Low volume ventilation strategy using a coaxial double-lumen tube: viability and effects on lung function and protection.

• Grant number: 15/22751-3
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• Start date: April 01, 2016
• End date: August 04, 2019
• Field of knowledge: Health Sciences - Medicine
• Principal Investigator: Marcelo Britto Passos Amato
• Grantee: Nadja Cristinne Silva Carvalho
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Associated scholarship(s): 17/16180-9 - Long term effect of coaxial double lumen tube ventilation associated with moderately high breathing frequency on lungs protection and function in an experimental model of acute respiratory distress syndrome, BE.EP.PD

Abstract

Acute Respiratory Distress Syndrome (ARDS) is characterized by shunt and increased dead-space ventilation, resulting in hypoxia and increased carbon dioxide tension with respiratory acidosis. Historically, MV with high tidal volumes (VT=10-15 mL/kg) and high pressures had been recommended in patients with ARDS to ameliorate gas exchange. However, there is convincing evidence suggesting that such settings may lead to serious damage in both previously healthy and diseased lungs during MV. The concept of a lung-protective strategy, i.e low VT (6 mL/kg) and limited pressure (d35 cmH2O), in the management of patients with ARDS has been proposed as a method to overcome such problems. However, the reduction of VT may result in an increased PaCO2, which has potentially adverse consequences. Promptly intervention to improve CO2 washout is a reduction of instrumental dead-space and an increase in respiratory rate (RR), which should be increased with caution since hypothesis exist that increased respiratory rate can be injurious per se. With this project, the candidate will exploit the effects of an adjunctive tool named coaxial double lumen tube on instrumental dead-space reduction. The present study will be performed in animal model (piglets) after induced lung injury. The expected objectives of the current work are that the association of the coaxial double-lumen tube and moderately high RR (40-60 bpm) allows to maintain PaCO2 at clinically acceptable levels and enable the use of ultra-protective tidal volumes (below 6ml/kg).