Gianmaria Cammarota
- Department of Anaesthesia and Intensive Care Medicine, University of Perugia, Perugia, Italy
| | - Eugenio Biamonte
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Letizia Troisi
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Leonardo Cosenza
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Corrado Pelaia
- Pulmonary Medicine Unit, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Paolo Navalesi
- Anaesthesia and Intensive Care, Department of Medicine-DIMED, Padua Hospital, University of Padua, Padua, Italy
| | - Federico Longhini
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy. .,Intensive Care Unit, Department of Medical and Surgical Sciences, Mater Domini University Hospital, Magna Graecia University, Viale Europa, 88100, Catanzaro, Italy.
| | - Andrea Bruni
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
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Peták F, Fodor GH, Schranc Á, Südy R, Balogh ÁL, Babik B, Dos Santos Rocha A, Bayat S, Bizzotto D, Dellacà RL, Habre W. Expiratory high-frequency percussive ventilation: a novel concept for improving gas exchange. Respir Res 2022; 23:283. [PMID: 36243752 PMCID: PMC9569091 DOI: 10.1186/s12931-022-02215-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background Although high-frequency percussive ventilation (HFPV) improves gas exchange, concerns remain about tissue overdistension caused by the oscillations and consequent lung damage. We compared a modified percussive ventilation modality created by superimposing high-frequency oscillations to the conventional ventilation waveform during expiration only (eHFPV) with conventional mechanical ventilation (CMV) and standard HFPV. Methods Hypoxia and hypercapnia were induced by decreasing the frequency of CMV in New Zealand White rabbits (n = 10). Following steady-state CMV periods, percussive modalities with oscillations randomly introduced to the entire breathing cycle (HFPV) or to the expiratory phase alone (eHFPV) with varying amplitudes (2 or 4 cmH2O) and frequencies were used (5 or 10 Hz). The arterial partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) were determined. Volumetric capnography was used to evaluate the ventilation dead space fraction, phase 2 slope, and minute elimination of CO2. Respiratory mechanics were characterized by forced oscillations. Results The use of eHFPV with 5 Hz superimposed oscillation frequency and an amplitude of 4 cmH2O enhanced gas exchange similar to those observed after HFPV. These improvements in PaO2 (47.3 ± 5.5 vs. 58.6 ± 7.2 mmHg) and PaCO2 (54.7 ± 2.3 vs. 50.1 ± 2.9 mmHg) were associated with lower ventilation dead space and capnogram phase 2 slope, as well as enhanced minute CO2 elimination without altering respiratory mechanics. Conclusions These findings demonstrated improved gas exchange using eHFPV as a novel mechanical ventilation modality that combines the benefits of conventional and small-amplitude high-frequency oscillatory ventilation, owing to improved longitudinal gas transport rather than increased lung surface area available for gas exchange. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02215-2.
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Affiliation(s)
- Ferenc Peták
- Department of Medical Physics and Informatics, University of Szeged, 9, Korányi fasor, Szeged, 6720, Hungary.
