Effects of different flow patterns and end-inspiratory pause on oxygenation and ventilation in newborn piglets: an experimental study

摘要

Background Historically, the elective ventilatory flow pattern for neonates has been decelerating flow (DF). Decelerating flow waveform has been suggested to improve gas exchange in the neonate when compared with square flow (SF) waveform by improving the ventilation perfusion. However, the superiority of DF compared with SF has not yet been demonstrated during ventilation in small infants. The aim of this study was to compare SF vs. DF, with or without end-inspiratory pause (EIP), in terms of oxygenation and ventilation in an experimental model of newborn piglets. Methods The lungs of 12 newborn Landrace/LargeWhite crossbred piglets were ventilated with SF, DF, SF-EIP and DF-EIP. Tidal volume (VT), inspiratory to expiratory ratio (I/E), respiratory rate (RR), and FiO₂ were keep constant during the study. In order to assure an open lung during the study while preventing alveolar collapse, a positive end-expiratory pressure (PEEP) of 6 cmH₂O was applied after a single recruitment maneuver. Gas exchange, lung mechanics and hemodynamics were measured. Results The inspiratory flow waveform had no effect on arterial oxygenation pressure (PaO₂) (276 vs. 278?mmHg, p = 0.77), alveolar dead space to alveolar tidal volume (VDalv/VTalv) (0.21 vs. 0.19?ml, p = 0.33), mean airway pressure (Pawm) (13.1 vs. 14.0 cmH₂O, p = 0.69) and compliance (Crs) (3.5 vs. 3.5?ml cmH₂O?1, p = 0.73) when comparing SF and DF. A short EIP (10%) did not produce changes in the results. Conclusion The present study showed that there are no differences between SF, DF, SF-EIP and DF-EIP in oxygenation, ventilation, lung mechanics, or hemodynamics in this experimental model of newborn piglets with healthy lungs.