Bubble bilevel ventilation facilitates gas exchange in anesthetized rabbits.
Journal
Pediatric research
ISSN: 1530-0447
Titre abrégé: Pediatr Res
Pays: United States
ID NLM: 0100714
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
22
01
2019
accepted:
15
04
2020
revised:
14
04
2020
pubmed:
2
5
2020
medline:
15
1
2022
entrez:
2
5
2020
Statut:
ppublish
Résumé
Bubble continuous positive airway pressure is an established therapy for infants in respiratory distress. In resource-limited settings, few treatment options exist for infants requiring further respiratory support. A bubble bilevel device has been developed to provide nonelectric, time-cycled, pressure-limited respiratory support. We compared the efficacy of bubble bilevel ventilation with conventional mechanical ventilation in sedated rabbits. Six adult rabbits under inhaled isoflurane general anesthesia were ventilated by alternating intervals of conventional and bubble bilevel ventilation for three 10-15-min periods. During each period, interval arterial blood gas (ABG) measurements were obtained after at least 10 min on the respective mode of ventilation. The bubble bilevel system was able to deliver the following pressures: 20/7, 15/5, 12/5, 8/5 cm H This study demonstrates promising in vivo results on the efficacy of a novel bubble bilevel device, which may prove useful for infants in respiratory distress. Given the lack of personnel, funds or infrastructure to provide neonatal mechanical ventilation in resource-limited settings, additional low-cost, low-tech treatments are necessary to save infant lives. Bubble bilevel ventilation reliably delivers two levels of airway pressure to anesthetized rabbits resulting in normalization of blood gases comparable to those achieved on a traditional ventilator. If proven effective, simple technologies like this device have the potential to significantly impact neonatal mortality due to respiratory distress globally.
Sections du résumé
BACKGROUND
Bubble continuous positive airway pressure is an established therapy for infants in respiratory distress. In resource-limited settings, few treatment options exist for infants requiring further respiratory support. A bubble bilevel device has been developed to provide nonelectric, time-cycled, pressure-limited respiratory support. We compared the efficacy of bubble bilevel ventilation with conventional mechanical ventilation in sedated rabbits.
METHODS
Six adult rabbits under inhaled isoflurane general anesthesia were ventilated by alternating intervals of conventional and bubble bilevel ventilation for three 10-15-min periods. During each period, interval arterial blood gas (ABG) measurements were obtained after at least 10 min on the respective mode of ventilation.
RESULTS
The bubble bilevel system was able to deliver the following pressures: 20/7, 15/5, 12/5, 8/5 cm H
CONCLUSION
This study demonstrates promising in vivo results on the efficacy of a novel bubble bilevel device, which may prove useful for infants in respiratory distress.
IMPACT
Given the lack of personnel, funds or infrastructure to provide neonatal mechanical ventilation in resource-limited settings, additional low-cost, low-tech treatments are necessary to save infant lives. Bubble bilevel ventilation reliably delivers two levels of airway pressure to anesthetized rabbits resulting in normalization of blood gases comparable to those achieved on a traditional ventilator. If proven effective, simple technologies like this device have the potential to significantly impact neonatal mortality due to respiratory distress globally.
Identifiants
pubmed: 32357365
doi: 10.1038/s41390-020-0928-0
pii: 10.1038/s41390-020-0928-0
pmc: PMC7223040
doi:
Substances chimiques
Gases
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
622-627Références
Liu, L. et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet 388, 3027–3035 (2016).
doi: 10.1016/S0140-6736(16)31593-8
Duke, T. CPAP: a guide for clinicians in developing countries. Paediatr. Int. Child Health 34, 3–11 (2014).
doi: 10.1179/2046905513Y.0000000102
Martin, S., Duke, T. & Davis, P. Efficacy and safety of bubble CPAP in neonatal care in low and middle income countries: a systematic review. Arch. Dis. Child. Fetal Neonatal Ed. 99, F495–F504 (2014).
doi: 10.1136/archdischild-2013-305519
Bhandari, V. Nasal intermittent positive pressure ventilation in the newborn: review of literature and evidence-based guidelines. J. Perinatol. 30, 505–512 (2010).
doi: 10.1038/jp.2009.165
John, S. C. et al. Development and testing of a bubble bi-level positive airway pressure system. Respir. Care 62, 1131–1136 (2017).
doi: 10.4187/respcare.05443
John, S. C. et al. Bench testing of a bubble noninvasive ventilation device in an infant lung simulator. Respir. Care (2020). in press.