| | - Gergely H Fodor
- Department of Medical Physics and Informatics, University of Szeged, 9, Korányi fasor, Szeged, 6720, Hungary
| | - Álmos Schranc
- Department of Medical Physics and Informatics, University of Szeged, 9, Korányi fasor, Szeged, 6720, Hungary
| | - Roberta Südy
- Department of Medical Physics and Informatics, University of Szeged, 9, Korányi fasor, Szeged, 6720, Hungary.,Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Ádám L Balogh
- Unit for Anaesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
| | - Barna Babik
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - André Dos Santos Rocha
- Unit for Anaesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
| | - Sam Bayat
- Univ. Grenoble Alpes, Inserm UA07 STROBE Laboratory & Department of Pneumology and Clinical Physiology, Grenoble University Hospital, Grenoble, France
| | - Davide Bizzotto
- Dipartimento Di Elettronica, Informazione E Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Raffaele L Dellacà
- Dipartimento Di Elettronica, Informazione E Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Walid Habre
- Unit for Anaesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland.,Paediatric Anaesthesia Unit, Department of Acute Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Geerts L, Carvalho H, Jarahyan E, Mulier J. Impact of opioid free Anaesthesia versus opioid Anaesthesia on the immediate postoperative oxygenation after bariatric surgery: a prospective observational study. ACTA ANAESTHESIOLOGICA BELGICA 2022. [DOI: 10.56126/73.3.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Introduction: Opioid induced respiratory depression (OIRD) is a preventable aetiology of postoperative respiratory depression with 85% of the episodes taking place in the first 24 postoperative hours. Due to altered respiratory functional metrics and frequently coexisting comorbidities, obese patients are at a particularly higher risk for such complications. The present study aimed to assess if an opioid-free anesthesia (OFA) was associated with a reduced immediate postoperative OIRD when compared to Opiod-based anesthesia (OA).
Methods: Obese patients presenting for bariatric surgery were consecutively included in a non-randomized fashion. Lung protective ventilation strategies applied in both groups. In the OA group, Sufentanil was used for intraoperative analgesia in a liberal fashion. In the OFA group, patients received a pre-induction dexmedetomidine loading, followed by a lidocaine, ketamine and dexmedetomidine bolus immediately before induction, further maintained throughout the intraoperative period. Plethysmographic saturations were obtained before induction as well as after extubation and in the Post-anesthesia care unit (PACU). Opioid requirement and Postoperative Nausea and Vomiting incidence were similarly registered.
Results: Thirty-four patients were included in the OFA group, and 30 in the OA group. No significant anthropometric and comorbidity differences were found between both groups. OFA patients had significantly lower pre-induction saturations after dexmedetomidine loading. No difference was found for post-extubation saturations as well as well as pre-PACU discharge. The need for supplemental oxygen at the PACU was higher in the OA group. Opioid requirement and cumulative consumption (MEDs) were significantly higher with OA. Conclusion: OFA was not associated with significant postoperative saturation changes but led to a lower need of postoperative supplemental oxygen therapy. OA led to higher opioid rescue need. No fatal respiratory complications were registered in both groups in the immediate postoperative period.
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Yuan Y, Chen Y, Zhou L, Liu W, Dai Z. Gas Exchange Mechanism of High Frequency Ventilation: A Brief Narrative Review and Prospect. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (SCIENCE) 2022; 28:1-5. [PMID: 35600242 PMCID: PMC9109743 DOI: 10.1007/s12204-022-2424-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023]
Abstract
The high frequency ventilation (HFV) can well support the breathing of respiratory patient with 20%-40% of normal tidal volume. Now as a therapy of rescue ventilation when conversional ventilation failed, the HFV has been applied in the treatments of severe patients with acute respiratory failure (ARF), acute respiratory distress syndrome (ARDS), etc. However, the gas exchange mechanism (GEM) of HFV is still not fully understood by researchers. In this paper, the GEM of HFV is reviewed to track the studies in last decades and prospect for the next likely studies. And inspired by previous studies, the GEM of HFV is suggested to be continually developed with various hypotheses which will be testified in simulation, experiment and clinic trail. One of the significant measures is to study the GEM of HFV under the cross-disciplinary integration of medicine and engineering. Fully understanding the GEM can theoretically support and expand the applications of HFV, and is helpful in investigating the potential indications and contraindications of HFV.
