Etude de la mecanique respiratoire par la technique des oscillations forcees au cours de la ventilation liquidienne totale.

摘要

Background. This study aimed to implement low-frequency forced oscillation technique (LFFOT) in neonatal total liquid ventilation (TLV) and to provide the first insight into respiratory impedance under this new modality of ventilation. Method. Thirteen newborn lambs weighing 2.5 +/- 0.4 kg (mean +/- SD) were premedicated, intubated, anesthetized, and then placed under TLV using a specially-design liquid ventilator and a perfluorocarbon. The respiratory mechanics measurements protocol was started immediately after TLV initiation. Three blocks of measurements were first performed: one during initial respiratory system adaptation to TLV, followed by two others series during steady state conditions. Lambs were then divided into two groups prior to undergoing another three blocks of measurements: the first group received a 10-min i v infusion of salbutamol (1.5 mug/kg/min) after continuous infusion of methacholine (9 mug/kg/min) while the second group of lambs were chest-strapped. Respiratory impedance was measured using serial single-frequency tests at frequencies ranging between 0.05-2 Hz and then fitted with a constant-phase model. 0.2 Hz harmonic test signals were also launched every ten minutes throughout the measurement protocol. Results. Airway resistance and inertance were starkly increased in TLV compared to gas ventilation with a resonant frequency &le1.2 Hz. 0.2 Hz resistance and reactance were sensitive to bronchoconstriction and dilation as well as during compliance reduction. Conclusions. We report successful implementation of LFFOT to neonatal total liquid ventilation and present the first insight into respiratory impedance under this new modality of ventilation. We show that LFFOT is an effective tool to track respiratory mechanics under TLV.Key Words: Respiratory impedance Perfluorocarbons Mechanical ventilation Sheep Methacholine