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May 1990, Vol 144, No. 5 >
Article | May 1990

The Effect of 100% Oxygen on the Propagation of Tracheobronchial Injury During High-Frequency and Conventional Mechanical Ventilation FREE

Thomas E. Wiswell, MD, MC; Susan H. Wiswell
[+] Author Affiliations

Accepted for publication November 28, 1989.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army, the Department of Defense, the Southwest Foundation for Biomedical Research, or the University of Texas at San Antonio.

Reprint requests to Department of Pediatrics, Walter Reed Army Medical Center, Washington, DC 20307-5001 (Dr Wiswell).


Am J Dis Child. 1990;144(5):560-564. doi:10.1001/archpedi.1990.02150290054026.
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• We compared the histologic alterations in the tracheae and bronchi of 30 premature baboons that were ventilated with either 100% or prn (as needed) oxygen (the fraction of inspired oxygen necessary to maintain the PaO2 between 50 and 80 mm Hg). The baboons were treated with either conventional positive-pressure ventilation (7 were treated with 100%; 7, prn) or high-frequency oscillatory ventilation (8 were treated with 100%; 8, prn). We used a semiquantitative scoring system to grade tissue changes in the trachea, carina, and main-stem bronchi. The fraction of inspired oxygen for all prn animals fell to a plateau of approximately 0.28 after 36 hours, where it remained for the duration of the study. The 15 100% baboons were ventilated for a mean of 139 hours, while the 15 prn baboons were ventilated for a mean of 151 hours. The findings in all conventional and oscillator-ventilated animals were similar and characterized by squamous metaplasia, cilia loss, and goblet cell loss. For both methods of ventilation, there were no differences in the injury scores between 100% and prn oxygen-treated animals. We concluded that there were no additional tracheobronchial histologic changes with 100% oxygen compared with prn oxygen.

(AJDC. 1990;144:560-564)