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Affiliation(s)
- Yueyang Yuan
- School of Mechanical and Electrical Engineering, Hunan City University, Yiyang, Hunan, 413099 China
| | - Yuqing Chen
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai, 200030 China
| | - Li Zhou
- School of Mechanical and Electrical Engineering, Hunan City University, Yiyang, Hunan, 413099 China
| | - Wei Liu
- Hunan Micomme Medical Technology Development Co., Ltd., Changsha, 410205 China
| | - Zheng Dai
- Hunan Micomme Medical Technology Development Co., Ltd., Changsha, 410205 China
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Marchenko SP, Scarlatescu E, Vogt PR, Naumov A, Bognenko S. Intermittent High-Frequency Percussive Ventilation Therapy in 3 Patients with Severe COVID-19 Pneumonia. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928421. [PMID: 33542171 PMCID: PMC7872946 DOI: 10.12659/ajcr.928421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/22/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND High-frequency percussive ventilation (HFPV) is a method that combines mechanical ventilation with high-frequency oscillatory ventilation. This report describes 3 cases of patients with severe COVID-19 pneumonia who received intermittent adjunctive treatment with HFPV at a single center without requiring admission to the Intensive Care Unit (ICU). CASE REPORT Case 1 was a 60-year-old woman admitted to the hospital 14 days after the onset of SARS-CoV-2 infection symptoms, and cases 2 and 3 were men aged 65 and 72 years who were admitted to the hospital 10 days after the onset of SARS-CoV-2 infection symptoms. All 3 patients presented with clinical deterioration accompanied by worsening lung lesions on computed tomography (CT) scans after 21 days from the onset of symptoms. SARS-CoV-2 infection was confirmed in all patients by real-time reverse transcription-polymerase chain reaction (RT-PCR) assay from nasal swabs. All 3 patients had impending respiratory failure when non-invasive intermittent HFPV therapy was initiated. After therapy, the patients had significant clinical improvement and visibly decreased lung lesions on followup CT scans performed 4-6 days later. CONCLUSIONS The 3 cases described in this report showed that the use of intermittent adjunctive treatment with HFPV in patients with severe pneumonia due to infection with SARS-CoV-2 improved lung function and may have prevented clinical deterioration. However, recommendations on the use of intermittent HFPV as an adjunctive treatment in COVID-19 pneumonia requires large-scale controlled clinical studies. In the pandemic context, with a shortage of ICU beds, avoiding ICU admission by using adjunctive therapies on the ward is a useful option.
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Affiliation(s)
- Sergey P. Marchenko
- Department of Cardiac Surgery, Pavlov First St. Petersburg Medical University, St. Petersburg, Russian Federation
| | - Ecaterina Scarlatescu
- Department of Anaesthesia and Intensive Care Medicine III, Fundeni Clinical Institute, Bucharest, Romania
| | | | - Alexey Naumov
- Department of Cardiac Surgery, Pavlov First St. Petersburg Medical University, St. Petersburg, Russian Federation
| | - Sergey Bognenko
- Department of Cardiac Surgery, Pavlov First St. Petersburg Medical University, St. Petersburg, Russian Federation
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Lucangelo U, Ajčević M, Lena E, Ferluga M, Comuzzi L, Accardo A, Zin WA. On some factors determining the pressure drop across tracheal tubes during high-frequency percussive ventilation: a flow-independent model. J Clin Monit Comput 2020; 35:885-890. [PMID: 32588314 PMCID: PMC7316425 DOI: 10.1007/s10877-020-00548-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/11/2020] [Indexed: 11/29/2022]
Abstract
To provide an in vitro estimation of the pressure drop across tracheal tubes (ΔPTT) in the face of given pulsatile frequencies and peak pressures (Pwork) delivered by a high-frequency percussive ventilator (HFPV) applied to a lung model. Tracheal tubes (TT) 6.5, 7.5 and 8.0 were connected to a test lung simulating the respiratory system resistive (R = 5, 20, 50 cmH2O/L/s) and elastic (C = 10, 20, and 50 mL/cmH2O) loads. The model was ventilated by HFPV with a pulse inspiratory peak pressure (work pressure Pwork) augmented in 5-cmH2O steps from 20 to 45 cmH2O, yielding 6 diverse airflows. The percussive frequency (f) was set to 300, 500 and 700 cycles/min, respectively. Pressure (Paw and Ptr) and flow (V’) measurements were performed for all 162 possible combinations of loads, frequencies, and work pressures for each TT size, thus yielding 486 determinations. For each respiratory cycle ΔPTT was calculated by subtracting each peak Ptr from its corresponding peak Paw. A non-linear model was constructed to assess the relationships between single parameters. Performance of the produced model was measured in terms of root mean square error (RMSE) and the coefficient of determination (r2). ΔPTT was predicted by Pwork (exponential Gaussian relationship), resistance (quadratic and linear terms), frequency (quadratic and linear terms) and tube diameter (linear term), but not by compliance. RMSE of the model on the testing dataset was 1.17 cmH2O, r2 was 0.79 and estimation error was lower than 1 cmH2O in 68% of cases. As a result, even without a flow value, the physician would be able to evaluate ΔPTT pressure. If the present results of our bench study could be clinically confirmed, the use of a nonconventional ventilatory strategy as HFPV, would be safer and easier.