Lee, K. S., Dunn, M. S., Fenwick, M. & Shennan, A. T. A comparison of underwater bubble continuous positive airway pressure with ventilator-derived continuous positive airway pressure in premature neonates ready for extubation. Neonatology 73, 69–75 (1998).
doi: 10.1159/000013962
Urs, P. S., Khan, F. & Maiya, P. P. Bubble CPAP—a primary respiratory support for respiratory distress syndrome in newborns. Indian Pediatr. 46, 409–411 (2009).
pubmed: 19179737
Pillow, J. J. et al. Bubble continuous positive airway pressure enhances lung volume and gas exchange in preterm lambs. Am. J. Respir. Crit. Care Med. 176, 63–69 (2007).
doi: 10.1164/rccm.200609-1368OC
Tagare, A., Kadam, S., Vaidya, U., Pandit, A. & Patole, S. Bubble CPAP versus ventilator CPAP in preterm neonates with early onset respiratory distress—a randomized controlled trial. J. Trop. Pediatr. 59, 113–119 (2013).
doi: 10.1093/tropej/fms061
Chen, A. et al. Cost-effectiveness analysis of a low-cost bubble CPAP device in providing ventilatory support for neonates in Malawi—a preliminary report. BMC Pediatr. 14, 288 (2014).
doi: 10.1186/s12887-014-0288-1
Lista, G. et al. Nasal continuous positive airway pressure (CPAP) versus bi-level nasal CPAP in preterm babies with respiratory distress syndrome: a randomised control trial. Arch. Dis. Child. Fetal Neonatal Ed. 95, F85–F89 (2010).
doi: 10.1136/adc.2009.169219
Davis, P. G., Morley, C. J. & Owen, L. S. Non-invasive respiratory support of preterm neonates with respiratory distress: continuous positive airway pressure and nasal intermittent positive pressure ventilation. Semin. Fetal Neonatal Med. 14, 14–20 (2009).
doi: 10.1016/j.siny.2008.08.003
Migliori, C., Motta, M., Angeli, A. & Chirico, G. Nasal bilevel vs. continuous positive airway pressure in preterm infants. Pediatr. Pulmonol. 40, 426–430 (2005).
doi: 10.1002/ppul.20276
Lampland, A. L., Plumm, B., Worwa, C., Meyers, P. & Mammel, M. C. Bi-level CPAP does not improve gas exchange when compared with conventional CPAP for the treatment of neonates recovering from respiratory distress syndrome. Arch. Dis. Child. Fetal Neonatal Ed. 100, F31–F34 (2015).
doi: 10.1136/fetalneonatal-2013-305665
Mahmoud, R. A., Roehr, C. C. & Schmalisch, G. Current methods of non-invasive ventilatory support for neonates. Paediatr. Respir. Rev. 12, 196–205 (2011).
doi: 10.1016/j.prrv.2010.12.001
Tang, S., Zhao, J., Shen, J., Hu, Z. & Shi, Y. Nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure in neonates: a systematic review and meta-analysis. Indian Pediatr. 50, 371–376 (2013).
doi: 10.1007/s13312-013-0122-0
Meneses, J., Bhandari, V. & Alves, J. G. Nasal intermittent positive-pressure ventilation vs nasal continuous positive airway pressure for preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch. Pediatr. Adolesc. Med. 166, 372–376 (2012).
doi: 10.1001/archpediatrics.2011.1142
Sai Sunil Kishore, M., Dutta, S. & Kumar, P. Early nasal intermittent positive pressure ventilation versus continuous positive airway pressure for respiratory distress syndrome. Acta Paediatr. 98, 1412–1415 (2009).
doi: 10.1111/j.1651-2227.2009.01348.x
Kugelman, A. et al. Nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure for respiratory distress syndrome: a randomized, controlled, prospective study. J. Pediatr. 150, 521–526 (2007). 526.e521.
doi: 10.1016/j.jpeds.2007.01.032
Armanian, A. M., Badiee, Z., Heidari, G., Feizi, A. & Salehimehr, N. Initial treatment of respiratory distress syndrome with nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure: a randomized controlled trial. Int. J. Prev. Med. 5, 1543–1551 (2014).
pubmed: 25709790
pmcid: 4336985
Diblasi, R. M., Zignego, J. C., Smith, C. V., Hansen, T. N. & Richardson, C. P. Effective gas exchange in paralyzed juvenile rabbits using simple, inexpensive respiratory support devices. Pediatr. Res. 68, 526–530 (2010).
doi: 10.1203/PDR.0b013e3181f985f0