Effects of frequency and inspiratory plateau pressure during recruitment manoeuvres on lung and distal organs in acute lung injury
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To evaluate the effects of frequency and inspiratory plateau pressure (Pplat) during recruitment manoeuvres (RMs) on lung and distal organs in acute lung injury (ALI).
We studied paraquat-induced ALI rats. At 24 h, rats were anesthetized and RMs were applied using continuous positive airway pressure (CPAP, 40 cmH2O/40 s) or three-different sigh strategies: (a) 180 sighs/h and Pplat = 40 cmH2O (S180/40), (b) 10 sighs/h and Pplat = 40 cmH2O (S10/40), and (c) 10 sighs/h and Pplat = 20 cmH2O (S10/20).
S180/40 yielded alveolar hyperinflation and increased lung and kidney epithelial cell apoptosis as well as type III procollagen (PCIII) mRNA expression. S10/40 resulted in a reduction in epithelial cell apoptosis and PCIII expression. Static elastance and alveolar collapse were higher in S10/20 than S10/40.
The reduction in sigh frequency led to a protective effect on lung and distal organs, while the combination with reduced Pplat worsened lung mechanics and histology.
KeywordsAcute lung injury Sigh Ventilator-induced lung injury Transpulmonary pressure Apoptosis
We would like to express our gratitude to Mr. Andre Benedito da Silva for animal care, Mrs. Miriam Regina Taborda Simone and Ana Lucia Neves da Silva for their help with microscopy, Ms. Jaqueline Lima do Nascimento for her skilful technical assistance during the experiments, and Mrs. Moira Elizabeth Schöttler for assistance in editing the manuscript.
- 1.Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, Takagaki TY, Carvalho CR (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338:347–354PubMedCrossRefGoogle Scholar
- 2.Acute Respiratory Distress Syndrome Network. 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 342:1301–1308Google Scholar
- 3.Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ, Davies AR, Hand LE, Zhou Q, Thabane L, Austin P, Lapinsky S, Baxter A, Russell J, Skrobik Y, Ronco JJ, Stewart TE, Lung Open Ventilation Study Investigators (2008) Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 299:637–645PubMedCrossRefGoogle Scholar
- 4.Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL, Lefrant JY, Prat G, Richecoeur J, Nieszkowska A, Gervais C, Baudot J, Bouadma L, Brochard L, Expiratory Pressure (Express) Study Group (2008) Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 299:646–655PubMedCrossRefGoogle Scholar
- 7.Imai Y, Parodo J, Kajikawa O, de Perrot M, Fischer S, Edwards V, Cutz E, Liu M, Keshavjee S, Martin TR, Marshall JC, Ranieri VM, Slutsky AS (2003) Injurious mechanical ventilation and end-organ epithelial cell apoptosis and organ dysfunction in an experimental model of acute respiratory distress syndrome. JAMA 289:2104–2112PubMedCrossRefGoogle Scholar
- 18.Steimback PW, Silva PL, Oliveira GP, Rangel G, Capelozzi VL, Morales MM, Pelosi P, Rocco PR (2007) Sigh induced lung mechanical stress in acute lung injury. Am J Resp Crit Care A22Google Scholar
- 19.Weibel ER (1990) Morphometry: stereological theory and practical methods. In: Gil J (ed) Models of lung disease—microscopy and structural methods. Marcel Dekker, New York, pp 199–247Google Scholar
- 23.Fabisiak JP, Kagan VE, Tyurina YY, Tyurin VA, Lazo JS (1998) Paraquat-induced phosphatidylserine oxidation and apoptosis are independent of activation of PLA2. Am J Physiol 274:793–802Google Scholar
- 25.Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, Tallarini F, Cozzi P, Cressoni M, Colombo A, Marini JJ, Gattinoni L (2008) Lung stress and strain during mechanical ventilation of the acute respiratory distress syndrome. Am J Respir Crit Care Med 178:346–355PubMedCrossRefGoogle Scholar
- 33.Nakos G, Batistatou A, Galiatsou E, Konstanti E, Koulouras V, Kanavaros P, Doulis A, Kitsakos A, Karachaliou A, Lekka ME, Bai M (2006) Lung and ‘end organ’ injury due to mechanical ventilation in animals: comparison between the prone and supine positions. Crit Care 10:R38PubMedCrossRefGoogle Scholar