| Comparison of "Open Lung" Modes with Low Tidal Volumes in a Porcine Lung Injury Model. | |
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MedLine Citation:
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PMID: 21195426 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: Ventilator strategies that maintain an "open lung" have shown promise in treating hypoxemic patients. We compared three "open lung" strategies with standard of care low tidal volume ventilation and hypothesized that each would diminish physiologic and histopathologic evidence of ventilator induced lung injury (VILI). MATERIALS AND METHODS: Acute lung injury (ALI) was induced in 22 pigs via 5% Tween and 30-min of injurious ventilation. Animals were separated into four groups: (1) low tidal volume ventilation (LowVt -6 mL/kg); (2) high-frequency oscillatory ventilation (HFOV); (3) airway pressure release ventilation (APRV); or (4) recruitment and decremental positive-end expiratory pressure (PEEP) titration (RM+OP) and followed for 6 h. Lung and hemodynamic function was assessed on the half-hour. Bronchoalveolar lavage fluid (BALF) was analyzed for cytokines. Lung tissue was harvested for histologic analysis. RESULTS: APRV and HFOV increased PaO(2)/FiO(2) ratio and improved ventilation. APRV reduced BALF TNF-α and IL-8. HFOV caused an increase in airway hemorrhage. RM+OP decreased SvO(2), increased PaCO(2), with increased inflammation of lung tissue. CONCLUSION: None of the "open lung" techniques were definitively superior to LowVt with respect to VILI; however, APRV oxygenated and ventilated more effectively and reduced cytokine concentration compared with LowVt with nearly indistinguishable histopathology. These data suggest that APRV may be of potential benefit to critically ill patients but other "open lung" strategies may exacerbate injury. |
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Authors:
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Scott Albert; Brian D Kubiak; Christopher J Vieau; Shreyas K Roy; Joseph Dirocco; Louis A Gatto; Jennifer L Young; Sudipta Tripathi; Girish Trikha; Carlos Lopez; Gary F Nieman |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2010-11-12 |
Journal Detail:
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Title: The Journal of surgical research Volume: - ISSN: 1095-8673 ISO Abbreviation: - Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2011-1-3 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376340 Medline TA: J Surg Res Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2010 Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Surgery, Upstate Medical University, Syracuse, New York. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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