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Positive end-expiratory pressure modulates local and systemic inflammatory responses in a sepsis-induced lung injury model.
Intensive Care Med. 2003 Aug; 29(8):1345-53.IC

Abstract

OBJECTIVE

Previous animal studies have shown that certain modes of mechanical ventilation (MV) can injure the lungs. Most of those studies were performed with models that differ from clinical causes of respiratory failure. We examined the effects of positive end-expiratory pressure (PEEP) in the setting of a clinically relevant, in vivo animal model of sepsis-induced acute lung injury ventilated with low or injurious tidal volume.

METHODS

Septic male Sprague-Dawley rats were anesthetized and randomized to spontaneous breathing or four different strategies of MV for 3 h at low (6 ml/kg) or high (20 ml/kg) tidal volume (V(T)) with zero PEEP or PEEP above inflection point in the pressure-volume curve. Sepsis was induced by cecal ligation and perforation. Mortality rates, pathological evaluation, lung tissue cytokine gene expression, and plasma cytokine concentrations were analyzed in all experimental groups.

RESULTS

Lung damage, cytokine synthesis and release, and mortality rates were significantly affected by the method of MV in the presence of sepsis. PEEP above the inflection point significantly attenuated lung damage and decreased mortality during 3 h of ventilation with low V(T) (25% vs. 0%) and increased lung damage and mortality in the high V(T) group (19% vs. 50%). PEEP attenuated lung cytokine gene expression and plasma concentrations during mechanical ventilation with low V(T).

CONCLUSIONS

The use of a PEEP level above the inflection point in a sepsis-induced acute lung injury animal model modulates the pulmonary and systemic inflammatory responses associated with sepsis and decreases mortality during 3 h of MV.

Authors+Show Affiliations

Research Institute, Hospital Universitario N.S. de Candelaria, Carretera del Rosario s/n, 38010, Santa Cruz de Tenerife, Canary Islands, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12698249

Citation

Herrera, María Teresa, et al. "Positive End-expiratory Pressure Modulates Local and Systemic Inflammatory Responses in a Sepsis-induced Lung Injury Model." Intensive Care Medicine, vol. 29, no. 8, 2003, pp. 1345-53.
Herrera MT, Toledo C, Valladares F, et al. Positive end-expiratory pressure modulates local and systemic inflammatory responses in a sepsis-induced lung injury model. Intensive Care Med. 2003;29(8):1345-53.
Herrera, M. T., Toledo, C., Valladares, F., Muros, M., Díaz-Flores, L., Flores, C., & Villar, J. (2003). Positive end-expiratory pressure modulates local and systemic inflammatory responses in a sepsis-induced lung injury model. Intensive Care Medicine, 29(8), 1345-53.
Herrera MT, et al. Positive End-expiratory Pressure Modulates Local and Systemic Inflammatory Responses in a Sepsis-induced Lung Injury Model. Intensive Care Med. 2003;29(8):1345-53. PubMed PMID: 12698249.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Positive end-expiratory pressure modulates local and systemic inflammatory responses in a sepsis-induced lung injury model. AU - Herrera,María Teresa, AU - Toledo,Claudia, AU - Valladares,Francisco, AU - Muros,Mercedes, AU - Díaz-Flores,Lucio, AU - Flores,Carlos, AU - Villar,Jesús, Y1 - 2003/04/16/ PY - 2002/10/15/received PY - 2003/03/11/accepted PY - 2003/4/17/pubmed PY - 2005/4/26/medline PY - 2003/4/17/entrez SP - 1345 EP - 53 JF - Intensive care medicine JO - Intensive Care Med VL - 29 IS - 8 N2 - OBJECTIVE: Previous animal studies have shown that certain modes of mechanical ventilation (MV) can injure the lungs. Most of those studies were performed with models that differ from clinical causes of respiratory failure. We examined the effects of positive end-expiratory pressure (PEEP) in the setting of a clinically relevant, in vivo animal model of sepsis-induced acute lung injury ventilated with low or injurious tidal volume. METHODS: Septic male Sprague-Dawley rats were anesthetized and randomized to spontaneous breathing or four different strategies of MV for 3 h at low (6 ml/kg) or high (20 ml/kg) tidal volume (V(T)) with zero PEEP or PEEP above inflection point in the pressure-volume curve. Sepsis was induced by cecal ligation and perforation. Mortality rates, pathological evaluation, lung tissue cytokine gene expression, and plasma cytokine concentrations were analyzed in all experimental groups. RESULTS: Lung damage, cytokine synthesis and release, and mortality rates were significantly affected by the method of MV in the presence of sepsis. PEEP above the inflection point significantly attenuated lung damage and decreased mortality during 3 h of ventilation with low V(T) (25% vs. 0%) and increased lung damage and mortality in the high V(T) group (19% vs. 50%). PEEP attenuated lung cytokine gene expression and plasma concentrations during mechanical ventilation with low V(T). CONCLUSIONS: The use of a PEEP level above the inflection point in a sepsis-induced acute lung injury animal model modulates the pulmonary and systemic inflammatory responses associated with sepsis and decreases mortality during 3 h of MV. SN - 0342-4642 UR - https://www.unboundmedicine.com/medline/citation/12698249/Positive_end_expiratory_pressure_modulates_local_and_systemic_inflammatory_responses_in_a_sepsis_induced_lung_injury_model_ L2 - https://dx.doi.org/10.1007/s00134-003-1756-5 DB - PRIME DP - Unbound Medicine ER -