Sustained inflation at birth did not alter lung injury from mechanical ventilation in surfactant-treated fetal lambs

N.H. Hillman, Matthew Kemp, Yuichiro Miura, Suhas Kallapur, Alan Jobe

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

© 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.
Original languageEnglish
Pages (from-to)e113473
JournalPLoS One
Volume9
Issue number11
DOIs
Publication statusPublished - 2014

Fingerprint

inflation
Economic Inflation
Lung Injury
Artificial Respiration
Surface-Active Agents
surfactants
lambs
lungs
Parturition
Ventilation
Physiology
Acute-Phase Reaction
HSP70 Heat-Shock Proteins
Fluids
Respiratory Physiological Phenomena
respiratory physiology
Functional Residual Capacity
tidal volume
Lung
Tracheostomy

Cite this

@article{a4ee04bb66ef45c4b657531943f7ecce,
title = "Sustained inflation at birth did not alter lung injury from mechanical ventilation in surfactant-treated fetal lambs",
abstract = "{\circledC} 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.",
author = "N.H. Hillman and Matthew Kemp and Yuichiro Miura and Suhas Kallapur and Alan Jobe",
year = "2014",
doi = "10.1371/journal.pone.0113473",
language = "English",
volume = "9",
pages = "e113473",
journal = "P L o S One",
issn = "1932-6203",
publisher = "Public Library of Science (PLoS)",
number = "11",

}

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 journalArticle

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 -