Skip Navigation



BJA Advance Access published online on August 16, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael215
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
97/4/525    most recent
ael215v1
Right arrow E-Letters: Submit a response to the article
Right arrow E-letters: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by David, M.
Right arrow Articles by Gervais, H. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by David, M.
Right arrow Articles by Gervais, H. W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted May 19, 2006

Laboratory Investigation

Initiation of high-frequency oscillatory ventilation and its effects upon cerebral circulation in pigs: an experimental study

M. David 1 *, K. Markstaller 1, A. L. Depta 1, J. Karmrodt 1, A. Herweling 1, O. Kempski 2, M. Geisen 1, and H. W. Gervais 1

1 Department of Anaesthesiology, Johannes Gutenberg-University, Mainz, Germany
2 Institute of Neurosurgical Pathophysiology, Johannes Gutenberg-University, Mainz, Germany

* To whom correspondence should be addressed.
M. David, E-mail: david{at}mail.uni-mainz.de


  Abstract

Background. Current practice at high-frequency oscillatory ventilation (HFOV) initiation is a stepwise increase of the constant applied airway pressure to achieve lung recruitment. We hypothesized that HFOV would lead to more adverse cerebral haemodynamics than does pressure controlled ventilation (PCV) in the presence of experimental intracranial hypertension (IH) and acute lung injury (ALI) in pigs with similar mean airway pressure settings.

Methods. In 12 anesthetized pigs (24-27 kg) with IH and ALI, mean airway pressure (Pmean) was increased (to 20, 25, 30 cm H2O every 30 min), either with HFOV or with PCV. The order of the two ventilatory modes (cross-over) was randomized. Mean arterial pressure (MAP), intracranial pressure (ICP), cerebral perfusion pressure (CPP), cerebral blood flow (CBF) (fluorescent microspheres), cerebral metabolism, transpulmonary pressures (PT), and blood gases were determined at each Pmean setting. Our end-points of interest related to the cerebral circulation were ICP, CPP and CBF.

Results. CBF and cerebral metabolism were unaffected but there were no differences between the values for HFOV and PCV. ICP increased slightly (HFOV median +1 mm Hg, P<0.05; PCV median +2 mm Hg, P<0.05). At Pmean setting of 30 cm H2O, CPP decreased during HFOV (median -13 mm Hg, P<0.05) and PCV (median -17 mm Hg, P<0.05) paralleled by a decrease of MAP (HFOV median -11 mm Hg, P<0.05; PCV median -13 mm Hg, P<0.05). PT increased (HFOV median +8 cm H2O, P<0.05; PCV median +8 cm H2O, P<0.05). Oxygenation improved and normocapnia maintained by HFOV and PCV. There were no differences between both ventilatory modes.

Conclusions. In animals with elevated ICP and ALI, both ventilatory modes had effects upon cerebral haemodynamics. The effects upon cerebral haemodynamics were dependent of the PT level without differences between both ventilatory modes at similar Pmean settings. HFOV seems to be a possible alternative ventilatory strategy when MAP deterioration can be avoided.

Keywords: acute respiratory distress syndrome, intracranial pressure, cerebrovascular circulation, high-frequency oscillatory ventilation.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


E-letters:

Read all E-letters

Brain-lung interactions during high-frequency ventilation
Patrick Meybohm, et al.
British Journal of Anaesthesia, 27 Sep 2006 [Full text]

Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.