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Low tidal volume and high positive end-expiratory pressure mechanical ventilation results in increased inflammation and ventilator-associated lung injury in normal lungs.
Anesth Analg. 2010 Jun 01; 110(6):1652-60.A&A

Abstract

BACKGROUND

Protective mechanical ventilation with low tidal volume (Vt) and low plateau pressure reduces mortality and decreases the length of mechanical ventilation in patients with acute respiratory distress syndrome. Mechanical ventilation that will protect normal lungs during major surgical procedures of long duration may improve postoperative outcomes. We performed an animal study comparing 3 ventilation strategies used in the operating room in normal lungs. We compared the effects on pulmonary mechanics, inflammatory mediators, and lung tissue injury.

METHODS

Female pigs were randomized into 3 groups. Group H-Vt/3 (n = 6) was ventilated with a Vt of 15 mL/kg predicted body weight (PBW)/positive end-expiratory pressure (PEEP) of 3 cm H(2)O, group L-Vt/3 (n = 6) with a Vt of 6 mL/kg PBW/PEEP of 3 cm H(2)O, and group L-Vt/10 (n = 6) with a Vt of 6 mL/kg PBW/PEEP of 10 cm H(2)O, for 8 hours. Hemodynamics, airway mechanics, arterial blood gases, and inflammatory markers were monitored. Bronchoalveolar lavage (BAL) was analyzed for inflammatory markers and protein concentration. The right lower lobe was assayed for mRNA of specific cytokines. The right lower lobe and right upper lobe were evaluated histologically.

RESULTS

In contrast to groups H-Vt/3 and L-Vt/3, group L-Vt/10 exhibited a 6-fold increase in inflammatory mediators in BAL (P < 0.001). Cytokines in BAL were similar in groups H-Vt/3 and L-Vt/3. Group H-Vt/3 had a significantly lower lung injury score than groups L-Vt/3 and L-Vt/10.

CONCLUSION

Comparing intraoperative strategies, ventilation with high PEEP resulted in increased production of inflammatory markers. Low PEEP resulted in lower levels of inflammatory markers. High Vt/low PEEP resulted in less histologic lung injury.

Authors+Show Affiliations

Department of Anesthesiology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

20103541

Citation

Hong, Caron M., et al. "Low Tidal Volume and High Positive End-expiratory Pressure Mechanical Ventilation Results in Increased Inflammation and Ventilator-associated Lung Injury in Normal Lungs." Anesthesia and Analgesia, vol. 110, no. 6, 2010, pp. 1652-60.
Hong CM, Xu DZ, Lu Q, et al. Low tidal volume and high positive end-expiratory pressure mechanical ventilation results in increased inflammation and ventilator-associated lung injury in normal lungs. Anesth Analg. 2010;110(6):1652-60.
Hong, C. M., Xu, D. Z., Lu, Q., Cheng, Y., Pisarenko, V., Doucet, D., Brown, M., Aisner, S., Zhang, C., Deitch, E. A., & Delphin, E. (2010). Low tidal volume and high positive end-expiratory pressure mechanical ventilation results in increased inflammation and ventilator-associated lung injury in normal lungs. Anesthesia and Analgesia, 110(6), 1652-60. https://doi.org/10.1213/ANE.0b013e3181cfc416
Hong CM, et al. Low Tidal Volume and High Positive End-expiratory Pressure Mechanical Ventilation Results in Increased Inflammation and Ventilator-associated Lung Injury in Normal Lungs. Anesth Analg. 2010 Jun 1;110(6):1652-60. PubMed PMID: 20103541.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low tidal volume and high positive end-expiratory pressure mechanical ventilation results in increased inflammation and ventilator-associated lung injury in normal lungs. AU - Hong,Caron M, AU - Xu,Da-Zhong, AU - Lu,Qi, AU - Cheng,Yunhui, AU - Pisarenko,Vadim, AU - Doucet,Danielle, AU - Brown,Margaret, AU - Aisner,Seena, AU - Zhang,Chunxiang, AU - Deitch,Edwin A, AU - Delphin,Ellise, Y1 - 2010/01/26/ PY - 2010/1/28/entrez PY - 2010/1/28/pubmed PY - 2010/6/16/medline SP - 1652 EP - 60 JF - Anesthesia and analgesia JO - Anesth Analg VL - 110 IS - 6 N2 - BACKGROUND: Protective mechanical ventilation with low tidal volume (Vt) and low plateau pressure reduces mortality and decreases the length of mechanical ventilation in patients with acute respiratory distress syndrome. Mechanical ventilation that will protect normal lungs during major surgical procedures of long duration may improve postoperative outcomes. We performed an animal study comparing 3 ventilation strategies used in the operating room in normal lungs. We compared the effects on pulmonary mechanics, inflammatory mediators, and lung tissue injury. METHODS: Female pigs were randomized into 3 groups. Group H-Vt/3 (n = 6) was ventilated with a Vt of 15 mL/kg predicted body weight (PBW)/positive end-expiratory pressure (PEEP) of 3 cm H(2)O, group L-Vt/3 (n = 6) with a Vt of 6 mL/kg PBW/PEEP of 3 cm H(2)O, and group L-Vt/10 (n = 6) with a Vt of 6 mL/kg PBW/PEEP of 10 cm H(2)O, for 8 hours. Hemodynamics, airway mechanics, arterial blood gases, and inflammatory markers were monitored. Bronchoalveolar lavage (BAL) was analyzed for inflammatory markers and protein concentration. The right lower lobe was assayed for mRNA of specific cytokines. The right lower lobe and right upper lobe were evaluated histologically. RESULTS: In contrast to groups H-Vt/3 and L-Vt/3, group L-Vt/10 exhibited a 6-fold increase in inflammatory mediators in BAL (P < 0.001). Cytokines in BAL were similar in groups H-Vt/3 and L-Vt/3. Group H-Vt/3 had a significantly lower lung injury score than groups L-Vt/3 and L-Vt/10. CONCLUSION: Comparing intraoperative strategies, ventilation with high PEEP resulted in increased production of inflammatory markers. Low PEEP resulted in lower levels of inflammatory markers. High Vt/low PEEP resulted in less histologic lung injury. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/20103541/Low_tidal_volume_and_high_positive_end_expiratory_pressure_mechanical_ventilation_results_in_increased_inflammation_and_ventilator_associated_lung_injury_in_normal_lungs_ DB - PRIME DP - Unbound Medicine ER -