Article

Adaptive support ventilation prevents ventilator-induced diaphragmatic dysfunction in piglet: an in vivo and in vitro study.

Department of Anesthesiology and Critical Care, Intensive Care Unit, Saint Eloi Teaching Hospital, Equipe soutenue par la Région et l'Institut National de la Santé et de la Recherche Médicale 25, Centre Hospitalier Universitaire Montpellier, Montpellier, France.
Anesthesiology (impact factor: 5.36). 06/2010; 112(6):1435-43. DOI:10.1097/ALN.0b013e3181d7b036 pp.1435-43
Source: PubMed

ABSTRACT Contrary to adaptive support ventilation (ASV), prolonged totally controlled mechanical ventilation (CMV) results in the absence of diaphragm activity and causes ventilator-induced diaphragmatic dysfunction. Because maintaining respiratory muscles at rest is likely a major cause of ventilator-induced diaphragmatic dysfunction, ASV may prevent its occurrence in comparison with CMV. The aim of our study was to compare the effects of ASV with those of CMV on both in vivo and in vitro diaphragmatic properties.
Two groups of six anesthetized piglets were ventilated during a 72-h period. Piglets in the CMV group (n = 6) were ventilated without spontaneous ventilation, and piglets in the ASV group (n = 6) were ventilated with spontaneous breaths. Transdiaphragmatic pressure was measured after bilateral, supramaximal transjugular stimulation of the two phrenic nerves. A pressure-frequency curve was drawn after stimulation from 20 to 120 Hz of the phrenic nerves. Diaphragm fiber proportions and mean sectional area were evaluated.
After 72 h of ventilation, transdiaphragmatic pressure decreased by 30% of its baseline value in the CMV group, whereas it did not decrease in the ASV group. Although CMV was associated with an atrophy of the diaphragm (evaluated by mean cross-sectional area of both the slow and fast myosin chains), atrophy was not detected in the ASV group.
Maintaining diaphragmatic contractile activity by using the ASV mode may protect the diaphragm against the deleterious effect of prolonged CMV, as demonstrated both in vitro and in vivo, in healthy piglets.

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    Article: Clinical review: ventilator-induced diaphragmatic dysfunction--human studies confirm animal model findings!
    Samir Jaber, Boris Jung, Stefan Matecki, Basil J Petrof
    [show abstract] [hide abstract]
    ABSTRACT: Diaphragmatic function is a major determinant of the ability to successfully wean patients from mechanical ventilation. However, the use of controlled mechanical ventilation in animal models results in a major reduction of diaphragmatic force-generating capacity together with structural injury and atrophy of diaphragm muscle fibers, a condition termed ventilator-induced diaphragmatic dysfunction (VIDD). Increased oxidative stress and exaggerated proteolysis in the diaphragm have been linked to the development of VIDD in animal models, but much less is known about the extent to which these phenomena occur in humans undergoing mechanical ventilation in the ICU. In the present review, we first briefly summarize the large body of evidence demonstrating the existence of VIDD in animal models, and outline the major cellular mechanisms that have been implicated in this process. We then relate these findings to very recently published data in critically ill patients, which have thus far been found to exhibit a remarkable degree of similarity with the animal model data. Hence, the human studies to date have indicated that mechanical ventilation is associated with increased oxidative stress, atrophy, and injury of diaphragmatic muscle fibers along with a rapid loss of diaphragmatic force production. These changes are, to a large extent, directly proportional to the duration of mechanical ventilation. In the context of these human data, we also review the methods that can be used in the clinical setting to diagnose and/or monitor the development of VIDD in critically ill patients. Finally, we discuss the potential for using different mechanical ventilation strategies and pharmacological approaches to prevent and/or to treat VIDD and suggest promising avenues for future research in this area.
    Critical care (London, England) 03/2011; 15(2):206. · 4.61 Impact Factor
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Keywords

adaptive support ventilation
 
anesthetized piglets
 
ASV group
 
ASV mode
 
causes ventilator-induced diaphragmatic dysfunction
 
CMV group
 
cross-sectional area
 
Diaphragm fiber proportions
 
fast myosin chains
 
healthy piglets
 
Maintaining diaphragmatic contractile activity
 
major cause
 
mechanical ventilation
 
sectional area
 
spontaneous breaths
 
spontaneous ventilation
 
supramaximal transjugular stimulation
 
Transdiaphragmatic pressure
 
ventilator-induced diaphragmatic dysfunction
 
vitro diaphragmatic properties