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    Cordioli, Ricardo   Granier, Jean-Max   Lyazidi, Aissam   Suppan, Laurent   Garelli, Valentina   Savary, Dominique   Brochard, Laurent   Richard, Jean-Christophe  

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  • Impact of different ventilation modalities on lung volumes and pressures during automatic cardio pulmonary resuscitation: A bench study

    Cordioli, Ricardo   Lyazidi, Aissam   Granier, Jean-Max   Garelli, Valentina   Suppan, Laurent   Savary, Dominique   Brochard, Laurent   Richard, Jean-Christophe  

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  • Moderately high frequency ventilation with a conventional ventilator allows reduction of tidal volume without increasing mean airway pressure

    Cordioli, Ricardo   Park, Marcelo   Costa, Eduardo Leite   Gomes, Susimeire   Brochard, Laurent   Amato, Marcelo Britto   Azevedo, Luciano Cesar  

    The aim of this study was to explore if positive-pressure ventilation delivered by a conventional ICU ventilator at a moderately high frequency (HFPPV) allows a safe reduction of tidal volume (VT) below 6 mL/kg in a porcine model of severe acute respiratory distress syndrome (ARDS) and at a lower mean airway pressure than high-frequency oscillatory ventilation (HFOV). This is a prospective study. In eight pigs (median weight 34 [29,36] kg), ARDS was induced by pulmonary lavage and injurious ventilation. The animals were ventilated with a randomized sequence of respiratory rates: 30, 60, 90, 120, 150, followed by HFOV at 5 Hz. At each step, VT was adjusted to allow partial pressure of arterial carbon dioxide (PaCO2) to stabilize between 57 and 63 mmHg. Data are shown as median [P25th,P75th]. After lung injury, the PaO2/FiO2 (P/F) ratio was 92 [63,118] mmHg, pulmonary shunt 26 [17,31]%, and static compliance 11 [8,14] mL/cmH2O. Positive end-expiratory pressure (PEEP) was 14 [10,17] cmH2O. At 30 breaths/min, VT was higher than 6 (7.5 [6.8,10.2]) mL/kg, but at all higher frequencies, VT could be reduced and PaCO2 maintained, leading to reductions in plateau pressures and driving pressures. For frequencies of 60 to 150/min, VT progressively fell from 5.2 [5.1,5.9] to 3.8 [3.7,4.2] mL/kg (p < 0.001). There were no detrimental effects in terms of lung mechanics, auto-PEEP generation, hemodynamics, or gas exchange. Mean airway pressure was maintained constant and was increased only during HFOV. During protective mechanical ventilation, HFPPV delivered by a conventional ventilator in a severe ARDS swine model safely allows further tidal volume reductions. This strategy also allowed decreasing airway pressures while maintaining stable PaCO2 levels.
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  • Impact of dynamic airway collapse and continuous flow insufflation on initial and dynamic lung volume changes and intrathoracic pressure variation during automated cardiopulmonary resuscitation

    Cordioli, Ricardo   Granier, Jean-Max   Lyazidi, Aissam   Suppan, Laurent   Garelli, Valentina   Savary, Dominique   Brochard, Laurent   Richard, Jean-Christophe  

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  • UNITED STATES OF AMERICA.

    Cordioli, Ricardo   Granier, Jean-Max   Lyazidi, Aissam   Suppan, Laurent   Garelli, Valentina   Savary, Dominique   Brochard, Laurent   Richard, Jean-Christophe  

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  • CORRESPONDENTS.

    Cordioli, Ricardo   Granier, Jean-Max   Lyazidi, Aissam   Suppan, Laurent   Garelli, Valentina   Savary, Dominique   Brochard, Laurent   Richard, Jean-Christophe  

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