Document Detail


Influence of positive end-expiratory pressure (PEEP) on histopathological and bacteriological aspects of pneumonia during low tidal volume mechanical ventilation.
MedLine Citation:
PMID:  15536527     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Ventilatory strategies combining low tidal volume (V(T)) with positive end-expiratory pressure (PEEP) are considered to be lung protective. The influence of the PEEP level was investigated on bacteriology and histology in a model of ventilator-associated pneumonia. SUBJECTS: Nineteen New Zealand rabbits. INTERVENTIONS: The animals were mechanically ventilated with a positive inspiratory pressure of 15 cmH(2)O and received either a zero end-expiratory pressure (ZEEP, n=6), a 5 cmH(2)O PEEP (n=5) or a 10 cmH(2)O PEEP (n=4). An inoculum of Enterobacter aerogenes was then instilled intrabronchially. The non-ventilated pneumonia group (n=4) was composed of spontaneously breathing animals which received the same inoculum. Pneumonia was assessed 24 h later. MAIN RESULTS: The lung bacterial burden was higher in mechanically ventilated animals compared with spontaneously breathing animals. All animals from the latter group had negative spleen cultures. The spleen bacterial concentration was found to be lower in the 5 cmH(2)O PEEP group when compared to the ZEEP and 10 cmH(2)O PEEP groups (3.1+/-1.5 vs 4.9+/-1.1 and 5.0+/-1.3 log(10) cfu/g, respectively; p<0.05). Lung weight and histological score values were lower in the spontaneously breathing animals as well as in the 5 cmH(2)O PEEP group compared with the ZEEP and 10 cmH(2)O groups. CONCLUSIONS: Mechanical ventilation substantially increased the lung bacterial burden and worsened the histological aspects of pneumonia in this rabbit model. Variations in terms of lung injury and systemic spreading of infection were noted with respect to the ventilatory strategy.
Authors:
Pierre Emmanuel Charles; Laurent Martin; Manuel Etienne; Delphine Croisier; Lionel Piroth; Catherine Lequeu; Jerome Pugin; Henri Portier; Pascal Chavanet
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Publication Detail:
Type:  Journal Article     Date:  2004-11-04
Journal Detail:
Title:  Intensive care medicine     Volume:  30     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2005-01-14     Completed Date:  2005-04-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2263-70     Citation Subset:  IM    
Affiliation:
Laboratoire des Maladies Infectieuses, EA562, Dijon University Hospital, Boulevard Mal de Lattre de Tassigny, 21033 Dijon, France. pierre-emmanuel.charles@chu-dijon.fr
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MeSH Terms
Descriptor/Qualifier:
Animals
Enterobacter aerogenes
Enterobacteriaceae Infections / pathology*
Male
Pneumonia / etiology,  microbiology,  pathology*
Positive-Pressure Respiration*
Rabbits
Respiration, Artificial / adverse effects*

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