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Research ArticleOriginal Research

Shortened Automatic Lung Recruitment Maneuvers in an in vivo model of Neonatal Acute Respiratory Distress Syndrome. A new pathway to consider.

Verónica Guilló-Moreno, Alberto Gutiérrez-Martínez, Clara Serrano-Zueras, Martín Santos-González, Antonio Romero-Berrocal and Javier García-Fernández
Respiratory Care November 2022, respcare.10438; DOI: https://doi.org/10.4187/respcare.10438
Verónica Guilló-Moreno
Department of Anaesthesiology, Intensive Care and Pain, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain.
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  • For correspondence: [email protected]
Alberto Gutiérrez-Martínez
Department of Anaesthesiology, Intensive Care and Pain, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain.
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Clara Serrano-Zueras
Department of Anaesthesiology, Intensive Care and Pain, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain.
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Martín Santos-González
Medical and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana. Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain.
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Antonio Romero-Berrocal
Department of Anaesthesiology, Intensive Care and Pain, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain.
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Javier García-Fernández
Department of Anaesthesiology, Intensive Care and Pain, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain.
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Abstract

Background: The aim of this study is to assess the safety and efficacy of two protocols of automatic lung recruitment maneuver through stepwise increasing PEEP method, in a neonatal Acute Respiratory Distress Syndrome (ARDS) model. These protocols were designed with lower maximum opening pressures than traditional ones and differ each one in the duration of the opening phases (Fast vs Slow). We described hemodynamic changes through invasive monitoring and we analyzed if the behaviour of the variables depends on the duration of the opening phase of the LRM.

Methods: We designed a prospective, experimental study with 10 Landrace x Large White pigs with less than 48 hours old. Under general anesthesia, tracheal intubation, invasive hemodynamic monitoring with a pediatric arterial thermodilution catheter, was performed. ARDS model was developed with bronco-alveolar lavages. Two types of lung recruitment maneuver (LRM) performed in each piglet, with maximum peak inspiratory pressure (PIP) of 30cm H2O and PEEP 15cm H2O applied during: 8.5 seconds in the Fast LRM-type1 and 17 seconds in the Slow LRM-type 2. A comparative analysis by virtue of the Wilcoxon signed-rank test and a regression analysis using generalized estimation equation was performed.

Results: Both lung recruitment maneuver types have shown to be effective when it comes to oxygenation and respiratory mechanics. Shortening the duration of the opening branch and lowering the maximum opening pressures to PIP 30 and PEEP 15 cm H2O overpass the critical opening pressure to reverse alveoli collapse in our neonatal ARDS model. Although during both types of LRMs we observed hemodynamic variations, these were well tolerated.

Conclusions: Our LRM protocols overpass the critical opening pressure to reverse alveoli collapse in our neonatal ARDS model. This range of pressures might involve less hemodynamic disturbance. Duration of the maximum opening pressure step is a determining factor for hemodynamic alterations.

  • Acute Respiratory Distress Syndrome (ARDS)
  • Neonates
  • Lung Recruitment Maneuver (LRM)
  • Mechanical Ventilation
  • Hemodynamic
  • Safety

Footnotes

  • Corresponding Author:
    Verónica Guilló-Moreno MD, Department of Anesthesiology, Intensive Care and Pain, Hospital Universitario Puerta de Hierro-Majadahonda. C/Joaquin Rodrigo 1, 28222 Majadahonda, Spain. e-mail address: veronica.guillom{at}gmail.com
  • Received July 22, 2022.
  • Accepted November 15, 2022.
  • Copyright © 2022 by Daedalus Enterprises

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Respiratory Care: 68 (2)
Respiratory Care
Vol. 68, Issue 2
1 Feb 2023
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Shortened Automatic Lung Recruitment Maneuvers in an in vivo model of Neonatal Acute Respiratory Distress Syndrome. A new pathway to consider.
Verónica Guilló-Moreno, Alberto Gutiérrez-Martínez, Clara Serrano-Zueras, Martín Santos-González, Antonio Romero-Berrocal, Javier García-Fernández
Respiratory Care Nov 2022, respcare.10438; DOI: 10.4187/respcare.10438

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Shortened Automatic Lung Recruitment Maneuvers in an in vivo model of Neonatal Acute Respiratory Distress Syndrome. A new pathway to consider.
Verónica Guilló-Moreno, Alberto Gutiérrez-Martínez, Clara Serrano-Zueras, Martín Santos-González, Antonio Romero-Berrocal, Javier García-Fernández
Respiratory Care Nov 2022, respcare.10438; DOI: 10.4187/respcare.10438
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Keywords

  • Acute Respiratory Distress Syndrome (ARDS)
  • Neonates
  • Lung Recruitment Maneuver (LRM)
  • mechanical ventilation
  • Hemodynamic
  • Safety

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