Advertisement

Dynamic alveolar mechanics in four models of lung injury

Abstract

Objective

To determine whether pathological alterations in alveolar mechanics (i.e., the dynamic change in alveolar size and shape with ventilation) at a similar level of lung injury vary depending on the cause of injury.

Design and setting

Prospective controlled animal study in a university laboratory.

Subjects

30 male Sprague-Dawley rats (300–550 g).

Interventions

Rats were separated into one of four lung injury models or control (n=6): (a) 2% Tween-20 (Tween, n=6), (b) oleic acid (OA, n=6), (c) ventilator-induced lung injury (VILI, PIP 40/ZEEP, n=6), (d) endotoxin (LPS, n=6). Alveolar mechanics were assessed at baseline and after injury (PaO2/FIO2 <300 mmHg) by in vivo microscopy.

Measurements

Alveolar instability (proportional change in alveolar size during ventilation) was used as a measurement of alveolar mechanics.

Results

Alveoli were unstable in Tween, OA, and VILI as hypoxemia developed (baseline vs. injury: Tween, 7±2% vs. 67±5%; OA: 3±2% vs. 82±9%; VILI, 4±2% vs. 72±5%). Hypoxemia after LPS was not associated with significant alveolar instability (baseline vs. injury: LPS, 3±2 vs. 8±5%).

Conclusions

These data demonstrate that multiple pathological changes occur in dynamic alveolar mechanics. The nature of these changes depends upon the mechanism of lung injury.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

References

  1. 1.

    Rubenfeld GD (2003) Epidemiology of acute lung injury. Crit Care Med 31:S276–S284

  2. 2.

    Pinhu L, Whithead T, Evans T, Griffiths M (2003) Ventilator-associated lung injury. Lancet 361:332–340

  3. 3.

    Dreyfuss D, Ricard JD, Saumon G (2003) On the physiologic and clinical relevance of lung-borne cytokines during ventilator-induced lung injury. Am J Respir Crit Care Med 167:1467–1471

  4. 4.

    Gattinoni L, Pelosi P, Crotti S, Valenza F (1995) Effects of positive end-expiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome. Am J Respir Crit Care Med 151:1807–1814

  5. 5.

    Pelosi P, Goldner M, McKibben, Adams A, Eccher G, Caironi P, Losappio S, Gattinoni L, Marini JJ (2001) Recruitment and derecruitment during acute respiratory failure: an experimental study. Am J Respir Crit Care Med 164:122–130

  6. 6.

    Crotti S, Mascheroni D, Caironi P, Pelosi P, Ronzoni G, Mondino M, Marini JJ, Gattinoni L (2001) Recruitment and derecruitment during acute respiratory failure: a clinical study. Am J Respir Crit Care Med 164:131–140

  7. 7.

    Escolar JD, Escolar MA, Guzman J, Roques M (2002) Pressure volume curve and alveolar recruitment/de-recruitment. A morphometric model of the respiratory cycle. Histol Histopathol 17:383–392

  8. 8.

    Jonson B, Richard JC, Straus C, Mancebo J, Lemaire F, Brochard L (1999) Pressure-volume curves and compliance in acute lung injury: evidence of recruitment above the lower inflection point. Am J Respir Crit Care Med 159:1172–1178

  9. 9.

    Hickling KG (1998) The pressure-volume curve is greatly modified by recruitment. A mathematical model of ARDS lungs. Am J Respir Crit Care Med 158:194–202

  10. 10.

    Martynowicz MA, Minor TA, Walters BJ, Hubmayr RD (1999) Regional expansion of oleic acid-induced lungs. Am J Respir Crit Care Med 160:250–258

  11. 11.

    Wilson TA, Anafi RC, Hubmayr RD (2001) Mechanics of edematous lungs. J Appl Physiol 90:2088–2093

  12. 12.

    Hubmayr RD (2002) Perspective on lung injury and recruitment: a skeptical look at the opening and collapse story. Am J Respir Crit Care Med 165:1647–1653

  13. 13.

    Halter JM, Steinberg JM, Schiller HJ, DaSilva M, Gatto LA, Landas S, Nieman GF (2003) Positive end-expiratory pressure (PEEP) after a recruitment maneuver prevents both alveolar collapse and recruitment/derecruitment. Am J Respir Crit Care Med 167:1620–1626

  14. 14.

    Steinberg JM, Schiller HJ, Halter JM, Gatto LA, Lee HM, Pavone LA, Nieman GF (2004) Alveolar instability causes early ventilator-induced lung injury independent of neutrophils. Am J Respir Crit Care Med 169:57–63

  15. 15.

    Nieman GF, Bredenberg CE, Clark WR, West NR (1981) Alveolar function following surfactant deactivation. J Appl Physiol 51:895–904

  16. 16.