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Affiliation(s)
- Umberto Lucangelo
- Department of Perioperative Medicine, Intensive Care and Emergency, University of Trieste, Trieste, Italy
| | - Miloš Ajčević
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy.
| | - Enrico Lena
- Department of Perioperative Medicine, Intensive Care and Emergency, University of Trieste, Trieste, Italy
| | - Massimo Ferluga
- Department of Perioperative Medicine, Intensive Care and Emergency, University of Trieste, Trieste, Italy
| | - Lucia Comuzzi
- Department of Perioperative Medicine, Intensive Care and Emergency, University of Trieste, Trieste, Italy
| | - Agostino Accardo
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Walter A Zin
- Carlos Chagas Filho Institute of Biophysics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Gerard SE, Herrmann J, Kaczka DW, Musch G, Fernandez-Bustamante A, Reinhardt JM. Multi-resolution convolutional neural networks for fully automated segmentation of acutely injured lungs in multiple species. Med Image Anal 2020; 60:101592. [PMID: 31760194 PMCID: PMC6980773 DOI: 10.1016/j.media.2019.101592] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/09/2019] [Accepted: 10/25/2019] [Indexed: 12/27/2022]
Abstract
Segmentation of lungs with acute respiratory distress syndrome (ARDS) is a challenging task due to diffuse opacification in dependent regions which results in little to no contrast at the lung boundary. For segmentation of severely injured lungs, local intensity and texture information, as well as global contextual information, are important factors for consistent inclusion of intrapulmonary structures. In this study, we propose a deep learning framework which uses a novel multi-resolution convolutional neural network (ConvNet) for automated segmentation of lungs in multiple mammalian species with injury models similar to ARDS. The multi-resolution model eliminates the need to tradeoff between high-resolution and global context by using a cascade of low-resolution to high-resolution networks. Transfer learning is used to accommodate the limited number of training datasets. The model was initially pre-trained on human CT images, and subsequently fine-tuned on canine, porcine, and ovine CT images with lung injuries similar to ARDS. The multi-resolution model was compared to both high-resolution and low-resolution networks alone. The multi-resolution model outperformed both the low- and high-resolution models, achieving an overall mean Jacaard index of 0.963 ± 0.025 compared to 0.919 ± 0.027 and 0.950 ± 0.036, respectively, for the animal dataset (N=287). The multi-resolution model achieves an overall average symmetric surface distance of 0.438 ± 0.315 mm, compared to 0.971 ± 0.368 mm and 0.657 ± 0.519 mm for the low-resolution and high-resolution models, respectively. We conclude that the multi-resolution model produces accurate segmentations in severely injured lungs, which is attributed to the inclusion of both local and global features.
