Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model.
TL;DR: The concept that mechanical ventilation can have a significant influence on the inflammatory/anti-inflammatory milieu of the lung, and thus play a role in initiating or propagating a local, and possibly systemic inflammatory response, is supported.
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Abstract: We examined the effect of ventilation strategy on lung inflammatory mediators in the presence and absence of a preexisting inflammatory stimulus. 55 Sprague-Dawley rats were randomized to either intravenous saline or lipopolysaccharide (LPS). After 50 min of spontaneous respiration, the lungs were excised and randomized to 2 h of ventilation with one of four strategies: (a) control (C), tidal volume (Vt) = 7 cc/kg, positive end expiratory pressure (PEEP) = 3 cm H2O; (b) moderate volume, high PEEP (MVHP), Vt = 15 cc/kg; PEEP = 10 cm H2O; (c) moderate volume, zero PEEP (MVZP), Vt = 15 cc/kg, PEEP = 0; or (d) high volume, zero PEEP (HVZP), Vt = 40 cc/kg, PEEP = 0. Ventilation with zero PEEP (MVZP, HVZP) resulted in significant reductions in lung compliance. Lung lavage levels of TNFalpha, IL-1beta, IL-6, IL-10, MIP-2, and IFNgamma were measured by ELISA. Zero PEEP in combination with high volume ventilation (HVZP) had a synergistic effect on cytokine levels (e.g., 56-fold increase of TNFalpha versus controls). Identical end inspiratory lung distention with PEEP (MVHP) resulted in only a three-fold increase in TNFalpha, whereas MVZP produced a six-fold increase in lavage TNFalpha. Northern blot analysis revealed a similar pattern (C, MVHP < MVZP < HVZP) for induction of c-fos mRNA. These data support the concept that mechanical ventilation can have a significant influence on the inflammatory/anti-inflammatory milieu of the lung, and thus may play a role in initiating or propagating a local, and possibly systemic inflammatory response.
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Citations
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.
Roy G. Brower,Michael A. Matthay,Alan H. Morris,David A. Schoenfeld,B. Taylor Thompson,Arthur P. Wheeler +5 more
TL;DR: In patients with acute lung injury and the acute respiratory distress syndrome, mechanical ventilation with a lower tidal volume than is traditionally used results in decreased mortality and increases the number of days without ventilator use.
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Marcelo B. P. Amato,Carmen Silvia Valente Barbas,D Medeiros,R B Magaldi,Guilherme Schettino,Geraldo Lorenzi-Filho,Ronaldo Adib Kairalla,Daniel Deheinzelin,Carlos Munoz,Roselaine Pinheiro de Oliveira,Teresa Yae Takagaki,Carlos Roberto Ribeiro de Carvalho +11 more
TL;DR: As compared with conventional ventilation, the protective strategy was associated with improved survival at 28 days, a higher rate of weaning from mechanical ventilation, and a lower rate of barotrauma in patients with the acute respiratory distress syndrome.
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TL;DR: To the authors' knowledge, this constitutes the first example of a protective effect of PEEP during permeability edema, which was markedly reduced by PEEP and preserved the normal ultrastructural aspect of the alveolar epithelium.
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TL;DR: End-expiratory lung volume is an important determinant of the degree and site of lung injury during positive-pressure ventilation as ventilation occurs from below to above the infection point (Pinf) as determined from the inspiratory pressure-volume curve.
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