Effects of Ultraprotective Ventilation, Extracorporeal Carbon Dioxide Removal, and Spontaneous Breathing on Lung Morphofunction and Inflammation in Experimental Severe Acute Respiratory Distress Syndrome. (March 2015)

• Record Type: Journal Article
• Authors: Güldner, Andreas; Kiss, Thomas; Bluth, Thomas; Uhlig, Christopher; Braune, Anja; Carvalho, Nadja; Quast, Theresa; Rentzsch, Ines; Huhle, Robert; Spieth, Peter; Richter, Torsten; Saddy, Felipe; Rocco, Patricia R. M.; Kasper, Michael; Koch, Thea; Pelosi, Paolo; de Abreu, Marcelo Gama
• Is Part Of: Anesthesiology. Volume 122:Number 3(2015)
• Publication Date: 2015-03
• Subjects: Anesthesiology -- Periodicals; Anesthetics -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1097/ALN.0000000000000504
• Languages: English
• ISSNs: 0003-3022

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background:</title> <p>To investigate the role of ultraprotective mechanical ventilation (UP-MV) and extracorporeal carbon dioxide removal with and without spontaneous breathing (SB) to improve respiratory function and lung protection in experimental severe acute respiratory distress syndrome.</p> </sec> <sec> <title>Methods:</title> <p>Severe acute respiratory distress syndrome was induced by saline lung lavage and mechanical ventilation (MV) with higher tidal volume (V<sub>T</sub>) in 28 anesthetized pigs (32.8 to 52.5 kg). Animals (n = 7 per group) were randomly assigned to 6 h of MV (airway pressure release ventilation) with: (1) conventional P-MV with V<sub>T</sub> ≈6 ml/kg (P-MV<sub>contr</sub>); (2) UP-MV with V<sub>T</sub> ≈3 ml/kg (UP-MV<sub>contr</sub>); (3) UP-MV with V<sub>T</sub> ≈3 ml/kg and SB (UP-MV<sub>spont</sub>); and (4) UP-MV with V<sub>T</sub> ≈3 ml/kg and pressure supported SB (UP-MV<sub>PS</sub>). In UP-MV groups, extracorporeal carbon dioxide removal was used.</p> </sec> <sec> <title>Results:</title> <p>The authors found that: (1) UP-MV<sub>contr</sub> reduced diffuse alveolar damage score in dorsal lung zones (median[interquartile]) (12.0 [7.0 to 16.8] <italic>vs.</italic> 22.5 [13.8 to 40.8]), but worsened oxygenation and intrapulmonary shunt, compared to P-MV<sub>contr</sub>; (2) UP-MV<sub>spont</sub> and UP-MV<sub>PS</sub> improved oxygenation and intrapulmonary shunt, and redistributed ventilation towards dorsal areas, as compared to UP-MV<sub>contr</sub>; (3) compared to P-MV<sub>contr</sub>, UP-MV<sub>contr</sub> and UP-MV<sub>spont</sub>, UP-MV<sub>PS</sub> yielded higher levels of tumor necrosis factor-α (6.9 [6.5 to 10.1] <italic>vs.</italic> 2.8 [2.2 to 3.0], 3.6 [3.0 to 4.7] and 4.0 [2.8 to 4.4] pg/mg, respectively) and interleukin-8 (216.8 [113.5 to 343.5] <italic>vs.</italic> 59.8 [45.3 to 66.7], 37.6 [18.8 to 52.0], and 59.5 [36.1 to 79.7] pg/mg, respectively) in dorsal lung zones.</p> </sec> <sec> <title>Conclusions:</title> <p>In this model of severe acute respiratory distress syndrome, MV with V<sub>T</sub> ≈3 ml/kg and extracorporeal carbon dioxide removal without SB slightly reduced lung histologic damage, but not inflammation, as compared to MV with V<sub>T</sub> = 4 to 6 ml/kg. During UP-MV, pressure supported SB increased lung inflammation.</p> </sec> </abstract>