Intensive Care Medicine

, Volume 14, Issue 5, pp 538–546 | Cite as

Effects of positive end-expiratory pressure on hyaline membrane formation in a rabbit model of the neonatal respiratory distress syndrome

  • B. K. Sandhar
  • D. J. Niblett
  • E. P. Argiras
  • M. S. Dunnill
  • M. K. Sykes
Original Articles


Sixteen rabbits were anaesthetized and subjected to saline lavage of the lungs to produce surfactant deficiency. This resulted in an arterial oxygen tension of less than 12 kPa on 100% inspired oxygen and an inflection point on the pressure-volume curve at a pressure of 8–12 mmHg. After lavage the animals were randomly assigned to receive either conventional mechanical ventilation (CMV) with a positive end-expiratory pressure (PEEP) of 1–2 mmHg (group I —low PEEP) or CMV with PEEP equal to the inflection point pressure (group II — high PEEP). Mean airway pressures were kept at 14–16 mmHg in both groups by increasing the inspiratory: expiratory time ratios in the low PEEP group. The 5-h protocol was completed by 4 animals in group I and 6 animals in group II, early death usually being associated with a metabolic acidosis. On 100% oxygen, the mean PaO2 at 2-h post-lavage was 15.2±8.3 kPa in group I and 39.6±21.8 kPa in group II. Group I had much lower end-expiratory lung volumes (3.0±1.5 ml above FRC) than group II (34.9±12.2 ml above FRC). Histological examination of the lungs revealed significantly less hyaline membrane formation in group II (p=0.001). Thus, the prevention of alveolar collapse by the use of high PEEP levels appears to reduce lung damage in this preparation.