    DiRocco JD, Pavone LA, Weiss CA, Gatto LA, Landas SK, Nieman GF (2004) Dynamic alveolar mechanics in three models of acute lung injury. Am J Respir Crit Care Med 169:A209

  17. 17.

    Bredenberg CE, Paskanik AM, Nieman GF (1983) High surface tension pulmonary edema. J Surg Res 34:515–523

  18. 18.

    Davidson KG, Bersten AD, Barr HA, Dowling KD, Nicholas TE, Doyle IR (2000) Lung function, permeability, and surfactant composition in oleic acid-induced acute lung injury in rats. Am J Physiol Lung Cell Mol Physiol 279:L1091–1102

  19. 19.

    Iotti GA, Braschi A, Brunner JX, Smits T, Olivei M, Palo A, Veronesi R (1995) Respiratory mechanics by least squares fitting in mechanically ventilated patients: applications during paralysis and during pressure support ventilation. Intensive Care Med 21:406–413

  20. 20.

    King RJ (1982) Pulmonary surfactant. J Appl Physiol 53:1–8

  21. 21.

    Bredenberg CE, Paskanik AM, Nieman GF (1983) High surface tension pulmonary edema. J Surg Res 34:515–523

  22. 22.

    Faridy EE (1976) Effect of ventilation on movement of surfactant in airways. Respir Physiol 27:323–334

  23. 23.

    Ito Y, Veldhuizen RA, Yao LJ, McCaig LA, Bartlett AJ, Lewis JF (1997) Ventilation strategies affect surfactant aggregate conversion in acute lung injury. Am J Respir Crit Care Med 155:493–499

  24. 24.

    Dreyfuss D, Basset G, Soler P, Saumon G (1985) Intermittent positive-pressure hyperventilation with high inflation pressures produces pulmonary microvascular injury in rats. Am Rev Respir Dis 132:880–884

  25. 25.

    Robertson B, Curstedt T, Herting E, Sun B, Akino T, Schafer KP (1995) Alveolar-to-vascular leakage of surfactant protein A in ventilated immature newborn rabbits. Biol Neonate 68:185–190

  26. 26.

    Hofman WF, Ehrhart IC (1984) Permeability edema in dog lung depleted of blood components. J Appl Physiol 57:147–153

  27. 27.

    Motohiro A, Furukawa T, Yasumoto K, Inokuchi K (1986) Mechanisms involved in acute lung edema induced in dogs by oleic acid. Eur Surg Res 18:50–57

  28. 28.

    Hedlund LW, Vock P, Effmann EL, Putman CE (1985) Morphology of oleic acid-induced lung injury: observations from computed tomography, specimen radiography and histology. Invest Radiol 20:2–8

  29. 29.

    Oyarzun MJ, Cabezas E, Donoso P, Quijada D (1984) Effects of free fatty acid infusion on rabbit pulmonary surfactant. Influence of corticosteroids. Bull Eur Physiopathol Respir 20:105–111

  30. 30.

    Clark DA, Nieman GF, Thompson JE, Paskanik AM, Rokhar JE, Bredenberg CE (1987) Surfactant displacement by meconium free fatty acids: an alternative explanation for atelectasis in meconium aspiration syndrome. J Ped 110:765–770

  31. 31.

    Mora R, Arold S, Marzan Y, Suki B, Ingenito EP (2000) Determinants of surfactant function in acute lung injury and early recovery. Am J Physiol Lung Cell Mol Physiol 279:L342–L349

  32. 32.

    Carney DE, Bredenberg CE, Schiller HJ, Picone AL, McCann UG, Gatto LA, Bailey G, Fillinger M, Nieman GF (1999) The mechanism of lung volume change during mechanical ventilation. Am J Respir Crit Care Med 160:1697–1702

  33. 33.

    Pavone LA, Halter JM, Gatto LA, Lutz CJ, Nieman GF (2003) Non-dependent lung is preferentially susceptible to alveolar recruitment-derecruitment during high-pressure ventilation. Am J Respir Crit Care Med 167:A775

  34. 34.

    Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308

Download references

Author information

Correspondence to Joseph D. DiRocco.

Electronic Supplementary Material

Rights and permissions

Reprints and Permissions

About this article

Cite this article

DiRocco, J.D., Pavone, L.A., Carney, D.E. et al. Dynamic alveolar mechanics in four models of lung injury. Intensive Care Med 32, 140–148 (2006). https://doi.org/10.1007/s00134-005-2854-3

Download citation

Keywords

  • Acute lung injury
  • Acute respiratory distress syndrome
  • Alveolar mechanics
  • Hypoxemia
  • Oleic acid
  • Ventilator-induced lung injury