期刊
BRITISH JOURNAL OF ANAESTHESIA
卷 116, 期 5, 页码 708-715出版社
ELSEVIER SCI LTD
DOI: 10.1093/bja/aew093
关键词
Escherichia coli; inflammation; respiratory mechanics; inspiratory positive-pressure ventilation; mechanical ventilation
资金
- Coordination for the Improvement of Higher Education Personnel, Brasilia, Brazil [362/11]
- German Academic Exchange Service, Bonn, Germany [AZ 50753047, 415-br-PROBRAL]
- Carlos Chagas Filho Rio de Janeiro State Research Foundation, Rio de Janeiro, Brazil [E-26/103.118/2]
- Brazilian Council for Scientific and Technological Development, Brasilia, Brazil [471438/2012-0]
Background: Variable ventilation improves respiratory function, but it is not known whether the amount of variability in tidal volume (VT) can be reduced in recruited lungs without a deterioration of respiratory system elastance. Methods: Acute lung inflammation was induced by intratracheal instillation of lipopolysaccharide in 35 Wistar rats. Twenty-eight animals were anaesthetized and ventilated in volume-controlled mode. Lungs were recruited by random variation of VT (mean 6 ml kg(-1), coefficient of variation 30%, normal distribution) for 30 min. Animals were randomly assigned to different amounts of VT variability (n=7 for 90 min per group): 30, 15, 7.5, or 0%. Lung function, diffuse alveolar damage, and gene expression of biological markers associated with cell mechanical stress, inflammation, and fibrogenesis were assessed. Seven animals were not ventilated and served as controls for post-mortem analyses. Results: AV(T) variability of 30%, but not 15, 7.5, or 0%, prevented deterioration of respiratory system elastance [Mean (SD) -7.5 (8.7%), P<0.05; 21.1 (9.6%), P<0.05; 43.3 (25.9), P<0.05; and 41.2 (16.4), P<0.05, respectively]. Diffuse alveolar damagewas lower with a VT variability of 30% than with 0% and without ventilation, because of reduced oedema and haemorrhage. AVT variability of 30, 15, or 7.5% reduced the gene expression of amphiregulin, cytokine-induced neutrophil chemoattractant-1, and tumour necrosis factor a compared with a VT variability of 0%. Conclusions: In this model of acute lung inflammation, a VT variability of 30%, compared with 15 and 7.5%, was necessary to avoid deterioration of respiratory system elastance and was not associated with lung histological damage.
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