Delayed extubation to nasal continuous positive airway pressure in the immature baboon model of bronchopulmonary dysplasia: Lung clinical and pathological findings

Merran A. Thomson, Bradley A. Yoder, Vicki T. Winter, Luis Giavedoni, Yi Chang Ling, Jacqueline J. Coalson

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

OBJECTIVE. Using the 125-day baboon model of bronchopulmonary dysplasia treated with prenatal steroid and exogenous surfactant, we hypothesized that a delay of extubation from low tidal volume positive pressure ventilation to nasal continuous positive airway pressure at 5 days (delayed nasal continuous positive airway pressure group) would not induce more lung injury when compared with baboons aggressively weaned to nasal continuous positive airway pressure at 24 hours (early nasal continuous positive airway pressure group), because both received positive pressure ventilation. METHODS AND RESULTS. After delivery by cesarean section at 125 days (term: 185 days), infants received 2 doses of Curosurf (Chiesi Farmaceutica S.p.A., Parma, Italy) and daily caffeine citrate. The delay in extubation to 5 days resulted in baboons in the delayed nasal continuous positive airway pressure group having a lower arterial to alveolar oxygen ratio, high PaCO2, and worse respiratory function. The animals in the delayed nasal continuous positive airway pressure group exhibited a poor respiratory drive that contributed to more reintubations and time on mechanical ventilation. A few animals in both groups developed necrotizing enterocolitis and/or sepsis, but infectious pneumonias were not documented. Cellular bronchiolitis and peribronchiolar alveolar wall thickening were more frequently seen in the delayed nasal continuous positive airway pressure group. Bronchoalveolar lavage levels of interleukin-6, interleukin-8, monocyte chemotactic protein-1, macrophage inflammatory protein-1 α, and growth-regulated oncogene-α were significantly increased in the delayed nasal continuous positive airway pressure group. Standard and digital morphometric analyses showed no significant differences in internal surface area and nodal measurements between the groups. Platelet endothelial cell adhesion molecule vascular staining was not significantly different between the 2 nasal continuous positive airway pressure groups. CONCLUSIONS. Volutrauma and/or low-grade colonization of airways secondary to increased reintubations and ventilation times are speculated to play causative roles in the delayed nasal continuous positive airway pressure group findings.

Original languageEnglish (US)
Pages (from-to)2038-2050
Number of pages13
JournalPediatrics
Volume118
Issue number5
DOIs
StatePublished - Nov 2006

Fingerprint

Bronchopulmonary Dysplasia
Continuous Positive Airway Pressure
Papio
Lung
Positive-Pressure Respiration
Macrophage Inflammatory Proteins
Necrotizing Enterocolitis
Bronchiolitis
Chemokine CCL2
Tidal Volume
Cell Adhesion Molecules
Lung Injury
Bronchoalveolar Lavage
Interleukin-8
Oncogenes
Artificial Respiration
Surface-Active Agents
Cesarean Section
Italy
Blood Vessels

Keywords

  • Alveolization
  • Biotrauma
  • Bronchiolitis
  • Bronchopulmonary dysplasia
  • Chemokines
  • Cytokines
  • Nasal continuous positive airway pressure
  • Necrotizing enterocolitis
  • Sepsis
  • Vasculogenesis
  • Volutrauma

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Delayed extubation to nasal continuous positive airway pressure in the immature baboon model of bronchopulmonary dysplasia : Lung clinical and pathological findings. / Thomson, Merran A.; Yoder, Bradley A.; Winter, Vicki T.; Giavedoni, Luis; Ling, Yi Chang; Coalson, Jacqueline J.

In: Pediatrics, Vol. 118, No. 5, 11.2006, p. 2038-2050.

Research output: Contribution to journalArticle

Thomson, Merran A. ; Yoder, Bradley A. ; Winter, Vicki T. ; Giavedoni, Luis ; Ling, Yi Chang ; Coalson, Jacqueline J. / Delayed extubation to nasal continuous positive airway pressure in the immature baboon model of bronchopulmonary dysplasia : Lung clinical and pathological findings. In: Pediatrics. 2006 ; Vol. 118, No. 5. pp. 2038-2050.
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T2 - Lung clinical and pathological findings

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AU - Yoder, Bradley A.

AU - Winter, Vicki T.

