SESSION TYPE: New Insights into ARDS/Lung Injury
PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM
PURPOSE: Acute lung injury (ALI) is a common condition that leads to respiratory impairment with patients, specifically regarding oxygenation. Using a POC, it has been shown in a mechanical model that pulsed dose delivery of oxygen is an alternative to continuous oxygen flow in order to conserve oxygen, while still maintaining adequate oxygen delivery. We hypothesize that using a modified POC and pulsed dose oxygen delivery can be sufficient for ventilated patients, thus reducing oxygen requirements.
METHODS: In a crossover study, we induced ALI in 15 locally bred pigs using an oleic acid model. We ventilated the pigs using equipment that is used by Critical Care Air Transport Teams of the United States Air Force. Each animal served as its own control as we compared oxygen delivery using a POC in both continuous flow with a reservoir bag and pulsed dose. We performed this in both volume control and pressure control mechanical ventilation.
RESULTS: There was no statistical difference regarding any of the ventilator variables including respiratory rate, Tidal volume in the ventilator modes or in oxygen delivery methods, with the exception of mean airway pressures (4.1±0.9 cm H2O vs. 6.5±2.7 cm H2O, p=0.03). There was no difference in the baseline P:F ratios for the pulsed dose delivery and continuous flow. In volume control, pulsed dose oxygen delivery had a significant increase in the P:F Ratio, (168.8±96.1 vs. 91.7±65.4, p=0.002) compared with continuous flow. However, this was not seen in pressure control ventilation (89.0±74.5 vs 79.1±65.4, p=0.67).
CONCLUSIONS: We were able to demonstrate that oxygen delivery using a POC in mechanically ventilated pigs with ALI is possible. We were also able to demonstrate that pulsed dose delivery from a POC is at least equivalent to continuous oxygen delivery for oxygenation in acute lung injuries, when using volume control.
CLINICAL IMPLICATIONS: We propose that this is a safe alternative to conserve oxygen in the transport of critically ill patients, though human studies are required.
DISCLOSURE: The following authors have nothing to disclose: Josh Gustafson, Chris Blakeman, Warren Dorlac, Jay Johannigman, Richard Branson
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