Abstract
We have developed two devices: a high-amplitude bubble continuous positive airway pressure (HAB-CPAP) and an inexpensive bubble intermittent mandatory ventilator (B-IMV) to test the hypotheses that simple, inexpensive devices can provide gas exchange similar to that of bubble CPAP (B-CPAP) and conventional mechanical ventilation (CMV). Twelve paralyzed juvenile rabbits were intubated, stabilized on CMV, and then switched to CPAP. On identical mean airway pressures (MAPs), animals were unable to maintain pulse oximeter oxygen saturation (SpO2) >80% on conventional B-CPAP, but all animals oxygenated well (97.3 ± 2.1%) on HAB-CPAP. In fact, arterial partial pressures of O2 (Pao2) were higher during HAB-CPAP than during CMV (p = 0.01). After repeated lung lavages, arterial partial pressures of CO2 (Paco2) were lower with B-IMV than with CMV (p < 0.0001), despite identical ventilator settings. In lavaged animals, when HAB-CPAP was compared with CMV at the same MAP and 100% O2, no differences were observed in Pao2, but Paco2 levels were higher with HAB-CPAP (70 ± 7 versus 50 ± 5 mm Hg; p < 0.05). Arterial blood pressures were not impaired by HAB-CPAP or B-IMV. The results confirm that simple inexpensive devices can provide respiratory support in the face of severe lung disease and could extend the use of respiratory support for preterm infants into severely resource-limited settings.
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Abbreviations
- ABG:
-
arterial blood gas analyses
- B-CPAP:
-
bubble CPAP
- B-IMV:
-
bubble intermittent mandatory ventilation or ventilators
- B-IMV0:
-
B-IMV with PEEP bubbler angle of 0
- B-IMV90:
-
B-IMV with PEEP bubbler angle of 90
- B-IMV135:
-
B-IMV with PEEP bubbler angle of 135
- CPAP:
-
continuous positive airway pressure
- CMV:
-
conventional mechanical ventilation
- FiO2:
-
fraction of inspired oxygen
- HAB-CPAP:
-
high-amplitude bubble CPAP
- HAB-CPAP0:
-
HAB-CPAP with bubbler angle of 0°, functionally equivalent to conventional B-CPAP
- HAB-CPAP90:
-
HAB-CPAP with bubbler angle of 90°, parallel with the surface of water
- HAB-CPAP135:
-
HAB-CPAP with bubbler angle of 135°
- IMV:
-
intermittent mandatory ventilation
- MAP:
-
mean airway pressures
- Paw:
-
airway pressures
- PEEP:
-
positive end-expiratory pressure
- SNK:
-
Student-Newman-Keuls
- SpO2:
-
pulse oximeter oxygen saturations.
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Supported by the Seattle Children's Research Institute.
Patent applications concerning the devices described in this manuscript have been submitted to USPTO (US Provisional Patent Application Numbers 61/044,002 61/150,670) and to International Patent Application (PCT/US2009/039957) by Seattle Children's Research Institute (SCRI). The applications are in review. Authors R.M.D., J.C.Z., C.V.S., T.N.H., and C.P.R. are inventors on the patent applications and could benefit financially from the inventions. http://www.wipo.int/pctdb/en/wo.jsp?WO=2009126739.
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Diblasi, R., Zignego, J., Smith, C. et al. Effective Gas Exchange in Paralyzed Juvenile Rabbits Using Simple, Inexpensive Respiratory Support Devices. Pediatr Res 68, 526–530 (2010). https://doi.org/10.1203/PDR.0b013e3181f985f0
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DOI: https://doi.org/10.1203/PDR.0b013e3181f985f0
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