Effects of Ultraprotective Ventilation, Extracorporeal Carbon Dioxide Removal, and Spontaneous Breathing on Lung Morphofunction and Inflammation in Experimental Severe Acute Respiratory Distress Syndrome
BACKGROUND:To investigate the role of ultraprotective mechanical ventilation (UP-MV) and extracorporeal carbon dioxide removal with and without spontaneous breathing (SB) to improve respiratory function and lung protection in experimental severe acute respiratory distress syndrome. METHODS:Severe acute respiratory distress syndrome was induced by saline lung lavage and mechanical ventilation (MV) with higher tidal volume (VT) in 28 anesthetized pigs (32.8 to 52.5 kg). Animals (n = 7 per group) were randomly assigned to 6 h of MV (airway pressure release ventilation) with(1) conventional P-MV with VT ≈6 ml/kg (P-MVcontr); (2) UP-MV with VT ≈3 ml/kg (UP-MVcontr); (3) UP-MV with VT ≈3 ml/kg and SB (UP-MVspont); and (4) UP-MV with VT ≈3 ml/kg and pressure supported SB (UP-MVPS). In UP-MV groups, extracorporeal carbon dioxide removal was used. RESULTS:The authors found that(1) UP-MVcontr reduced diffuse alveolar damage score in dorsal lung zones (median[interquartile]) (12.0 [7.0 to 16.8] vs. 22.5 [13.8 to 40.8]), but worsened oxygenation and intrapulmonary shunt, compared to P-MVcontr; (2) UP-MVspont and UP-MVPS improved oxygenation and intrapulmonary shunt, and redistributed ventilation towards dorsal areas, as compared to UP-MVcontr; (3) compared to P-MVcontr, UP-MVcontr and UP-MVspont, UP-MVPS yielded higher levels of tumor necrosis factor-α (6.9 [6.5 to 10.1] vs. 2.8 [2.2 to 3.0], 3.6 [3.0 to 4.7] and 4.0 [2.8 to 4.4] pg/mg, respectively) and interleukin-8 (216.8 [113.5 to 343.5] vs. 59.8 [45.3 to 66.7], 37.6 [18.8 to 52.0], and 59.5 [36.1 to 79.7] pg/mg, respectively) in dorsal lung zones. CONCLUSIONS:In this model of severe acute respiratory distress syndrome, MV with VT ≈3 ml/kg and extracorporeal carbon dioxide removal without SB slightly reduced lung histologic damage, but not inflammation, as compared to MV with VT = 4 to 6 ml/kg. During UP-MV, pressure supported SB increased lung inflammation..
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2015 |
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| Erschienen: |
2015 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:122 |
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| Enthalten in: |
Anesthesiology - 122(2015), 3, Seite 631-646 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Güldner, Andreas [VerfasserIn] |
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| Links: |
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| RVK: |
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| doi: |
10.1097/ALN.0000000000000504 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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OLC1963377877 |
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| 100 | 1 | |a Güldner, Andreas |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Effects of Ultraprotective Ventilation, Extracorporeal Carbon Dioxide Removal, and Spontaneous Breathing on Lung Morphofunction and Inflammation in Experimental Severe Acute Respiratory Distress Syndrome |
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| 520 | |a BACKGROUND:To investigate the role of ultraprotective mechanical ventilation (UP-MV) and extracorporeal carbon dioxide removal with and without spontaneous breathing (SB) to improve respiratory function and lung protection in experimental severe acute respiratory distress syndrome. METHODS:Severe acute respiratory distress syndrome was induced by saline lung lavage and mechanical ventilation (MV) with higher tidal volume (VT) in 28 anesthetized pigs (32.8 to 52.5 kg). Animals (n = 7 per group) were randomly assigned to 6 h of MV (airway pressure release ventilation) with(1) conventional P-MV with VT ≈6 ml/kg (P-MVcontr); (2) UP-MV with VT ≈3 ml/kg (UP-MVcontr); (3) UP-MV with VT ≈3 ml/kg and SB (UP-MVspont); and (4) UP-MV with VT ≈3 ml/kg and pressure supported SB (UP-MVPS). In UP-MV groups, extracorporeal carbon dioxide removal was used. RESULTS:The authors found that(1) UP-MVcontr reduced diffuse alveolar damage score in dorsal lung zones (median[interquartile]) (12.0 [7.0 to 16.8] vs. 22.5 [13.8 to 40.8]), but worsened oxygenation and intrapulmonary shunt, compared to P-MVcontr; (2) UP-MVspont and UP-MVPS improved oxygenation and intrapulmonary shunt, and redistributed ventilation towards dorsal areas, as compared to UP-MVcontr; (3) compared to P-MVcontr, UP-MVcontr and UP-MVspont, UP-MVPS yielded higher levels of tumor necrosis factor-α (6.9 [6.5 to 10.1] vs. 2.8 [2.2 to 3.0], 3.6 [3.0 to 4.7] and 4.0 [2.8 to 4.4] pg/mg, respectively) and interleukin-8 (216.8 [113.5 to 343.5] vs. 59.8 [45.3 to 66.7], 37.6 [18.8 to 52.0], and 59.5 [36.1 to 79.7] pg/mg, respectively) in dorsal lung zones. CONCLUSIONS:In this model of severe acute respiratory distress syndrome, MV with VT ≈3 ml/kg and extracorporeal carbon dioxide removal without SB slightly reduced lung histologic damage, but not inflammation, as compared to MV with VT = 4 to 6 ml/kg. During UP-MV, pressure supported SB increased lung inflammation. | ||
| 540 | |a Nutzungsrecht: Copyright © by 2015, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. | ||
| 650 | 4 | |a Lung - physiology | |
| 650 | 4 | |a Respiratory Distress Syndrome, Adult - metabolism | |
| 650 | 4 | |a Respiratory Distress Syndrome, Adult - therapy | |
| 650 | 4 | |a Lung - pathology | |
| 650 | 4 | |a Carbon Dioxide - metabolism | |
| 650 | 4 | |a Respiratory Distress Syndrome, Adult - pathology | |
| 650 | 4 | |a Extracorporeal Membrane Oxygenation - methods | |
| 650 | 4 | |a Respiratory Mechanics - physiology | |
| 650 | 4 | |a Respiration, Artificial - methods | |
| 700 | 1 | |a Kiss, Thomas |4 oth | |
| 700 | 1 | |a Bluth, Thomas |4 oth | |
| 700 | 1 | |a Uhlig, Christopher |4 oth | |
| 700 | 1 | |a Braune, Anja |4 oth | |
| 700 | 1 | |a Carvalho, Nadja |4 oth | |
| 700 | 1 | |a Quast, Theresa |4 oth | |
| 700 | 1 | |a Rentzsch, Ines |4 oth | |
| 700 | 1 | |a Huhle, Robert |4 oth | |
| 700 | 1 | |a Spieth, Peter |4 oth | |
| 700 | 1 | |a Richter, Torsten |4 oth | |
| 700 | 1 | |a Saddy, Felipe |4 oth | |
| 700 | 1 | |a Rocco, Patricia R M |4 oth | |
| 700 | 1 | |a Kasper, Michael |4 oth | |
| 700 | 1 | |a Koch, Thea |4 oth | |
| 700 | 1 | |a Pelosi, Paolo |4 oth | |
| 700 | 1 | |a de Abreu, Marcelo Gama |4 oth | |
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