Positive end-expiratory pressure enhances development of a functional residual capacity in preterm rabbits ventilated from birth

Melissa Li-Lian Siew, Arjan B Te Pas, Megan Jane Wallace, Marcus John Kitchen, Robert A Lewis, Andreas Fouras, Colin J Morley, Peter G Davis, Naoto Yagi, Kentaro Uesugi, Stuart Brian Hooper

Research output: Contribution to journalArticleResearchpeer-review

Abstract

The factors regulating lung aeration and the initiation of pulmonary gas exchange at birth are largely unknown, particularly in infants born very preterm. As hydrostatic pressure gradients may play a role, we have examined the effect of a positive end-expiratory pressure (PEEP) on the spatial and temporal pattern of lung aeration in preterm rabbit pups mechanically ventilated from birth using simultaneous phase contrast X-ray imaging and plethysmography. Preterm rabbit pups were delivered by caesarean section at 28d of gestational age, anesthetized, intubated and placed within a water-filled plethysmograph (head out). Pups were imaged as they were mechanically ventilated from birth with either a PEEP of 0 cmH2O or 5 cmH2O. The peak inflation pressure was held constant at 35 cmH2O. Without PEEP, gas only entered into the distal airways during inflation. The distal airways collapsed during expiration and as a result, the functional residual capacity (FRC) did not increase above the lung s anatomical dead space volume (2.5+/-0.8 mL/kg). In contrast, ventilation with 5 cmH2O PEEP gradually increased aeration of the distal airways, which did not collapse at end expiration. The FRC achieved in pups ventilated with PEEP (19.9+/-3.2 mL/kg) was significantly greater than in pups ventilated without PEEP (-2.3+/-3.5 mL/kg). PEEP greatly facilitates aeration of the distal airways, the accumulation of FRC and prevents distal airway collapse at end-expiration in very preterm rabbit pups mechanically ventilated from birth. Key words: phase contrast X-ray imaging, plethysmography, resuscitation, PEEP.
Original languageEnglish
Pages (from-to)1487 - 1493
Number of pages7
JournalJournal of Applied Physiology
Volume106
Issue number5
DOIs
Publication statusPublished - 2009

Cite this

Siew, Melissa Li-Lian ; Te Pas, Arjan B ; Wallace, Megan Jane ; Kitchen, Marcus John ; Lewis, Robert A ; Fouras, Andreas ; Morley, Colin J ; Davis, Peter G ; Yagi, Naoto ; Uesugi, Kentaro ; Hooper, Stuart Brian. / Positive end-expiratory pressure enhances development of a functional residual capacity in preterm rabbits ventilated from birth. In: Journal of Applied Physiology. 2009 ; Vol. 106, No. 5. pp. 1487 - 1493.
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abstract = "The factors regulating lung aeration and the initiation of pulmonary gas exchange at birth are largely unknown, particularly in infants born very preterm. As hydrostatic pressure gradients may play a role, we have examined the effect of a positive end-expiratory pressure (PEEP) on the spatial and temporal pattern of lung aeration in preterm rabbit pups mechanically ventilated from birth using simultaneous phase contrast X-ray imaging and plethysmography. Preterm rabbit pups were delivered by caesarean section at 28d of gestational age, anesthetized, intubated and placed within a water-filled plethysmograph (head out). Pups were imaged as they were mechanically ventilated from birth with either a PEEP of 0 cmH2O or 5 cmH2O. The peak inflation pressure was held constant at 35 cmH2O. Without PEEP, gas only entered into the distal airways during inflation. The distal airways collapsed during expiration and as a result, the functional residual capacity (FRC) did not increase above the lung s anatomical dead space volume (2.5+/-0.8 mL/kg). In contrast, ventilation with 5 cmH2O PEEP gradually increased aeration of the distal airways, which did not collapse at end expiration. The FRC achieved in pups ventilated with PEEP (19.9+/-3.2 mL/kg) was significantly greater than in pups ventilated without PEEP (-2.3+/-3.5 mL/kg). PEEP greatly facilitates aeration of the distal airways, the accumulation of FRC and prevents distal airway collapse at end-expiration in very preterm rabbit pups mechanically ventilated from birth. Key words: phase contrast X-ray imaging, plethysmography, resuscitation, PEEP.",
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Positive end-expiratory pressure enhances development of a functional residual capacity in preterm rabbits ventilated from birth. / Siew, Melissa Li-Lian; Te Pas, Arjan B; Wallace, Megan Jane; Kitchen, Marcus John; Lewis, Robert A; Fouras, Andreas; Morley, Colin J; Davis, Peter G; Yagi, Naoto; Uesugi, Kentaro; Hooper, Stuart Brian.

In: Journal of Applied Physiology, Vol. 106, No. 5, 2009, p. 1487 - 1493.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Positive end-expiratory pressure enhances development of a functional residual capacity in preterm rabbits ventilated from birth

AU - Siew, Melissa Li-Lian

AU - Te Pas, Arjan B

AU - Wallace, Megan Jane

AU - Kitchen, Marcus John

AU - Lewis, Robert A

AU - Fouras, Andreas

AU - Morley, Colin J

AU - Davis, Peter G

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AU - Hooper, Stuart Brian

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