REFERENCES

1 +
Clark RH, Wiswell TE, Null DM, deLamos RR, Coalson JJ.  Tracheal and bronchial injury in high-frequency oscillatory ventilation compared with conventional positive-pressure ventilation . J Pediatr . 1987;;111:114-118.
2 +
Wiswell TE, Clark RH, Null DM, deLamos RR, Coalson JJ.  Tracheal and bronchial injury in high-frequency oscillatory ventilation and high-frequency flow interruption compared with conventional positive-pressure ventilation . J Pediatr . 1988;;112:249-254.
3 +
Mammel MC, Boros SJ.  Airway damage and mechanical ventilation: a review and commentary . Pediatr Pulmonol . 1987;;3:443-447.
4 +
Gaylord MS, Quissell BJ, Lair ME.  High-frequency ventilation in the treatment of infants weighing less than 1,500 grams with pulmonary interstitial emphysema: a pilot study . Pediatrics . 1987;;80:915-921.
5 +
Joshi VV, Mandavia MB, Stern L, Wigles-worth FW.  Acute lesions induced by endotracheal intubation . AJDC . 1972;;124:646-649.
6 +
Kirpilani H, Higa T, Perlman M, Friedberg J, Cutz E.  Diagnosis and therapy of necrotizing tracheobronchitis in ventilated neonates . Crit Care Med . 1985;;13:792-797.
7 +
Mimouni F, Ballard JL, Ballard ET, Cotton RT.  Necrotizing tracheobronchitis: case report . Pediatrics . 1986;;77:366-368.
8 +
Pietsch JB, Nagaraj HS, Groff DB, Yacoub UAH, Roberts JL.  Necrotizing tracheobronchitis: a new indication for emergency bronchoscopy in the neonate . J Pediatr Surg . 1985;;20:391-393.
9 +
Minton D, Stoddard RA, Lassen G, et al.  Silicone particulate debris in the life pulse high frequency jet ventilator . Pediatr Pulmonol . 1987;;3:375.
10 +
Mammel MC, Ophoven JP, Lewallen PK, Gordon MJ, Sutton MC, Boros SJ.  High-frequency ventilation and tracheal injuries . Pediatrics 1986;;77:608-613.
11 +
Polak MJ, Donnelly WH, Bucciarelli RL.  Comparison of airway pathologic lesions after high-frequency jet or conventional ventilation . AJDC . 1989;;143:228-232.
12 +
Hanson JB, Waldstein G, Hernandez JA, Fan LL.  Necrotizing tracheobronchitis: an ischemic lesion . AJDC . 1988;;142:1094-1098.
13 +
Metlay LA, Macpherson TA, Milley JR.  Necrotizing tracheobronchitis in intubated new-borns: a complication of assisted ventilation . Pediatr Pathol . 1987;;7:575-584.
14 +
Wiswell TE, Turner BS, Bley JA, Fritz DL, Hunt RE.  Determinants of tracheobronchial histologic alterations during conventional mechanical ventilation . Pediatrics . 1989;;84:304-311.
15 +
Wiswell TE, Bley JA, Turner BS, Hunt RE, Fritz DL.  The effect of different high frequency ventilator strategies on the propagation of tracheobronchial histopathologic changes . Pediatrics . 1990;;85:70-78.
16 +
Marfatia S, Donahoe PK, Hendren WH.  Effeet of dry and humidified gases on the respiratory epithelium in rabbits . J Pediatr Surg . 1975;;10:583-592.
17 +
Northway WH, Roxan RC, Porter DY.  Pulmonary disease following respirator therapy of hyaline-membrane disease . N Engl J Med . 1967;;276: 357-368.
18 +
Edwards DK, Dyer WM, Northway WH.  Twelve years' experience with bronchopulmonary dysplasia . Pediatrics . 1977;;59:839-846.
19 +
Philip AGS.  Oxygen plus pressure plus time: the etiology of bronchopulmonary dysplasia . Pediatrics . 1975;;55:44-50.
20 +
Bonikos DS, Bensch KG, Northway WH, Edwards DK.  Bronchopulmonary dysplasia: the pulmonary pathologic sequel of necrotizing bronchiolitis and pulmonary fibrosis . Hum Pathol . 1976;;7:643-666.
21 +
Anderson WR, Strickland MB.  Pulmonary complications of oxygen therapy in the neonate . Arch Pathol Lab Med . 1971;;91:506-514.
22 +
Boat TF, Kleinerman JI, Fanaroff AA, Matthews LW.  Toxic effects of oxygen on cultured human neonatal respiratory epithelium . Pediatr Res . 1973;;7:607-615.
23 +
Escobedo MB, Hilliared JL, Smith F, et al.  A baboon model of bronchopulmonary dysplasia, I: clinical features . Exp Mol Pathol . 1982;;37:323-334.
24 +
Coalson JJ, Kuehl TJ, Escobedo MB, et al.  A baboon model of bronchopulmonary dysplasia, II: pathologic features . Exp Mol Pathol. 1982;;37:335-350.
25 +
Bell RE, Kuehl TJ, Coalson JJ, et al.  High-frequency ventilation compared to conventional positive-pressure ventilation in the treatment of hyaline membrane disease in primates . Crit Care Med . 1984;;12:764-768.
26 +
deLemos RA, Coalson JJ, Null DM, et al.  Ventilatory management of infant baboons with hyaline membrance disease: the use of high frequency ventilation . Pediatr Res . 1987;;21:594-602.
27 +
Gerstman DR, deLemos RA, Coalson JJ, et al.  Influence of ventilatory technique on pulmonary baroinjury in baboons with hyaline membrane disease . Pediatr Pulmonol . 1988;;5:82-91.
28 +
Rasche RFH, Kuhns LR.  Histopathologic changes in airway mucosa of infants after endotracheal intubation . Pediatrics . 1972;;50:632-637.
29 +
Ludwin SK, Northway WH, Bensch KG.  Oxygen toxicity in the newborn: necrotizing bronchiolitis in mice exposed to 100 percent oxygen . Lab Invest . 1974;;31:425-435.
30 +
Coalson JJ, Beller JJ, Greenfield LJ.  Effects of 100 percent oxygen ventilation on pulmonary ultrastructure and mechanics . J Pathol . 1971;;104: 267-273.

