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Intensive Care Medicine

, Volume 36, Issue 8, pp 1417–1426 | Cite as

Assisted ventilation modes reduce the expression of lung inflammatory and fibrogenic mediators in a model of mild acute lung injury

  • Felipe Saddy
  • Gisele P. Oliveira
  • Cristiane S. N. B. Garcia
  • Liliane M. Nardelli
  • Andreia F. Rzezinski
  • Debora S. Ornellas
  • Marcelo M. Morales
  • Vera L. Capelozzi
  • Paolo Pelosi
  • Patricia R. M. RoccoEmail author
Experimental

Abstract

Purpose

The goal of the study was to compare the effects of different assisted ventilation modes with pressure controlled ventilation (PCV) on lung histology, arterial blood gases, inflammatory and fibrogenic mediators in experimental acute lung injury (ALI).

Methods

Paraquat-induced ALI rats were studied. At 24 h, animals were anaesthetised and further randomized as follows (n = 6/group): (1) pressure controlled ventilation mode (PCV) with tidal volume (V T) = 6 ml/kg and inspiratory to expiratory ratio (I:E) = 1:2; (2) three assisted ventilation modes: (a) assist-pressure controlled ventilation (APCV1:2) with I:E = 1:2, (b) APCV1:1 with I:E = 1:1; and (c) biphasic positive airway pressure and pressure support ventilation (BiVent + PSV), and (3) spontaneous breathing without PEEP in air. PCV, APCV1:1, and APCV1:2 were set with P insp = 10 cmH2O and PEEP = 5 cmH2O. BiVent + PSV was set with two levels of CPAP [inspiratory pressure (P High = 10 cmH2O) and positive end-expiratory pressure (P Low = 5 cmH2O)] and inspiratory/expiratory times: T High = 0.3 s and T Low = 0.3 s. PSV was set as follows: 2 cmH2O above P High and 7 cmH2O above P Low. All rats were mechanically ventilated in air and PEEP = 5 cmH2O for 1 h.

Results

Assisted ventilation modes led to better functional improvement and less lung injury compared to PCV. APCV1:1 and BiVent + PSV presented similar oxygenation levels, which were higher than in APCV1:2. Bivent + PSV led to less alveolar epithelium injury and lower expression of tumour necrosis factor-α, interleukin-6, and type III procollagen.

Conclusions

In this experimental ALI model, assisted ventilation modes presented greater beneficial effects on respiratory function and a reduction in lung injury compared to PCV. Among assisted ventilation modes, Bi-Vent + PSV demonstrated better functional results with less lung damage and expression of inflammatory mediators.

Keywords

Acute lung injury Ventilator-associated lung injury Cytokines Type III procollagen 

Notes

Acknowledgments

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 skillful technical assistance during the experiments, Mrs. Moira Elizabeth Schöttler for assistance in editing the manuscript, and Maquet for borrowing us Servo-I ventilator. Supported by Centres of Excellence Program (PRONEX-FAPERJ), Brazilian Council for Scientific and Technological Development (CNPq), Carlos Chagas Filho, Rio de Janeiro State Research Supporting Foundation (FAPERJ), São Paulo State Research Supporting Foundation (FAPESP).

Supplementary material

134_2010_1808_MOESM1_ESM.doc (96 kb)
Supplementary material 1 (DOC 96 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Felipe Saddy
    • 1
    • 2
    • 3
  • Gisele P. Oliveira
    • 1
  • Cristiane S. N. B. Garcia
    • 1
  • Liliane M. Nardelli
    • 1
  • Andreia F. Rzezinski
    • 1
  • Debora S. Ornellas
    • 1
    • 4
  • Marcelo M. Morales
    • 4
  • Vera L. Capelozzi
    • 5
  • Paolo Pelosi
    • 6
  • Patricia R. M. Rocco
    • 1
    Email author
  1. 1.Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics-C.C.S.Federal University of Rio de JaneiroRio de JaneiroBrazil
  2. 2.Ventilatory Care Unit Copa D`Or HospitalRio de JaneiroBrazil
  3. 3.Intensive Care Unit Pro Cardiaco HospitalRio de JaneiroBrazil
  4. 4.Laboratory of Cellular and Molecular Physiology, Carlos Chagas Filho Institute of Biophysics-C.C.S.Federal University of Rio de JaneiroRio de JaneiroBrazil
  5. 5.Department of PathologyUniversity of São PauloSão PauloBrazil
  6. 6.Department of Ambient, Health and SafetyUniversity of InsubriaVareseItaly

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