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      Implementación de un protocolo de anestesia intravenosa durante la validación de un prototipo de respirador en modelo porcino Translated title: Implementation of an intravenous anesthetic protocol during the validation of a prototype respirator in a pig model

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          Abstract

          RESUMEN Antecedentes y objetivos: se revisan los resultados obtenidos en la aplicación de un protocolo anestésico intravenoso, en el desarrollo de los procedimientos realizados sobre dos cerdos en el marco de un proyecto autorizado para la validación de un prototipo de ventilador mecánico (respirador), según un protocolo excepcional habilitado ante la crisis sanitaria provocada por el COVID-19. Material y métodos: se someten a los animales a un procedimiento de anestesia mediante una infusión continua de propofol, y de fentanilo a demanda, y mantenimiento mediante ventilación mandatoria continua controlada por presión, con respirador anestésico homologado. Se comparan los valores basales de monitorización anestésica y gasometría, con los obtenidos durante la conexión al prototipo respirador en condiciones de normalidad, y con el mismo prototipo bajo condiciones de estrés respiratorio inducido mediante un modelo de lavado de surfactante con solución salina 0,9%. Resultados: se pone de manifiesto la estabilidad del estado anestésico conseguido con el protocolo anestésico propuesto, sin que se identifiquen diferencias estadísticas significativas entre los parámetros de monitorización obtenidos durante los tres periodos anestésicos. Conclusión: este trabajo pone de manifiesto como dicho protocolo anestésico intravenoso permitió completar el proyecto de validación del prototipo, manteniéndose en todo momento las condiciones que dieron lugar a la autorización del proyecto.

          Translated abstract

          SUMMARY Objectives: The results obtained through the application of an intravenous anesthetic protocol are reviewed, in the development of the procedures carried out on two pigs in the framework of an authorized project for the validation of a prototype mechanical ventilator (respirator). All done according to the exceptional protocols enabled during the COVID-19 health crisis. Material and methods: The animals were subjected to an anesthetic procedure, in which , an infusion of propofol was used and in demand additioned fentanyl. Maintenance was achieved by means of continuous pressure-controlled mandatory ventilation, with an approved anesthetic ventilator. The baseline values with anesthetic monitorization and blood gas are compared with those obtained during connection to the respirator prototype under normal conditions, also with the same prototype under conditions of respiratory stress induced with a preparation of 0.9% saline solution wash. Results: The stability of the anesthetic state achieved with the proposed anesthetic protocol is revealed, without identifying significant statistical differences between the monitoring parameters obtained during the three anesthetic periods. Conclusions: This work shows how said intravenous anesthetic protocol allowed the completion of the prototype validation project, maintaining at all times the conditios that led to the authorization of the project.

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          Most cited references12

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          Acute respiratory distress syndrome: the Berlin Definition.

          The acute respiratory distress syndrome (ARDS) was defined in 1994 by the American-European Consensus Conference (AECC); since then, issues regarding the reliability and validity of this definition have emerged. Using a consensus process, a panel of experts convened in 2011 (an initiative of the European Society of Intensive Care Medicine endorsed by the American Thoracic Society and the Society of Critical Care Medicine) developed the Berlin Definition, focusing on feasibility, reliability, validity, and objective evaluation of its performance. A draft definition proposed 3 mutually exclusive categories of ARDS based on degree of hypoxemia: mild (200 mm Hg < PaO2/FIO2 ≤ 300 mm Hg), moderate (100 mm Hg < PaO2/FIO2 ≤ 200 mm Hg), and severe (PaO2/FIO2 ≤ 100 mm Hg) and 4 ancillary variables for severe ARDS: radiographic severity, respiratory system compliance (≤40 mL/cm H2O), positive end-expiratory pressure (≥10 cm H2O), and corrected expired volume per minute (≥10 L/min). The draft Berlin Definition was empirically evaluated using patient-level meta-analysis of 4188 patients with ARDS from 4 multicenter clinical data sets and 269 patients with ARDS from 3 single-center data sets containing physiologic information. The 4 ancillary variables did not contribute to the predictive validity of severe ARDS for mortality and were removed from the definition. Using the Berlin Definition, stages of mild, moderate, and severe ARDS were associated with increased mortality (27%; 95% CI, 24%-30%; 32%; 95% CI, 29%-34%; and 45%; 95% CI, 42%-48%, respectively; P < .001) and increased median duration of mechanical ventilation in survivors (5 days; interquartile [IQR], 2-11; 7 days; IQR, 4-14; and 9 days; IQR, 5-17, respectively; P < .001). Compared with the AECC definition, the final Berlin Definition had better predictive validity for mortality, with an area under the receiver operating curve of 0.577 (95% CI, 0.561-0.593) vs 0.536 (95% CI, 0.520-0.553; P < .001). This updated and revised Berlin Definition for ARDS addresses a number of the limitations of the AECC definition. The approach of combining consensus discussions with empirical evaluation may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning.
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            Acute respiratory distress induced by repeated saline lavage provides stable experimental conditions for 24 hours in pigs.

