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Intensive Care Medicine

, Volume 30, Issue 4, pp 693–701 | Cite as

Infectious and inflammatory dissemination are affected by ventilation strategy in rats with unilateral pneumonia

  • Frédérique SchortgenEmail author
  • Lila Bouadma
  • Marie-Laure Joly-Guillou
  • Jean-Damien Ricard
  • Didier Dreyfuss
  • Georges Saumon
Experimental

Abstract

Objective

To evaluate the effect of VT reduction and alveolar recruitment on systemic and contralateral dissemination of bacteria and inflammation during right-side pneumonia.

Design

Interventional animal study.

Setting

University hospital research laboratory.

Subjects

A total of 54 male Wistar rats.

Interventions

One day after right lung instillation of 1.4×107 Pseudomonas aeruginosa, rats were left unventilated or ventilated for 2 h at low VT (6 ml/kg) with different strategies of alveolar recruitment: no PEEP, 8 cm H2O PEEP, 8 cm H2O PEEP in a left lateral position, 3 cm H2O PEEP with partial liquid ventilation, or high VT (set such as end-inspiratory pressure was 30 cm H2O) without PEEP (ZEEP). After ventilation the lungs, spleen and liver were cultivated for bacterial counts. Global bacterial dissemination was scored considering the percentage of positive spleen, liver and left lung cultures. TNF-α was assayed in plasma before and after mechanical ventilation.

Measurements and results

All rats had right-side pneumonia with similar bacterial counts. All mechanical ventilation strategies, with the exception of low VT-PEEP 8, promoted contralateral lung dissemination. Overall bacterial dissemination was less in non-ventilated controls (22%) and low VT-PEEP 8 (22%) than in high VT-ZEEP (67%), low VT-PEEP 8 in left lateral position (59%) and low VT-ZEEP (56%) (p<0.05). Partial liquid ventilation prevented systemic bacterial translocation, but at the expense of contralateral bacterial seeding. Plasma TNF-α concentration increased significantly after mechanical ventilation with no PEEP at both high and low VT.

Conclusions

Our results suggest that PEEP might reduce the risk of ventilation-induced bacterial and inflammatory mediator dissemination during pneumonia.

Keywords

Mechanical ventilation Pneumonia Pseudomonas End-expiratory pressure Cytokine 

Supplementary material

supp.pdf (143 kb)
Supplementary Material (PDF 146 KB)

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Frédérique Schortgen
    • 1
    Email author
  • Lila Bouadma
    • 1
  • Marie-Laure Joly-Guillou
    • 2
  • Jean-Damien Ricard
    • 1
    • 3
  • Didier Dreyfuss
    • 1
    • 3
  • Georges Saumon
    • 1
  1. 1.EA 3512, Faculté Xavier Bichat ParisFrance
  2. 2.Service de MicrobiologieHôpital Louis MourierColombesFrance
  3. 3.Service de Réanimation MédicaleHôpital Louis MourierColombesFrance

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