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THE USE OF ITPV VS CONVENTIONAL VENTILATION IN MECONIUM ASPIRATION SYNDROME IN A NEWBORN PIG MODEL. ▴ 1988

Intratracheal Pulmonary Ventilation (ITPV) uses a venturi (reverse thrust) catheter to introduce gas exchange at the level of the carina. This method reduces anatomic dead space and enhances oxygenation and carbon dioxide elimination, which allows gas exchange with lower levels of ventilatory support and reduces the incidence of barotrauma. To test this hypothesis we compared ITPV to conventional ventilation in a newborn pig model of MAS. Piglets (n=17), 2-7 days of age, 1.8-2.8 kg were anesthetized, paralyzed, intubated, and ventilated. Femoral arterial and venous catheters were placed for IV fluids, medications, and physiologic and blood gas monitoring. 5 ml/kg of 20% meconium in normal saline was instilled into the endotracheal tube. Animals were randomized to either ITPV or conventional ventilation and settings were adjusted to maintain ideal blood gases, i.e. pH=7.35-7.45, PaCO2=40-45, PaO2=70-90, and SaO2≥90%. Ventilator settings were increased as needed until maximum settings of: FiO2=1.00, PIP=40, Peep=5, and IMV=80. Arterial blood gases and physiologic measurements were taken every 30 minutes for four hours and ventilator settings were adjusted to maintain optimal blood gases. At the end of the experiment animals were sacrificed with a KCL/pentobarbital overdose and the lungs were examined both grossly and histologically for evidence of barotrauma. Results are shown in the table. Conclusion: ITPV is as effective as conventional ventilation and allows for lower mean airway pressure and PIP to effectively support piglets with MAS. The lungs of animals treated with ITPV were less hemorrhagic and had less evidence of pneumothoraces when compared with the conventional group.