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Affiliation(s)
- Sarah E Gerard
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Jacob Herrmann
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA; Department of Anesthesia, University of Iowa, Iowa City, IA, USA
| | - David W Kaczka
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA; Department of Radiology, University of Iowa, Iowa City, IA, USA; Department of Anesthesia, University of Iowa, Iowa City, IA, USA
| | - Guido Musch
- Department of Anesthesiology, Washington University, St. Louis, MO, USA
| | | | - Joseph M Reinhardt
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA; Department of Radiology, University of Iowa, Iowa City, IA, USA.
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Albecker D, Glen Bouder T, Franklin Lewis B. High frequency percussive ventilation as a rescue mode for refractory status asthmaticus - a case study. J Asthma 2019; 58:340-343. [PMID: 31668108 DOI: 10.1080/02770903.2019.1687714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION A severe asthma exacerbation is called status asthmaticus when symptoms worsen despite conventional medical treatment in the hospital. If arterial blood gas (ABG) values deteriorate and this is accompanied by respiratory muscle fatigue, the patient will require mechanical ventilation. However, mechanical ventilation of the severe asthmatic presents difficult challenges. CASE STUDY We report on High Frequency Percussive Ventilation (HFPV) used along with continuous inhaled albuterol and neuromuscular blockade, as rescue therapy for a case of acute, severe asthma that was refractory to conventional treatment and conventional mechanical ventilation. RESULTS This patient's arterial pH was 6.97 when we initiated HFPV, but ten hours post-intubation her ABG values normalized. She was successfully extubated six days later and discharged from ICU the following day. CONCLUSION This case describes the successful use of HFPV for a status asthmaticus patient failing conventional mechanical ventilation. We have anecdotal evidence of other medical centers using HFPV for these patients but larger studies are needed to verify its efficacy.
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Herrmann J, Tawhai MH, Kaczka DW. Strain, strain rate, and mechanical power: An optimization comparison for oscillatory ventilation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3238. [PMID: 31318162 PMCID: PMC6785367 DOI: 10.1002/cnm.3238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/07/2019] [Accepted: 07/14/2019] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to assess the potential for optimization of mechanical ventilator waveforms using multiple frequencies of oscillatory flow delivered simultaneously to minimize the risk of ventilator-induced lung injury (VILI) associated with regional strain, strain rate, and mechanical power. Optimization was performed using simulations of distributed oscillatory flow and gas transport in a computational model of anatomically derived branching airway segments and viscoelastic terminal acini under healthy and injured conditions. Objective functions defined by regional strain or strain rate were minimized by single-frequency ventilation waveforms using the highest or lowest frequencies available, respectively. However, a mechanical power objective function was minimized by a combination of multiple frequencies delivered simultaneously. This simulation study thus demonstrates the potential for multifrequency oscillatory ventilation to reduce regional mechanical power in comparison to single-frequency ventilation, and thereby reduce the risk of VILI.
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Affiliation(s)
- Jacob Herrmann
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
- Department of Anesthesia, University of Iowa, Iowa City, Iowa, USA
| | - Merryn H. Tawhai
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - David W. Kaczka
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
- Department of Anesthesia, University of Iowa, Iowa City, Iowa, USA
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
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Lan CC, Huang HK, Wu CP, Tu CC, Huang TW, Tsai WC, Tseng NC, Chang H. Recruitment maneuver leads to increased expression of pro-inflammatory cytokines in acute respiratory distress syndrome. Respir Physiol Neurobiol 2019; 271:103284. [PMID: 31472287 DOI: 10.1016/j.resp.2019.103284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/18/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is a disease with high morbidity and mortality rates. The recruitment maneuver (RM) is one of the interventions used for ARDS patients suffering from severe hypoxemia. RM works by opening the atelectatic lungs using high transpulmonary pressure. RM has therefore been widely used for many years in patients with ARDS. However, because of the high transpulmonary pressure used in this intervention, there are concerns about both biotrauma and hemodynamic instability. To assess the effects of RM in ARDS, we conducted a study using three groups of pigs (n = 6 in each group): group I (control), group II (ARDS), and group III (ARDS with RM). After measuring the baseline values, ARDS was induced by deactivating the surfactant with 5% Tweens lavage. For pigs of group III, the RM protocol used was positive end-expiratory pressure (PEEP) of 25 cmH2O and peak pressure of 45 cmH2O. Gas exchange, hemodynamics, the expression of cytokines in serum, bronchoalveolar lavage fluid (BALF), and exhaled breath condensates (EBCs) were measured. The baseline measurements taken were similar across the three groups, and no significant difference was noted. After the induction of ARDS, PaO2 substantially decreased, while PaCO2, alveolar-arterial O2 gradient, pulmonary arterial pressure, lung water, level of cytokines in serum, EBCs, and BALF all increased. After RM, gas exchange and lung water level improved, but the level of cytokines in EBCs and BALF increased. Although RM led to an improvement in gas exchange, it may cause release of inflammatory cytokines in the EBCs and BALF.
