Comparison of Airway Pressure Release Ventilation to Conventional Mechanical Ventilation in the Early Management of Smoke Inhalation Injury in Swine
Abstract
Objective: The role of airway pressure release ventilation in the management of early smoke inhalation injury has not been studied. We compared the effects of airway pressure release ventilation and conventional mechanical ventilation on oxygenation in a porcine model of acute respiratory distress syndrome induced by wood smoke inhalation. Design: Prospective animal study. Setting: Government laboratory animal intensive care unit. Patients: Thirty-three Yorkshire pigs. Interventions: Smoke inhalation injury. Measurements and Main Results: Anesthetized female Yorkshire pigs (n=3) inhaled room-temperature pine-bark smoke. Before injury, the pigs were randomized to receive conventional mechanical ventilation (n=5) or airway pressure release ventilation (n=2) for 48 hrs after smoke inhalation. As acute respiratory distress syndrome developed (PaO2/FIO2 ratio <200), plateau pressures were limited to <35 cm H2O. Six uninjured pigs received conventional mechanical ventilation for 48 hrs and served as time controls. Changes in PaO2/FIO2 ratio, tidal volume, respiratory rate, mean airway pressure, plateau pressure, and hemodynamic variables were recorded. Survival was assessed using Kaplan- Meier analysis. PaO2/FIO2 ratio was lower in airway pressure release ventilation vs. conventional mechanical ventilation pigs at 12, 18, and 24 hrs (p<.05) but not at 48 hrs. Tidal volumes were lower in conventional mechanical ventilation animals between 30 and 48 hrs post injury (p < .05). Respiratory rates were lower in airway pressure release ventilation at 24, 42, and 48 hrs (p < .05). Mean airway pressures were higher in airway pressure release ventilation animals between 6 and 48 hrs (p < .05). There was no difference in plateau pressures, hemodynamic variables, or survival between conventional mechanical ventilation and airway pressure release ventilation pigs.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jan 01, 2011
- Accession Number
- ADA618838
Entities
People
- Andriy I Batchinsky
- Bryan S. Jordan
- Corina Necsoiu
- Dara D. Regn
- Kevin K Chung
- Margaret A. Hanson
- Michael J. Morris
- Ruth Nguyen
- Samuel E. Burkett
- Thomas B. Zanders
Organizations
- United States Army Institute of Surgical Research