Key words

Mechanical ventilation Positive end-expiratory pressure Hyaline membranes 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Argiras EP, Blakeley CR, Dunnill MS, Otremski S, Sykes MK (1987) Reduction of hyaline membrane formation by the use of high PEEP. Br J Anaesth 59:1278Google Scholar
  2. 2.
    Avery ME, Mead J (1959) Surface properties in relation to atelectasis and hyaline membrane disease. Am J Dis Child 97:(5) Part 1 and 517Google Scholar
  3. 3.
    Capers TH (1961) Pulmonary hyaline membrane formation in the adult. Am J Med 31:701Google Scholar
  4. 4.
    Faridy EE (1976) Effect of ventilation on movement of surfactant in airways. Respir Physiol 27:323Google Scholar
  5. 5.
    Hamilton PP, Onayemi A, Smyth JA Gillan JE, Cutz E, Froese AB, Bryan AC (1983) Comparison of conventional and high-frequency ventilation: oxygenation and lung pathology. J Appl Physiol 55:131Google Scholar
  6. 6.
    Kawano T, Mori S, Cybulsky M, Burger R, Ballin A, Cutz E, Bryan AC (1987) Effect of granulocyte depletion in a ventilated surfactant-depleted lung. J Appl Physiol 62:27Google Scholar
  7. 7.
    Kolton M, Cattran CB, Kent G, Volgyesi G, Froese AB, Bryan AC (1982) Oxygenation during high-frequency ventilation compared with conventional mechanical ventilation in two models of lung injury. Anesth Analg 61:323Google Scholar
  8. 8.
    Lachmann B, Robertson B, Vogel J (1980) In vivo lung lavage as an experimental model of respiratory distress syndrome. Acta Anaesthesiol Scand 24:231Google Scholar
  9. 9.
    Lachmann B, Jonson B, Lindroth M, Robertson B (1982) Modes of artificial ventilation in severe respiratory distress syndrome. Crit Care Med 10:724Google Scholar
  10. 10.
    Lauweryns JM (1970) Hyaline Membrane Disease in newborn infants. Hum Pathol 1:175Google Scholar
  11. 11.
    Lemaire F, Harf A, Simonneau G, Matamis D, Rivara D, Atlan G (1981) Echanges gazeux, courbe statique pression-volume et ventilation en pression positive de fin d'expiration. Ann Anesth Fr 5:435Google Scholar
  12. 12.
    McClenahan JB, Urtnowski A (1967) Effect of ventilation on surfactant, and its turnover rate. J Appl Physiol 23:215Google Scholar
  13. 13.
    Mead J, Takishima T, Leith D (1970) Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol 28:596Google Scholar
  14. 14.
    Menkes H, Lindsay D, Wood L, Muir A, Macklem PT (1972) Interdependence of lung units in intact dog lungs. J Appl Physiol 32:681Google Scholar
  15. 15.
    Nash G, Blennerhassett JB, Pontoppidan H (1967) Pulmonary lesions associated with oxygen therapy and artificial ventilation. N Engl J Med 276:368Google Scholar
  16. 16.
    Pesenti A, Kolobow T, Buchhold DK, Pierce JE, Huang H, Chen V (1982) Prevention of hyaline membrane disease in premature lambs by apneic oxygenation and extracorporeal carbon dioxide removal. Intensive Care Med 8:11Google Scholar
  17. 17.
    Pesenti A, Marcolin R, Prato P, Borelli M, Riboni A, Gattinoni L (1985) Mean airway pressure vs. positive end-expiratory pressure during mechanical ventilation. Crit Care Med 13:34Google Scholar
  18. 18.
    Quan SF, Militzer HW, Calkins JM, Sobonya RE, Waterson CK, Otto CW, Conahan TJ (1984) Comparison of high-frequency jet ventilation with conventional mechanical ventilation in saline-lavaged rabbits. Crit Care Med 12:759Google Scholar
  19. 19.
    Robertson B (1984) Surfactant replacement in neonatal and adult respiratory distress syndrome. Eur J Anaesthesiol 1:335Google Scholar
  20. 20.
    Schweiler GH, Robertson B (1976) Liquid ventilation in immature newborn rabbits. Biol Neonate 29:343Google Scholar
  21. 21.
    Shasby DM Fox RB, Harada RN, Repine JE (1982) Reduction of the edema of acute hyperoxic lung injury by granulocyte depletion. J Appl Physiol 52:1237Google Scholar
  22. 22.
    Stalcup SA, Lipset JS, Legant PM, Leuenberger PJ, Mellins RB (1979) Inhibition of converting enzyme activity by acute hypoxia in dogs. J Appl Physiol 46:227Google Scholar
  23. 23.
    Steinberg H, Das DK, Cerreta JM, Cantor JD (1986) Neutrophil kinetics in O2-exposed rabbits J Appl Physiol 61:775Google Scholar
  24. 24.
    Taghizadeh A, Reynolds EOR (1976) Pathogenesis of bronchopulmonary dysplasia following hyaline membrane disease. Am J Pathol 82:241Google Scholar
  25. 25.
    Truog WE, Standaert TA, Murphy J, Palmer S, Woodrum DE, Hodson WA (1983) Effect of high-frequency oscillation on gas exchange and pulmonary phospholipids in experimental hyaline membrane disease. Am Rev Respir Dis 127:585Google Scholar
  26. 26.
    Truog WE, Standaert TA, Murphy JH, Woodrum DE (1984) Effects of prolonged high-frequency oscillatory ventilation in premature primates with experimental hyaline membrane disease. Am Rev Respir Dis 130:76Google Scholar
  27. 27.
    Wyszogrodski I, Kyei-Aboage K, Taeusch HW, Avery ME (1975) Surfactant inactivation by hyperventilation: conservation by end-expiratory pressure. J Appl Physiol 38:461Google Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • B. K. Sandhar
    • 1
  • D. J. Niblett
    • 1
  • E. P. Argiras
    • 1
  • M. S. Dunnill
    • 2
  • M. K. Sykes
    • 1
  1. 1.Nuffield Department of AnaestheticsRadcliffe InfirmaryOxfordUK
  2. 2.Department of HistopathologyJohn Radcliffe HospitalOxfordUK

Personalised recommendations