| Low tidal volume and high positive end-expiratory pressure mechanical ventilation results in increased inflammation and ventilator-associated lung injury in normal lungs. | |
| | |
MedLine Citation:
|
PMID: 20103541 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Protective mechanical ventilation with low tidal volume (Vt) and low plateau pressure reduces mortality and decreases the length of mechanical ventilation in patients with acute respiratory distress syndrome. Mechanical ventilation that will protect normal lungs during major surgical procedures of long duration may improve postoperative outcomes. We performed an animal study comparing 3 ventilation strategies used in the operating room in normal lungs. We compared the effects on pulmonary mechanics, inflammatory mediators, and lung tissue injury. METHODS: Female pigs were randomized into 3 groups. Group H-Vt/3 (n = 6) was ventilated with a Vt of 15 mL/kg predicted body weight (PBW)/positive end-expiratory pressure (PEEP) of 3 cm H(2)O, group L-Vt/3 (n = 6) with a Vt of 6 mL/kg PBW/PEEP of 3 cm H(2)O, and group L-Vt/10 (n = 6) with a Vt of 6 mL/kg PBW/PEEP of 10 cm H(2)O, for 8 hours. Hemodynamics, airway mechanics, arterial blood gases, and inflammatory markers were monitored. Bronchoalveolar lavage (BAL) was analyzed for inflammatory markers and protein concentration. The right lower lobe was assayed for mRNA of specific cytokines. The right lower lobe and right upper lobe were evaluated histologically. RESULTS: In contrast to groups H-Vt/3 and L-Vt/3, group L-Vt/10 exhibited a 6-fold increase in inflammatory mediators in BAL (P < 0.001). Cytokines in BAL were similar in groups H-Vt/3 and L-Vt/3. Group H-Vt/3 had a significantly lower lung injury score than groups L-Vt/3 and L-Vt/10. CONCLUSION: Comparing intraoperative strategies, ventilation with high PEEP resulted in increased production of inflammatory markers. Low PEEP resulted in lower levels of inflammatory markers. High Vt/low PEEP resulted in less histologic lung injury. |
| | |
Authors:
|
Caron M Hong; Da-Zhong Xu; Qi Lu; Yunhui Cheng; Vadim Pisarenko; Danielle Doucet; Margaret Brown; Seena Aisner; Chunxiang Zhang; Edwin A Deitch; Ellise Delphin |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-01-26 |
Journal Detail:
|
Title: Anesthesia and analgesia Volume: 110 ISSN: 1526-7598 ISO Abbreviation: Anesth. Analg. Publication Date: 2010 Jun |
Date Detail:
|
Created Date: 2010-05-26 Completed Date: 2010-06-15 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: United States |
Other Details:
|
Languages: eng Pagination: 1652-60 Citation Subset: AIM; IM |
Affiliation:
|
Department of Anesthesiology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Anesthesia Animals Bronchoalveolar Lavage Fluid / cytology Carbon Dioxide / blood Cytokines / biosynthesis Female Hemodynamics Lung / pathology Oxygen / blood Pneumonia / etiology, pathology, prevention & control Pneumonia, Ventilator-Associated / etiology*, pathology, prevention & control Positive-Pressure Respiration / adverse effects* Pulmonary Gas Exchange RNA, Messenger / biosynthesis, genetics Respiratory Function Tests Respiratory Mechanics / physiology Reverse Transcriptase Polymerase Chain Reaction Swine Tidal Volume* |
| Chemical | |
Reg. No./Substance:
|
0/Cytokines; 0/RNA, Messenger; 124-38-9/Carbon Dioxide; 7782-44-7/Oxygen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: The effect of celiac plexus block in critically ill patients intolerant of enteral nutrition: a rand...
Next Document: A surgical site infection cluster: the process and outcome of an investigation--the impact of an alc...