Protective ventilation strategies in the management of phosgene-induced acute lung injury
| Autor: | BJ Jugg, Fraser M. Harban, John Jenner, R. F. R. Brown, Christopher E. Kenward, Jan Platt, DA Parkhouse, Paul Rice, Adam J. Smith |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
medicine.medical_specialty
Swine medicine.medical_treatment chemistry.chemical_element Lung injury Oxygen Intermittent Positive-Pressure Ventilation Positive-Pressure Respiration chemistry.chemical_compound Random Allocation medicine Tidal Volume Animals Chemical Warfare Agents Antidote Phosgene Tidal volume Positive end-expiratory pressure Respiratory Distress Syndrome business.industry Public Health Environmental and Occupational Health General Medicine Pulmonary edema medicine.disease Respiration Artificial Surgery chemistry Anesthesia Models Animal Breathing Female business Pulmonary Ventilation |
| Zdroj: | Military medicine. 172(3) |
| ISSN: | 0026-4075 |
| Popis: | Phosgene is a chemical widely used in the plastics industry and has been used in warfare. It produces a life-threatening pulmonary edema within hours of exposure, to which no specific antidote exists. This study aims to examine the pathophysiological changes seen with low tidal volume ventilation (protective ventilation (PV)) strategies compared to conventional ventilation (CV), in a model of phosgene-induced acute lung injury. Anesthetized pigs were instrumented and exposed to phosgene (concentration x time (Ct), 2,350 mg x min x m(-3)) and then ventilated with intermittent positive pressure ventilation (tidal volume (TV) = 10 ml x kg(-1); positive end expiratory pressure, 3 cm H2O; frequency, 20 breaths x min(-1); fractional concentration of inspired oxygen, 0.24), monitored for 6 hours after exposure, and then randomized into treatment groups: CV, PV (A) or (B) (TV, 8 or 6 ml x kg(-1); positive end expiratory pressure, 8 cm H2O; frequency, 20 or 25 breaths x min(-1); fractional concentration of inspired oxygen, 0.4). Pathophysiological parameters were measured for up to 24 hours. The results show that PV resulted in improved oxygenation, decreased shunt fraction, and mortality, with all animals surviving to 24 hours compared to only three of the CV animals. Microscopy confirmed reduced hemorrhage, neutrophilic infiltration, and intra-alveolar edema. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|