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The distribution of lung aeration at different positive end-expiratory pressure levels in newborn rabbits

Melissa Siew, Marcus Kitchen, Arjan te Pas, Megan Wallace, Muhammad Islam, Naoto Yagi, Kentaro Uesugi, Stuart Hooper
European Respiratory Journal 2011 38: 1921; DOI:
Melissa Siew
1The Ritchie Centre, Monash Institute of Medical Research, Clayton, Victoria, Australia
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Marcus Kitchen
2School of Physics, Monash University, Clayton, Victoria, Australia
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Arjan te Pas
3Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, Netherlands
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Megan Wallace
1The Ritchie Centre, Monash Institute of Medical Research, Clayton, Victoria, Australia
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Muhammad Islam
2School of Physics, Monash University, Clayton, Victoria, Australia
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Naoto Yagi
4SPring-8, JASRI, Hyogo, Japan
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Kentaro Uesugi
4SPring-8, JASRI, Hyogo, Japan
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Stuart Hooper
1The Ritchie Centre, Monash Institute of Medical Research, Clayton, Victoria, Australia
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Abstract

Background: Very preterm newborns with respiratory distress at birth demonstrate increased end-expiratory lung volumes when ventilated with positive end-expiratory pressure (PEEP). However, the regional distribution of ventilation is unknown, especially if PEEP is not held constant but altered as occurs during face mask removal.

Aim: To determine the how the distribution of ventilation changes between different PEEPs

Method: Rabbit pups (28dGA) were delivered by c-section and mechanically ventilated with a peak inflation pressure of 35cmH2O and a sequence of PEEP. The PEEP sequences were (A) 0-5-10-5-0cmH2O, (B) 5-10-0-5-0cmH2O and (C) 10-5-0-10-0cmH2O. Phase contrast X-ray imaging was used to image and analyse the distribution of aeration.

Results: In sequence A and B, upper lobes (U) were more aerated than lower lobes (L) at functional residual capacity (FRC) throughout the ventilation period (A: 10PEEP U vs L - 70.5±2.9% vs 55.7±3.3%, p<0.05; B: 10PEEP U vs L - 70.9±1.5% vs 56.8±2.8%, p<0.05). Tidal volume (VT) aerated U and L similarly until the volume of the lungs at peak inflation (VPIP) achieved >70% of maximal lung volume (p>0.05). Once VPIP was >70%, VT aerated L more than U (A: U vs L; 22.3±3.7% vs 30.3±3.6%, p<0.05; B: U vs L; 20.4±1.6% vs 26.9±1.7%, p<0.05). Sequence C ventilated differently; FRC was only different between lobes at 0PEEP (p>0.05) and VT lacked difference at 10PEEP despite VPIP >70% (p<0.05).

Conclusion: At FRC, U are better aerated than L at different PEEP levels. During inflation, the VT was distributed more to lower lobes than upper lobes after the lungs were fully aerated. This is not observed if lungs were initially aerated with a very high PEEP.

  • © 2011 ERS
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The distribution of lung aeration at different positive end-expiratory pressure levels in newborn rabbits
Melissa Siew, Marcus Kitchen, Arjan te Pas, Megan Wallace, Muhammad Islam, Naoto Yagi, Kentaro Uesugi, Stuart Hooper
European Respiratory Journal Sep 2011, 38 (Suppl 55) 1921;

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The distribution of lung aeration at different positive end-expiratory pressure levels in newborn rabbits
Melissa Siew, Marcus Kitchen, Arjan te Pas, Megan Wallace, Muhammad Islam, Naoto Yagi, Kentaro Uesugi, Stuart Hooper
European Respiratory Journal Sep 2011, 38 (Suppl 55) 1921;
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More in this TOC Section

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  • Appropriate level of volume targeting for ventilated infants born at or near term
Show more 240. Resuscitation and ventilation in the baby and infant

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