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Affiliation(s)
- Chou-Chin Lan
- Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan; School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Hsu-Kai Huang
- Department of Thoracic Surgery, Tri-Service General Hospital Taipei, National Defense Medical Center, Taiwan
| | - Chin-Pyng Wu
- Department of Critical Care Medicine, Landseed International Hospital, Tao-Yuan City, Taiwan
| | - Chuan-Chou Tu
- Department of Chest medicine, Taichung armed forces general hospital, National Defense Medical Center, Taiwan
| | - Tsai-Wang Huang
- Department of Thoracic Surgery, Tri-Service General Hospital Taipei, National Defense Medical Center, Taiwan
| | - Wen-Chiuan Tsai
- Department of Pathology, Tri-Service General Hospital Taipei, National Defense Medical Center, Taiwan
| | - Neng-Chuan Tseng
- Department of Nuclear Medicine, Taichung armed forces general hospital, Taiwan.
| | - Hung Chang
- Department of Thoracic Surgery, Tri-Service General Hospital Taipei, National Defense Medical Center, Taiwan.
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Ramin S, Charbit J, Jaber S, Capdevila X. Acute respiratory distress syndrome after chest trauma: Epidemiology, specific physiopathology and ventilation strategies. Anaesth Crit Care Pain Med 2019; 38:265-276. [DOI: 10.1016/j.accpm.2018.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 01/07/2023]
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13
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Spapen H, De Regt J, van Gorp V, Honoré PM. High-frequency percussive ventilation in acute respiratory distress syndrome: knocking at the door but can it be let in? Crit Care 2018; 22:55. [PMID: 29499761 PMCID: PMC5834875 DOI: 10.1186/s13054-018-1982-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/07/2018] [Indexed: 11/24/2022] Open
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14
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Oribabor C, Gulkarov I, Khusid F, Ms EF, Esan A, Rizzuto N, Tortolani A, Dattilo PA, Suen K, Ugwu J, Kenney B. The use of high-frequency percussive ventilation after cardiac surgery significantly improves gas exchange without impairment of hemodynamics. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2018; 54:58-61. [PMID: 30996643 PMCID: PMC6422108 DOI: 10.29390/cjrt-2018-013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Respiratory failure represents a significant source of morbidity and mortality for surgical patients. High-frequency percussive ventilation (HFPV) is emerging as a potentially effective rescue therapy in patients failing conventional mechanical ventilation (CMV). Use of HFPV is often limited by concerns for potential effects on hemodynamics, which is particularly tenuous in patients immediately after cardiac surgery. In this manuscript we evaluated the effects of HFPV on gas exchange and cardiac hemodynamics in the immediate postoperative period after cardiac surgery, in comparison with CMV. Methods Twenty-four consecutive cardiac surgery patients were ventilated in immediate postoperative period with HFPV for two to four hours, then they switched to a CMV using the adaptive support ventilation mode for weaning. Arterial blood gases were performed during the first and second hour on HFPV, and at 45 minutes after initiation of CMV. Respiratory settings and invasive hemodynamic data (mixed venous oxygen saturation, central venous pressure, systemic and pulmonary blood pressure, cardiac output and index) were collected utilizing right heart pulmonary catheter and arterial lines during HFPV and CMV. Primary outcome was improvement in the ratio between partial pressure of oxygen to fraction of inspired oxygen (P/F ratio) and changes in hemodynamics. Results Analysis of data for 24 patients revealed a significantly better P/F ratio during the first and second hour on HFPV, compared with a P/F ratio on CMV (420.0 ± 158.8, 459.2 ± 138.5, and 260.2 ± 98.5 respectively, p < 0.05), suggesting much better gas exchange on HFPV than on CMV. Hemodynamics were not affected by the mode of the ventilation. Conclusions Improvement in gas exchange, reflected in a significantly improved P/F ratio, wasn't accompanied by worsening in hemodynamic parameters. The significant gains in the P/F ratio were lost when patients were switched to conventional ventilation. This data suggest that HFPV provides significantly better gas exchange compared with CMV and can be safely utilized in postoperative cardiac patients without any significant effect on hemodynamics.
