Optimization of lung ventilation and perfusion in anesthetized horses using a ventilation mode with flow-limited expiration.

Autor:	Araos J; Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY., Driessen B; Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA., Brandly J; Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA., Gorenberg E; Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA., Heerdt P; Department of Anesthesiology, Yale School of Medicine, New Haven, CT., Bruhn A; Department of Intensive Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile., Martin-Flores M; Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY., Adler A; Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada., Hopster K; Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA.
Jazyk:	angličtina
Zdroj:	American journal of veterinary research [Am J Vet Res] 2023 Dec 18, pp. 1-8. Date of Electronic Publication: 2023 Dec 18.
DOI:	10.2460/ajvr.23.09.0200
Abstrakt:	Objective: To investigate the mechanisms underlying the improved arterial oxygenation described with flow-limited expiration (FLEX) ventilation in anesthetized horses. Animals: 5 healthy adult research horses. Methods: Horses underwent volume-controlled ventilation for 60 minutes (VCV1), followed by 60 minutes of FLEX, and 30 minutes of VCV (VCV2). Main outcomes included the arterial partial pressure of oxygen-to-Fio2 (PF) ratio and electrical impedance tomography (EIT)-derived functional indices at the end of each phase. The EIT data were used to create regional maps of relative lung ventilation and perfusion as well as regional maps of ventilation/perfusion (V/Q) ratios. Ventilation indices derived from EIT included the fraction of expired volume in 1 second (FEV1; %) and the time it took for the EIT signal to drop to 50% of the peak signal at end-inspiration (TClose50; seconds). Data were analyzed with 2-way ANOVA for repeated measures. P < .05 was considered significant. Results: The PF ratio increased significantly with FLEX compared to both VCV1 and VCV2 (P < .01). There were no differences in the relative distribution of ventilation nor perfusion between ventilation strategies. However, when ventilation and perfusion were superimposed and V/Q ratio maps were constructed, FLEX had a homogenizing effect toward values of 1.0. The FEV1 was shorter (P < .01) and the TClose50 was longer (P < .001) in all regions during FLEX compared to both VCV1 and VCV2. Clinical Relevance: Our findings suggest that FLEX ventilation in anesthetized horses enhances regional V/Q matching, likely by prolonging expiratory aeration and reducing airway closure.
Databáze:	MEDLINE
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