Document Detail


Assisted ventilation modes reduce the expression of lung inflammatory and fibrogenic mediators in a model of mild acute lung injury.
MedLine Citation:
PMID:  20333356     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The goal of the study was to compare the effects of different assisted ventilation modes with pressure controlled ventilation (PCV) on lung histology, arterial blood gases, inflammatory and fibrogenic mediators in experimental acute lung injury (ALI). METHODS: Paraquat-induced ALI rats were studied. At 24 h, animals were anaesthetised and further randomized as follows (n = 6/group): (1) pressure controlled ventilation mode (PCV) with tidal volume (V (T)) = 6 ml/kg and inspiratory to expiratory ratio (I:E) = 1:2; (2) three assisted ventilation modes: (a) assist-pressure controlled ventilation (APCV1:2) with I:E = 1:2, (b) APCV1:1 with I:E = 1:1; and (c) biphasic positive airway pressure and pressure support ventilation (BiVent + PSV), and (3) spontaneous breathing without PEEP in air. PCV, APCV1:1, and APCV1:2 were set with P (insp) = 10 cmH(2)O and PEEP = 5 cmH(2)O. BiVent + PSV was set with two levels of CPAP [inspiratory pressure (P (High) = 10 cmH(2)O) and positive end-expiratory pressure (P (Low) = 5 cmH(2)O)] and inspiratory/expiratory times: T (High) = 0.3 s and T (Low) = 0.3 s. PSV was set as follows: 2 cmH(2)O above P (High) and 7 cmH(2)O above P (Low). All rats were mechanically ventilated in air and PEEP = 5 cmH(2)O for 1 h. RESULTS: Assisted ventilation modes led to better functional improvement and less lung injury compared to PCV. APCV1:1 and BiVent + PSV presented similar oxygenation levels, which were higher than in APCV1:2. Bivent + PSV led to less alveolar epithelium injury and lower expression of tumour necrosis factor-alpha, interleukin-6, and type III procollagen. CONCLUSIONS: In this experimental ALI model, assisted ventilation modes presented greater beneficial effects on respiratory function and a reduction in lung injury compared to PCV. Among assisted ventilation modes, Bi-Vent + PSV demonstrated better functional results with less lung damage and expression of inflammatory mediators.
Authors:
Felipe Saddy; Gisele P Oliveira; Cristiane S N B Garcia; Liliane M Nardelli; Andreia F Rzezinski; Debora S Ornellas; Marcelo M Morales; Vera L Capelozzi; Paolo Pelosi; Patricia R M Rocco
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-03-24
Journal Detail:
Title:  Intensive care medicine     Volume:  36     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-09     Completed Date:  2010-11-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1417-26     Citation Subset:  IM    
Affiliation:
Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics-CCS, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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MeSH Terms
Descriptor/Qualifier:
Acute Lung Injury / metabolism,  physiopathology*
Animals
Collagen Type III / metabolism
Cytokines / metabolism
Monitoring, Physiologic / methods
Pneumonia, Ventilator-Associated / physiopathology*
Pulmonary Fibrosis / metabolism*
Random Allocation
Rats
Rats, Wistar
Respiration, Artificial / methods*
Severity of Illness Index
Chemical
Reg. No./Substance:
0/Collagen Type III; 0/Cytokines

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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