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Affiliation(s)
- Charles Oribabor
- Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Iosif Gulkarov
- Department of Cardiothoracic Surgery, Staten Island University Hospital Staten Island, NY, USA
| | - Felix Khusid
- Department of Respiratory Therapy, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Emma Fischer Ms
- Department of Respiratory Therapy, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Adebayo Esan
- Department of Medicine, Hanover Hospital, Hanover, PA, USA
| | - Nancy Rizzuto
- Department of Nursing, Brooklyn University Hospital and Medical Center, Brooklyn, NY, USA
| | - Anthony Tortolani
- Department of Surgery, Brooklyn University Hospital and Medical Center, Brooklyn, NY, USA
| | - Paris Ayanna Dattilo
- Department of Emergency Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Kaki Suen
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Justin Ugwu
- Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Brent Kenney
- Department of Respiratory Therapy, Mercy Hospital Springfield, Springfield, MO, USA
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15
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Godet T, Jabaudon M, Blondonnet R, Tremblay A, Audard J, Rieu B, Pereira B, Garcier JM, Futier E, Constantin JM. High frequency percussive ventilation increases alveolar recruitment in early acute respiratory distress syndrome: an experimental, physiological and CT scan study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:3. [PMID: 29325586 PMCID: PMC5763966 DOI: 10.1186/s13054-017-1924-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/13/2017] [Indexed: 01/27/2023]
Abstract
Background High frequency percussive ventilation (HFPV) combines diffusive (high frequency mini-bursts) and convective ventilation patterns. Benefits include enhanced oxygenation and hemodynamics, and alveolar recruitment, while providing hypothetic lung-protective ventilation. No study has investigated HFPV-induced changes in lung aeration in patients with early acute respiratory distress syndrome (ARDS). Methods Eight patients with early non-focal ARDS were enrolled and five swine with early non-focal ARDS were studied in prospective computed tomography (CT) scan and animal studies, in a university-hospital tertiary ICU and an animal laboratory. Patients were optimized under conventional “open-lung” ventilation. Lung CT was performed using an end-expiratory hold (Conv) to assess lung morphology. HFPV was applied for 1 hour to all patients before new CT scans were performed with end-expiratory (HFPV EE) and end-inspiratory (HFPV EI) holds. Lung volumes were determined after software analysis. At specified time points, blood gases and hemodynamic data were collected. Recruitment was defined as a change in non-aerated lung volumes between Conv, HFPV EE and HFPV EI. The main objective was to verify whether HFPV increases alveolar recruitment without lung hyperinflation. Correlation between pleural, upper airways and HFPV-derived pressures was assessed in an ARDS swine-based model. Results One-hour HFPV significantly improved oxygenation and hemodynamics. Lung recruitment significantly rose by 12.0% (8.5–18.0%), P = 0.05 (Conv-HFPV EE) and 12.5% (9.3–16.8%), P = 0.003 (Conv-HFPV EI). Hyperinflation tended to increase by 2.0% (0.5–2.5%), P = 0.89 (Conv-HFPV EE) and 3.0% (2.5–4.0%), P = 0.27 (Conv-HFPV EI). HFPV hyperinflation correlated with hyperinflated and