Carbon dioxide clearance using bubble CPAP with superimposed high-frequency oscillations in a premature infant lung model with abnormal lung mechanics.

Abstract:

BACKGROUND:High-frequency (HF) oscillatory ventilation has been shown to improve carbon dioxide (CO2 ) clearance in premature infants. In a previous in vitro lung model with normal lung mechanics we demonstrated significantly improved CO2 washout by HF oscillation of bubble continuous positive airway pressure (BCPAP). OBJECTIVE:To examine CO2 clearance in a premature infant lung model with abnormal lung mechanics via measurement of end-tidal CO2 levels (EtCO2 ) while connected to HF oscillated BCPAP. DESIGN AND METHODS:A 40 mL premature infant lung model with either: normal lung mechanics (NLM): compliance 1.0 mL/cm H2 O, airway resistance 56 cm H2 O/(L/s); or abnormal lung mechanics (ALM): compliance 0.5 mL/cm H2 O, airway resistance 136 cm H2 O/(L/s), was connected to BCPAP with HF oscillation at either 4, 6, 8, 10, or 12 Hz. EtCO2 was measured at BCPAPs of 4, 6, and 8 cm H2 O and respiratory rates (RR) of 40, 60, and 80 breaths/min and 6 mL tidal volume. RESULTS:HF oscillation decreased EtCO2 levels at all BCPAPs, RRs, and oscillation frequencies for both lung models. Overall mean ± SD EtCO2 levels decreased (P < .001) from nonoscillated baseline by 19.3 ± 10.2% for NLM vs 14.1 ± 8.8% for ALM. CO2 clearance improved for both lung models (P < .001) as a function of oscillation frequency and RR with greatest effectiveness at 40 to 60 breaths/min and HF at 8 to 12 Hz. CONCLUSIONS:In this in vitro premature infant lung model, HF oscillation of BCPAP was associated with improved CO2 clearance as compared with nonoscillated BCPAP for both NLM and ALM. The significant improvement in CO2 clearance in an abnormal lung environment is an important step towards clinical testing of this novel respiratory support modality.

journal_name

Pediatr Pulmonol

journal_title

Pediatric pulmonology

authors

Sivieri EM,Eichenwald EC,Rub D,Abbasi S

doi

10.1002/ppul.25040

subject

Has Abstract

pub_date

2020-11-01 00:00:00

pages

3189-3196

issue

11

eissn

8755-6863

issn

1099-0496

journal_volume

55

pub_type

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