Document Detail

Adverse effects of large tidal volume and low PEEP in canine acid aspiration.
MedLine Citation:
PMID:  2200314     Owner:  NLM     Status:  MEDLINE    
When normal lungs are ventilated with large tidal volumes (VT) and end-inspired pressures (Pei), surfactant is depleted and pulmonary edema develops. Both effects are diminished by positive end-expiratory pressure (PEEP). We reasoned that ventilatory with large VT-low PEEP would similarly increase edema following acute lung injury. To test this hypothesis, we ventilated dogs 1 h after hydrochloric acid (HCl) induced pulmonary edema with a large VT (30 ml/kg) and low PEEP (3 cm H2O) (large VT-low PEEP) and compared their results with dogs ventilated with a smaller VT (15 ml/kg) and 12 cm H2O PEEP (small VT-high PEEP). The small VT was the smallest that maintained eucapnia in our preparation; the large VT was chosen to match Pei and end-inspired lung volume. Pulmonary capillary wedge transmural pressure (Ppwtm) was kept at 8 mm Hg in both groups. Five hours after injury, the median lung wet weight to body weight ratio (WW/BW) was 25 g/kg higher in the large VT-low PEEP group than in the small VT-high PEEP group (p less than 0.05). Venous admixture (Qva/Qt) was similarly greater in the large VT-low PEEP group (49.8 versus 23.5%) (p less than 0.05). We conclude that small VT-high PEEP is a better mode of ventilating acute lung injury than large VT-low PEEP because edema accumulation is less and venous admixture is less. These advantages did not result from differences in Pei, end-inspiratory lung volume, or preload (Ppwtm).(ABSTRACT TRUNCATED AT 250 WORDS)
T C Corbridge; L D Wood; G P Crawford; M J Chudoba; J Yanos; J I Sznajder
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The American review of respiratory disease     Volume:  142     ISSN:  0003-0805     ISO Abbreviation:  Am. Rev. Respir. Dis.     Publication Date:  1990 Aug 
Date Detail:
Created Date:  1990-09-11     Completed Date:  1990-09-11     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0370523     Medline TA:  Am Rev Respir Dis     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  311-5     Citation Subset:  AIM; IM    
Section of Pulmonary and Critical Care Medicine, Michael Reese Hospital and Medical Center, Chicago, Illinois.
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MeSH Terms
Hydrochloric Acid / toxicity
Lung Volume Measurements*
Positive-Pressure Respiration / adverse effects*,  methods
Pulmonary Edema / chemically induced,  etiology*
Pulmonary Surfactants / physiology
Tidal Volume*
Time Factors
Grant Support
Reg. No./Substance:
0/Pulmonary Surfactants; 7647-01-0/Hydrochloric Acid
Comment In:
Am Rev Respir Dis. 1991 May;143(5 Pt 1):1198-200   [PMID:  2024837 ]

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