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References

1 +
Clark RH, Wiswell TE, Null DM, deLamos RR, Coalson JJ.  Tracheal and bronchial injury in high-frequency oscillatory ventilation compared with conventional positive-pressure ventilation . J Pediatr . 1987;;111:114-118.
2 +
Wiswell TE, Clark RH, Null DM, deLamos RR, Coalson JJ.  Tracheal and bronchial injury in high-frequency oscillatory ventilation and high-frequency flow interruption compared with conventional positive-pressure ventilation . J Pediatr . 1988;;112:249-254.
3 +
Mammel MC, Boros SJ.  Airway damage and mechanical ventilation: a review and commentary . Pediatr Pulmonol . 1987;;3:443-447.
4 +
Gaylord MS, Quissell BJ, Lair ME.  High-frequency ventilation in the treatment of infants weighing less than 1,500 grams with pulmonary interstitial emphysema: a pilot study . Pediatrics . 1987;;80:915-921.
5 +
Joshi VV, Mandavia MB, Stern L, Wigles-worth FW.  Acute lesions induced by endotracheal intubation . AJDC . 1972;;124:646-649.
6 +
Kirpilani H, Higa T, Perlman M, Friedberg J, Cutz E.  Diagnosis and therapy of necrotizing tracheobronchitis in ventilated neonates . Crit Care Med . 1985;;13:792-797.
7 +
Mimouni F, Ballard JL, Ballard ET, Cotton RT.  Necrotizing tracheobronchitis: case report . Pediatrics . 1986;;77:366-368.
8 +
Pietsch JB, Nagaraj HS, Groff DB, Yacoub UAH, Roberts JL.  Necrotizing tracheobronchitis: a new indication for emergency bronchoscopy in the neonate . J Pediatr Surg . 1985;;20:391-393.
9 +
Minton D, Stoddard RA, Lassen G, et al.  Silicone particulate debris in the life pulse high frequency jet ventilator . Pediatr Pulmonol . 1987;;3:375.
10 +
Mammel MC, Ophoven JP, Lewallen PK, Gordon MJ, Sutton MC, Boros SJ.  High-frequency ventilation and tracheal injuries . Pediatrics 1986;;77:608-613.
11 +
Polak MJ, Donnelly WH, Bucciarelli RL.  Comparison of airway pathologic lesions after high-frequency jet or conventional ventilation . AJDC . 1989;;143:228-232.
12 +
Hanson JB, Waldstein G, Hernandez JA, Fan LL.  Necrotizing tracheobronchitis: an ischemic lesion . AJDC . 1988;;142:1094-1098.
13 +
Metlay LA, Macpherson TA, Milley JR.  Necrotizing tracheobronchitis in intubated new-borns: a complication of assisted ventilation . Pediatr Pathol . 1987;;7:575-584.
14 +
Wiswell TE, Turner BS, Bley JA, Fritz DL, Hunt RE.  Determinants of tracheobronchial histologic alterations during conventional mechanical ventilation . Pediatrics . 1989;;84:304-311.
15 +
Wiswell TE, Bley JA, Turner BS, Hunt RE, Fritz DL.  The effect of different high frequency ventilator strategies on the propagation of tracheobronchial histopathologic changes . Pediatrics . 1990;;85:70-78.
16 +
Marfatia S, Donahoe PK, Hendren WH.  Effeet of dry and humidified gases on the respiratory epithelium in rabbits . J Pediatr Surg . 1975;;10:583-592.
17 +
Northway WH, Roxan RC, Porter DY.  Pulmonary disease following respirator therapy of hyaline-membrane disease . N Engl J Med . 1967;;276: 357-368.
18 +
Edwards DK, Dyer WM, Northway WH.  Twelve years' experience with bronchopulmonary dysplasia . Pediatrics . 1977;;59:839-846.
19 +
Philip AGS.  Oxygen plus pressure plus time: the etiology of bronchopulmonary dysplasia . Pediatrics . 1975;;55:44-50.
20 +
Bonikos DS, Bensch KG, Northway WH, Edwards DK.  Bronchopulmonary dysplasia: the pulmonary pathologic sequel of necrotizing bronchiolitis and pulmonary fibrosis . Hum Pathol . 1976;;7:643-666.
21 +
Anderson WR, Strickland MB.  Pulmonary complications of oxygen therapy in the neonate . Arch Pathol Lab Med . 1971;;91:506-514.
22 +
Boat TF, Kleinerman JI, Fanaroff AA, Matthews LW.  Toxic effects of oxygen on cultured human neonatal respiratory epithelium . Pediatr Res . 1973;;7:607-615.
23 +
Escobedo MB, Hilliared JL, Smith F, et al.  A baboon model of bronchopulmonary dysplasia, I: clinical features . Exp Mol Pathol . 1982;;37:323-334.
24 +
Coalson JJ, Kuehl TJ, Escobedo MB, et al.  A baboon model of bronchopulmonary dysplasia, II: pathologic features . Exp Mol Pathol. 1982;;37:335-350.
25 +
Bell RE, Kuehl TJ, Coalson JJ, et al.  High-frequency ventilation compared to conventional positive-pressure ventilation in the treatment of hyaline membrane disease in primates . Crit Care Med . 1984;;12:764-768.
26 +
deLemos RA, Coalson JJ, Null DM, et al.  Ventilatory management of infant baboons with hyaline membrance disease: the use of high frequency ventilation . Pediatr Res . 1987;;21:594-602.
27 +
Gerstman DR, deLemos RA, Coalson JJ, et al.  Influence of ventilatory technique on pulmonary baroinjury in baboons with hyaline membrane disease . Pediatr Pulmonol . 1988;;5:82-91.
28 +
Rasche RFH, Kuhns LR.  Histopathologic changes in airway mucosa of infants after endotracheal intubation . Pediatrics . 1972;;50:632-637.
29 +
Ludwin SK, Northway WH, Bensch KG.  Oxygen toxicity in the newborn: necrotizing bronchiolitis in mice exposed to 100 percent oxygen . Lab Invest . 1974;;31:425-435.
30 +
Coalson JJ, Beller JJ, Greenfield LJ.  Effects of 100 percent oxygen ventilation on pulmonary ultrastructure and mechanics . J Pathol . 1971;;104: 267-273.

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