normally-aerated lung volumes at baseline: r = 0.79, P = 0.05 and r = 0.79, P = 0.05, respectively (Conv-HFPV EE); and only hyperinflated lung volumes at baseline: r = 0.88, P = 0.01 (Conv-HFPV EI). HFPV CT-determined tidal volumes reached 5.7 (1.1–8.1) mL.kg-1 of ideal body weight (IBW). Correlations between pleural and HFPV-monitored pressures were acceptable and end-inspiratory pleural pressures remained below 25cmH20. Conclusions HFPV improves alveolar recruitment, gas exchanges and hemodynamics of patients with early non-focal ARDS without relevant hyperinflation. HFPV-derived pressures correlate with corresponding pleural or upper airways pressures. Trial registration ClinicalTrials.gov, NCT02510105. Registered on 1 June 2015. The trial was retrospectively registered. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1924-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas Godet
- Departement de Médecine Périopératoire (MPO), Hôpital Estaing, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 place Lucie Aubrac, Clermont-Ferrand, F-63003, France.,Université Clermont Auvergne, Laboratoire Universitaire GReD, UMR/CNRS 6293, INSERM U1103, Clermont-Ferrand, F-63003, France
| | - Matthieu Jabaudon
- Departement de Médecine Périopératoire (MPO), Hôpital Estaing, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 place Lucie Aubrac, Clermont-Ferrand, F-63003, France.,Université Clermont Auvergne, Laboratoire Universitaire GReD, UMR/CNRS 6293, INSERM U1103, Clermont-Ferrand, F-63003, France
| | - Raïko Blondonnet
- Departement de Médecine Périopératoire (MPO), Hôpital Estaing, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 place Lucie Aubrac, Clermont-Ferrand, F-63003, France.,Université Clermont Auvergne, Laboratoire Universitaire GReD, UMR/CNRS 6293, INSERM U1103, Clermont-Ferrand, F-63003, France
| | - Aymeric Tremblay
- Département d'Anesthésie et de Réanimation, Centre Hospitalier Universitaire (CHU) Saint-Etienne, Saint-Etienne, F-42000, France
| | - Jules Audard
- Departement de Médecine Périopératoire (MPO), Hôpital Estaing, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 place Lucie Aubrac, Clermont-Ferrand, F-63003, France.,Université Clermont Auvergne, Laboratoire Universitaire GReD, UMR/CNRS 6293, INSERM U1103, Clermont-Ferrand, F-63003, France
| | - Benjamin Rieu
- Departement de Médecine Périopératoire (MPO), Hôpital Estaing, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 place Lucie Aubrac, Clermont-Ferrand, F-63003, France
| | - Bruno Pereira
- Délégation à la Recherche Clinique et à l'Innovation (DRCI), Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, F-63000, France
| | - Jean-Marc Garcier
- Département de Radiologie, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, F-63003, France
| | - Emmanuel Futier
- Departement de Médecine Périopératoire (MPO), Hôpital Estaing, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 place Lucie Aubrac, Clermont-Ferrand, F-63003, France.,Université Clermont Auvergne, Laboratoire Universitaire GReD, UMR/CNRS 6293, INSERM U1103, Clermont-Ferrand, F-63003, France
| | - Jean-Michel Constantin
- Departement de Médecine Périopératoire (MPO), Hôpital Estaing, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 place Lucie Aubrac, Clermont-Ferrand, F-63003, France. .,Université Clermont Auvergne, Laboratoire Universitaire GReD, UMR/CNRS 6293, INSERM U1103, Clermont-Ferrand, F-63003, France.
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