Time-Controlled Adaptive Ventilation Does Not Induce Hemodynamic Impairment in a Swine ARDS Model

Mickael Lescroart; Benjamin Pequignot; Laurent Bitker; Héloïse Pina; N'Guyen Tran; Jean-Louis Hébert; Jean-Christophe Richard; Bruno Lévy; Matthieu Koszutski

doi:10.3389/fmed.2022.883950

Time-Controlled Adaptive Ventilation Does Not Induce Hemodynamic Impairment in a Swine ARDS Model

Front Med (Lausanne). 2022 May 17:9:883950. doi: 10.3389/fmed.2022.883950. eCollection 2022.

Authors

Mickael Lescroart^{1

2

3}, Benjamin Pequignot^{1

2

3}, Laurent Bitker^{4

5}, Héloïse Pina⁶, N'Guyen Tran^{3

7}, Jean-Louis Hébert⁸, Jean-Christophe Richard^{4

5}, Bruno Lévy^{1

2

3}, Matthieu Koszutski^{1

3}

Affiliations

¹ CHRU Nancy, Service de Médecine Intensive et Réanimation, Hôpital Brabois, Vandœuvre-lès-Nancy, France.
² INSERM U 1116, Groupe Choc, Équipe 2, Faculté de Médecine, Vandœuvre-lès-Nancy, France.
³ Université de Lorraine, Faculté de Médecine, Nancy, France.
⁴ Service de Médecine Intensive - Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
⁵ Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
⁶ CHRU de Nancy, Département D'Anatomie Pathologique, Laboratoires de Biologie Médicale et de Biopathologie, Hôpital Brabois, Vandœuvre-lès-Nancy, France.
⁷ Ecole de Chirurgie, Faculté de Médecine, Université de Lorraine, Nancy, France.
⁸ Université Paris XI, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.

Abstract

Background: The current standard of care during severe acute respiratory distress syndrome (ARDS) is based on low tidal volume (VT) ventilation, at 6 mL/kg of predicted body weight. The time-controlled adaptive ventilation (TCAV) is an alternative strategy, based on specific settings of the airway pressure release ventilation (APRV) mode. Briefly, TCAV reduces lung injury, including: (1) an improvement in alveolar recruitment and homogeneity; (2) reduction in alveolar and alveolar duct micro-strain and stress-risers. TCAV can result in higher intra-thoracic pressures and thus impair hemodynamics resulting from heart-lung interactions. The objective of our study was to compare hemodynamics between TCAV and conventional protective ventilation in a porcine ARDS model.

Methods: In 10 pigs (63-73 kg), lung injury was induced by repeated bronchial saline lavages followed by 2 h of injurious ventilation. The animals were then randomized into two groups: (1) Conventional protective ventilation with a VT of 6 mL/kg and PEEP adjusted to a plateau pressure set between 28 and 30 cmH₂O; (2) TCAV group with P-high set between 27 and 29 cmH₂O, P-low at 0 cmH₂O, T-low adjusted to terminate at 75% of the expiratory flow peak, and T-high at 3-4 s, with I:E > 6:1.

Results: Both lung elastance and PaO₂:FiO₂ were consistent with severe ARDS after 2 h of injurious mechanical ventilation. There was no significant difference in systemic arterial blood pressure, pulmonary blood pressure or cardiac output between Conventional protective ventilation and TCAV. Levels of total PEEP were significantly higher in the TCAV group (p < 0.05). Driving pressure and lung elastance were significantly lower in the TCAV group (p < 0.05).

Conclusion: No hemodynamic adverse events were observed in the TCAV group compared as to the standard protective ventilation group in this swine ARDS model, and TCAV appeared to be beneficial to the respiratory system.

Keywords: APRV; ARDS; TCAV; heart-lung interactions; hemodynamic; mechanical ventilation.