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The role of high airway pressure and dynamic strain on ventilator-induced lung injury in a heterogeneous acute lung injury model

Authors :
Sumeet V. Jain
Michaela Kollisch-Singule
Joshua Satalin
Quinn Searles
Luke Dombert
Osama Abdel-Razek
Natesh Yepuri
Antony Leonard
Angelika Gruessner
Penny Andrews
Fabeha Fazal
Qinghe Meng
Guirong Wang
Louis A. Gatto
Nader M. Habashi
Gary F. Nieman
Source :
Intensive Care Medicine Experimental, Vol 5, Iss 1, Pp 1-18 (2017)
Publication Year :
2017
Publisher :
SpringerOpen, 2017.

Abstract

Abstract Background Acute respiratory distress syndrome causes a heterogeneous lung injury with normal and acutely injured lung tissue in the same lung. Improperly adjusted mechanical ventilation can exacerbate ARDS causing a secondary ventilator-induced lung injury (VILI). We hypothesized that a peak airway pressure of 40 cmH2O (static strain) alone would not cause additional injury in either the normal or acutely injured lung tissue unless combined with high tidal volume (dynamic strain). Methods Pigs were anesthetized, and heterogeneous acute lung injury (ALI) was created by Tween instillation via a bronchoscope to both diaphragmatic lung lobes. Tissue in all other lobes was normal. Airway pressure release ventilation was used to precisely regulate time and pressure at both inspiration and expiration. Animals were separated into two groups: (1) over-distension + high dynamic strain (OD + HDS, n = 6) and (2) over-distension + low dynamic strain (OD + LDS, n = 6). OD was caused by setting the inspiratory pressure at 40 cmH2O and dynamic strain was modified by changing the expiratory duration, which varied the tidal volume. Animals were ventilated for 6 h recording hemodynamics, lung function, and inflammatory mediators followed by an extensive necropsy. Results In normal tissue (NT), OD + LDS caused minimal histologic damage and a significant reduction in BALF total protein (p

Details

Language :
English
ISSN :
2197425X
Volume :
5
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Intensive Care Medicine Experimental
Publication Type :
Academic Journal
Accession number :
edsdoj.4c47d7e6c18140fa80153cb84c48400e
Document Type :
article
Full Text :
https://doi.org/10.1186/s40635-017-0138-1