Abstract
| Original language | English |
|---|---|
| Pages (from-to) | e113473 |
| Journal | PLoS One |
| Volume | 9 |
| Issue number | 11 |
| DOIs | |
| Publication status | Published - 2014 |
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Sustained inflation at birth did not alter lung injury from mechanical ventilation in surfactant-treated fetal lambs. / Hillman, N.H.; Kemp, Matthew; Miura, Yuichiro; Kallapur, Suhas; Jobe, Alan.
In: PLoS One, Vol. 9, No. 11, 2014, p. e113473.Research output: Contribution to journal › Article
TY - JOUR
T1 - Sustained inflation at birth did not alter lung injury from mechanical ventilation in surfactant-treated fetal lambs
AU - Hillman, N.H.
AU - Kemp, Matthew
AU - Miura, Yuichiro
AU - Kallapur, Suhas
AU - Jobe, Alan
PY - 2014
Y1 - 2014
N2 - © 2014 Hillman et al. Background: Sustained inflations (SI) are used with the initiation of ventilation at birth to rapidly recruit functional residual capacity and may decrease lung injury and the need for mechanical ventilation in preterm infants. However, a 20 second SI in surfactant-deficient preterm lambs caused an acute phase injury response without decreasing lung injury from subsequent mechanical ventilation. Hypothesis: A 20 second SI at birth will decrease lung injury from mechanical ventilation in surfactant-treated preterm fetal lambs. Methods: The head and chest of fetal sheep at 126±1 day GA were exteriorized, with tracheostomy and removal of fetal lung fluid prior to treatment with surfactant (300 mg in 15 ml saline). Fetal lambs were randomized to one of four 15 minute interventions: 1) PEEP 8 cmH2O; 2) 20 sec SI at 40 cmH2O, then PEEP 8 cmH2O; 3) mechanical ventilation with 7 ml/kg tidal volume; or 4) 20 sec SI then mechanical ventilation at 7 ml/kg. Fetal lambs remained on placental support for the intervention and for 30 min after the intervention. Results: SI recruited a mean volume of 6.8±0.8 mL/kg. SI did not alter respiratory physiology during mechanical ventilation. Heat shock protein (HSP) 70, HSP60, and total protein in lung fluid similarly increased in both ventilation groups. Modest pro-inflammatory cytokine and acute phase responses, with or without SI, were similar with ventilation. SI alone did not increase markers of injury. Conclusion: In surfactant treated fetal lambs, a 20 sec SI did not alter ventilation physiology or markers of lung injury from mechanical ventilation.
AB - © 2014 Hillman et al. Background: Sustained inflations (SI) are used with the initiation of ventilation at birth to rapidly recruit functional residual capacity and may decrease lung injury and the need for mechanical ventilation in preterm infants. However, a 20 second SI in surfactant-deficient preterm lambs caused an acute phase injury response without decreasing lung injury from subsequent mechanical ventilation. Hypothesis: A 20 second SI at birth will decrease lung injury from mechanical ventilation in surfactant-treated preterm fetal lambs. Methods: The head and chest of fetal sheep at 126±1 day GA were exteriorized, with tracheostomy and removal of fetal lung fluid prior to treatment with surfactant (300 mg in 15 ml saline). Fetal lambs were randomized to one of four 15 minute interventions: 1) PEEP 8 cmH2O; 2) 20 sec SI at 40 cmH2O, then PEEP 8 cmH2O; 3) mechanical ventilation with 7 ml/kg tidal volume; or 4) 20 sec SI then mechanical ventilation at 7 ml/kg. Fetal lambs remained on placental support for the intervention and for 30 min after the intervention. Results: SI recruited a mean volume of 6.8±0.8 mL/kg. SI did not alter respiratory physiology during mechanical ventilation. Heat shock protein (HSP) 70, HSP60, and total protein in lung fluid similarly increased in both ventilation groups. Modest pro-inflammatory cytokine and acute phase responses, with or without SI, were similar with ventilation. SI alone did not increase markers of injury. Conclusion: In surfactant treated fetal lambs, a 20 sec SI did not alter ventilation physiology or markers of lung injury from mechanical ventilation.
U2 - 10.1371/journal.pone.0113473
DO - 10.1371/journal.pone.0113473
M3 - Article
VL - 9
SP - e113473
JO - P L o S One
JF - P L o S One
SN - 1932-6203
IS - 11
ER -