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Am. J. Respir. Crit. Care Med., Volume 165, Number 4, February 2002, 456-462

Improved Arterial Oxygenation with Biologically Variable or Fractal Ventilation Using Low Tidal Volumes in a Porcine Model of Acute Respiratory Distress Syndrome

ABDULAZIZ BOKER, M. RUTH GRAHAM, KEITH R. WALLEY, BRUCE M. MCMANUS, LINDA G. GIRLING, ELIZABETH WALKER, GERALD R. LEFEVRE, and W.ALAN C.  MUTCH

Department of Anesthesiology, University of Manitoba, Winnipeg; Department of Critical Care Medicine, and Department of Pathology and Laboratory Medicine, McDonald Research Laboratories/The iCapture Centre, University of British Columbia, Vancouver, Canada

We compared biologically variable ventilation (V bv; n = 9) with control mode ventilation (V c; n = 8) at low tidal volume (VT)-initial 6 ml/kg-in a porcine model of acute respiratory distress syndrome (ARDS). Hemodynamics, respiratory gases, airway pressures, and VT data were measured. Static P-V curves were generated at 5 h. Interleukin (IL)-8 and IL-10 were measured in serum and tracheal aspirate. By 5 h, higher PaO2 (173 ± 30 mm Hg versus 119 ± 23 mm Hg; mean ± SD; p < 0.0001 group × time interaction [G × T]), lower shunt fraction (6 ± 1% versus 9 ± 3%; p = 0.0026, G × T) at lower peak airway pressure (21 ± 2 versus 24 ± 1 cm H2O; p = 0.0342; G × T) occurred with V bv. IL-8 concentrations in tracheal aspirate and wet:dry weight ratios were inversely related; p = 0.011. With V c, IL-8 concentrations were 3.75-fold greater at wet:dry weight ratio of 10. IL-10 concentrations did not differ between groups. In both groups, ventilation was on the linear portion of the P-V curve. With V bv, VT variability demonstrated an inverse power law indicating fractal behavior. In this model of ARDS, V bv improved PaO2 at lower peak airway pressure and IL-8 levels compared with V c.




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