efficacy of non invasive biphasic cuirass ventilation (bcv) in neonatal piglets comparison with...

Efficacy of Non Invasive Biphasic Cuirass Ventilation (BCV)

in Neonatal Piglets Comparison with Conventional

Positive Pressure Ventilation

F.G. Eyal, MD, I. Gur, MD, K.T. O'Donnell, BS and C.R. Hamm Jr. University of South Alabama, Mobile, Alabama, United States and Bikur Holim Hospital, Jerusalem, Israel .

We have nothing to Disclose

The need for prolonged IPPVdespite successful surfactant treatment

is a major risk factor for BPDCan

NEGATIVE PRESSURE VENTILATION

be a successful NON INVASIVE alternative mode of ventilation for newborns at risk for BPD

DÉJÀ VU ?DÉJÀ VU ?1970197019501950 PAST :

Effective ventilation of surfactant deficient lungs required levels of inspiratory pressure beyond the capacity of

negative pressure respirators incubator

PRESENT : Surfactant treatment restores normal lung compliance Continued prolonged ventilatory support relates to poor respiratory drive (apnea of prematurity ) BCV is a modified efficient form of negative pressure

ventilation successful in adult and children with respiratory failure due to neuromotor dysfunction

HAYEK RTX Respirator

Medivent, London

HAYEK RTX Respirator

Medivent, London

Purpose of this study:

investigate the efficiency of BCV in an neonatal animal model

Purpose of this study:

investigate the efficiency of BCV in an neonatal animal model

• Can Biphasic Cuirass ventilation successfully ventilated apneic newborn

• Does the cuirass positive pressure component used during expiration :– Enhanced its efficiency– Can this “mild” compression adversely affect FRC

in newborn who have a very compliant chest wall

• What is the optimal I:E ratio in relation to efficiency

• Can Biphasic Cuirass ventilation successfully ventilated apneic newborn

• Does the cuirass positive pressure component used during expiration :– Enhanced its efficiency– Can this “mild” compression adversely affect FRC

in newborn who have a very compliant chest wall

• What is the optimal I:E ratio in relation to efficiency

MethodsMethods

Newborn piglets : 4.7 ± .4 days (2.2 ± 0.1 kg) (n= 42)

Anesthetized & paralyzed

Mechanical Ventilation40 breaths /mn; VT :11 ± .5 ml/kg , Fi02 : .4

Newborn piglets : 4.7 ± .4 days (2.2 ± 0.1 kg) (n= 42)

Anesthetized & paralyzed

Mechanical Ventilation40 breaths /mn; VT :11 ± .5 ml/kg , Fi02 : .4

PaCO2 PaO2

Ventilatory Efficiency Index (VEI)VEI=3800*/(respiratory rate x [PIP – PEEP or NCIP-EECP] x PaCO2]

*: 3800 is a CO2 production constant :([ml x mm Hg]/[kg x min])

BCV associated to nasal CPAP could be an beneficial alternative to endotracheal IPPV in preterm infants who continue to require

mechanical ventilation after surfactant treatment

BCV associated to nasal CPAP could be an beneficial alternative to endotracheal IPPV in preterm infants who continue to require

mechanical ventilation after surfactant treatment

CONCLUSIONSCONCLUSIONSBiphasic Cuirass Ventilation

is an effective method of ventilation in neonatesPositive expiratory cuirass pressure enhanced its efficiency

(in terms of C02 elimination)

This enables the use of inspiratory pressure of low amplitude (a limiting factor in the past for its efficient use in neonates)

The decline in lung volume associated with expiratory positive cuirass pressure

is prevented by the concomitant use of CPAP and a cuirass I:E ratio of 2:1

PROBLEMSSKIN INTEGRITY

THERMOREGULATION

PROBLEMSSKIN INTEGRITY

THERMOREGULATION