AU - Giavedoni, Luis

AU - Ling, Yi Chang

AU - Coalson, Jacqueline J.

PY - 2006/11

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N2 - OBJECTIVE. Using the 125-day baboon model of bronchopulmonary dysplasia treated with prenatal steroid and exogenous surfactant, we hypothesized that a delay of extubation from low tidal volume positive pressure ventilation to nasal continuous positive airway pressure at 5 days (delayed nasal continuous positive airway pressure group) would not induce more lung injury when compared with baboons aggressively weaned to nasal continuous positive airway pressure at 24 hours (early nasal continuous positive airway pressure group), because both received positive pressure ventilation. METHODS AND RESULTS. After delivery by cesarean section at 125 days (term: 185 days), infants received 2 doses of Curosurf (Chiesi Farmaceutica S.p.A., Parma, Italy) and daily caffeine citrate. The delay in extubation to 5 days resulted in baboons in the delayed nasal continuous positive airway pressure group having a lower arterial to alveolar oxygen ratio, high PaCO2, and worse respiratory function. The animals in the delayed nasal continuous positive airway pressure group exhibited a poor respiratory drive that contributed to more reintubations and time on mechanical ventilation. A few animals in both groups developed necrotizing enterocolitis and/or sepsis, but infectious pneumonias were not documented. Cellular bronchiolitis and peribronchiolar alveolar wall thickening were more frequently seen in the delayed nasal continuous positive airway pressure group. Bronchoalveolar lavage levels of interleukin-6, interleukin-8, monocyte chemotactic protein-1, macrophage inflammatory protein-1 α, and growth-regulated oncogene-α were significantly increased in the delayed nasal continuous positive airway pressure group. Standard and digital morphometric analyses showed no significant differences in internal surface area and nodal measurements between the groups. Platelet endothelial cell adhesion molecule vascular staining was not significantly different between the 2 nasal continuous positive airway pressure groups. CONCLUSIONS. Volutrauma and/or low-grade colonization of airways secondary to increased reintubations and ventilation times are speculated to play causative roles in the delayed nasal continuous positive airway pressure group findings.

AB - OBJECTIVE. Using the 125-day baboon model of bronchopulmonary dysplasia treated with prenatal steroid and exogenous surfactant, we hypothesized that a delay of extubation from low tidal volume positive pressure ventilation to nasal continuous positive airway pressure at 5 days (delayed nasal continuous positive airway pressure group) would not induce more lung injury when compared with baboons aggressively weaned to nasal continuous positive airway pressure at 24 hours (early nasal continuous positive airway pressure group), because both received positive pressure ventilation. METHODS AND RESULTS. After delivery by cesarean section at 125 days (term: 185 days), infants received 2 doses of Curosurf (Chiesi Farmaceutica S.p.A., Parma, Italy) and daily caffeine citrate. The delay in extubation to 5 days resulted in baboons in the delayed nasal continuous positive airway pressure group having a lower arterial to alveolar oxygen ratio, high PaCO2, and worse respiratory function. The animals in the delayed nasal continuous positive airway pressure group exhibited a poor respiratory drive that contributed to more reintubations and time on mechanical ventilation. A few animals in both groups developed necrotizing enterocolitis and/or sepsis, but infectious pneumonias were not documented. Cellular bronchiolitis and peribronchiolar alveolar wall thickening were more frequently seen in the delayed nasal continuous positive airway pressure group. Bronchoalveolar lavage levels of interleukin-6, interleukin-8, monocyte chemotactic protein-1, macrophage inflammatory protein-1 α, and growth-regulated oncogene-α were significantly increased in the delayed nasal continuous positive airway pressure group. Standard and digital morphometric analyses showed no significant differences in internal surface area and nodal measurements between the groups. Platelet endothelial cell adhesion molecule vascular staining was not significantly different between the 2 nasal continuous positive airway pressure groups. CONCLUSIONS. Volutrauma and/or low-grade colonization of airways secondary to increased reintubations and ventilation times are speculated to play causative roles in the delayed nasal continuous positive airway pressure group findings.

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KW - Bronchopulmonary dysplasia

KW - Chemokines

KW - Cytokines

KW - Nasal continuous positive airway pressure

KW - Necrotizing enterocolitis

KW - Sepsis

KW - Vasculogenesis

KW - Volutrauma

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