ERS Respiratory Channel

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Abstract

Background: High-frequency percussive ventilation (HFPV) combines conventional and high-frequency oscillatory ventilations. We compared conventional mechanical ventilation (CMV) to modalities generating the oscillatory component of HFPV by positive-pressure fluctuations in the trachea (pHFPV) or by producing subatmospheric extrathoracic oscillations (nHFPV).

Methods: Anaesthetized rabbits (n=9) were mechanically ventilated with CMV, pHFPV and nHFPV. A blower-driven ventilator superimposed the positive-pressure high-frequency oscillation (5 or 10 Hz) over the conventional waveform during pHFPV, while nHFPV was provided by negative extrathoracic pressure fluctuations (5 or 10 Hz) via a chest cuirass. Arterial partial pressures of oxygen (PaO₂) and carbon dioxide (PaCO₂) and intrapulmonary shunt (Qs/Qt) were assessed before, during and after capnoperitoneum induced by abdominal insufflation with CO₂.

Results: Compared to CMV, pHFPV with 5 Hz oscillations during capnoperitoneum elevated PaO₂ (166±12 vs. 182±15 mmHg, p<0.05) and diminished PaCO₂ (53±6 vs. 44±5 mmHg, p<0.05) and Qs/Qt. No improvements were obtained during pHFPV with 10 Hz and under nHFPV with either 5 or 10 Hz during and after capnoperitoneum.

Conclusions: Improvement in gas exchange using pHFPV during compromised gas exchange by capnoperitoneum was evidenced via combining the conventional and small-amplitude positive-pressure high-frequency oscillatory ventilation. The improved longitudinal gas transport may be a more effective mechanism during the application of positive intratracheal fluctuations than negative extrathoracic oscillations.

Funding: OTKA-NKFIH 138032

Abstract

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