            Surfactant depletion is most often used to study acute respiratory failure in animal models. Because model stability is often criticized, the authors tested the following hypotheses: Repeated pulmonary lavage with normal saline provides stable experimental conditions for 24 hours with a PaO2/FiO2 ratio < 300 mm Hg. Lung injury was induced by bilateral pulmonary lavages in 8 female pigs (51.5 +/- 4.8 kg). The animals were ventilated for 24 hours (PEEP: 5 cm H2O; tidal volume: 6 mL/kg; respiratory rate: 30/min). After 24 hours the animals were euthanized. For histopathology slides from all pulmonary lobes were obtained. Supernatant of the bronchoalveolar fluid collected before induction of acute respiratory distress syndrome (ARDS) and after 24 hours was analyzed. A total of 19 +/- 6 lavages were needed to induce ARDS. PaO2/FiO2 ratio and pulmonary shunt fraction remained significantly deteriorated compared to baseline values after 24 hours (P < .01). Slight to moderate histopathologic changes were detected. Significant increases of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, and IL-6 were observed after 24 hours (P < .01). The presented surfactant depletion-based lung injury model was associated with increased pulmonary inflammation and fulfilled the criteria of acute ling injury (ALI) for 24 hours.
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              Laboratory animal anesthesia

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                Author and article information

                Journal
                sm
                Sanidad Militar
                Sanid. Mil.
                Ministerio de Defensa (Madrid, Madrid, Spain )
                1887-8571
                December 2020
                : 76
                : 4
                : 213-220
                Affiliations
                [2] Madrid orgnameHospital Central de la Defensa (HCD) orgdiv1Sección de Higiene y Vigilancia Ambiental
                [3] Madrid orgnameHospital Central de la Defensa (HCD) orgdiv1Servicio de Medicina y Cirugía Experimental
                [5] orgnameGrupo Hospitales Vithas orgdiv1Fundación Vithas
                [6] Madrid Madrid orgnameUniversidad Francisco de Vitoria orgdiv1Facultad de Ciencias Experimentales Spain
                [1] Madrid orgnameHospital Central de la Defensa (HCD) orgdiv1Servicio de Medicina y Cirugía Experimental
                [4] orgnameHospital Central de la Defensa (HCD) orgdiv1Servicios Veterinarios
                Article
                S1887-85712020000400213 S1887-8571(20)07600400213
                10.4321/s1887-85712020000400002
                a86e6b8b-d44f-4226-af0c-ff4b041eeb07

                http://creativecommons.org/licenses/by/4.0/

                History
                : 09 December 2020
                : 14 October 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 14, Pages: 8
                Product

                SciELO Spain

                Categories
                Artículo Original

                porcino,Anestesia intravenosa,ventilador,monitorización anestésica,lavado broncoalveolar,Intravenous anesthetic,Ventilator,Anesthesia monitoring,Bronchoalveolar Lavage,Porcine

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