Comparison of lung protective ventilation strategies in a rabbit model of acute lung injury

Rotta, Alexandre T.; Gunnarsson, Björn; Fuhrman, Bradley P.; Hernan, Lynn J.; Steinhorn, David M.

doi:10.1097/00003246-200111000-00021

Cited by 109 publications

(109 citation statements)

References 42 publications

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“…6 A ventilation strategy that avoids volutrauma, atelectrauma and biotrauma in the treatment of patients with diseases of abnormal lung compliance, such as ARDS, is firmly based on experimental literature and clinical experience. [2][3][4][5]28,30,32 The application of a lung protective strategy incorporating reduced tidal volumes, effective lung recruitment, adequate PEEP to minimize alveolar collapse during expiration and permissive hypercapnia has been shown to be advantageous in adult patients with ARDS, 5 although it has not been systematically studied in children.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] In contrast, a strategy that incorporates the basic principles of lung protective ventilation can hasten recovery and minimize pulmonary morbidity with its attendant mortality. 5 …”

Section: S100mentioning

confidence: 99%

“…The use of inadequately low PEEP that is insufficient to prevent the collapse of less compliant alveoli at end-expiration results in atelectrauma, while the use of adequate levels of PEEP that maintain an acceptable lung volume during exhalation is associated with more favorable physiological outcomes. 3,30,31 …”

Section: Atelectraumamentioning

confidence: 99%

“…43 The resulting hypercapnia, which may reach blood levels over twice normal, is tolerated but not necessarily the goal of therapy, although experimental data suggest that hypercapnic acidosis might be associated with improved physiological outcomes. 3,[43][44][45] Permissive hypercapnia as part of a ventilation strategy tailored to minimize VILI was first used over 20 years ago in neonates with severe respiratory failure and pulmonary hypertension. 46 Since then reports from various centers indicate that this approach can be successful in managing infants with severe respiratory failure and pulmonary hypertension due to congenital diaphragmatic hernia or meconium aspiration syndrome, while minimizing the need for extracorporeal membrane oxygenation (ECMO) and morbidity related to aggressive ventilatory therapy.…”

Section: Permissive Hypercapniamentioning

confidence: 99%

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Ventilação mecânica convencional em pediatria

Rotta¹,

Steinhorn²

2007

J. Pediatr. (Rio J.)

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Objective: To review the various challenges of providing mechanical ventilation to pediatric patients with diseases of increased airway resistance, diseases of abnormal lung compliance or normal lungs. Sources:Original data from our pediatric intensive care unit and animal research laboratory. Relevant articles included in the MEDLINE electronic database during the last 10 years. Also included were book chapters and definitive studies, as judged by the authors, in the fields of asthma, acute respiratory distress syndrome, mechanical ventilation, ventilator-induced lung injury and permissive hypercapnia. Summary of the findings:Mechanical ventilation of patients with diseases of increased airway resistance should center on avoidance of dynamic hyperinflation, allowing complete exhalation prior to the initiation of a subsequent breath and permissive hypercapnia. Positive end-expiratory pressure should be used sparingly to prevent atelectasis and facilitate synchrony in spontaneously breathing patients. Mechanical ventilation of patients with diseases of abnormal lung compliance should take into consideration the inhomogeneous distribution of lung disease. Focus should be on avoidance of volutrauma and atelectrauma that could result in ventilator-associated lung injury. Conclusions:The last decade was marked by significant advances in the management of pediatric respiratory failure. The choice of mechanical ventilation strategy can significantly influence the subsequent course of lung injury.Mechanical ventilation can no longer be viewed simply as a harmless support modality that is employed to keep patients alive while disease-specific treatments are used to ameliorate the underlying pathology.J Pediatr (Rio J). 2007;83(2 Suppl):S100-108: Mechanical ventilation, acute lung injury, acute respiratory distress syndrome, status asthmaticus, permissive hypercapnia.

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Section: Discussionmentioning

confidence: 99%

Section: S100mentioning

confidence: 99%

Section: Atelectraumamentioning

confidence: 99%

Section: Permissive Hypercapniamentioning

confidence: 99%

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Ventilação mecânica convencional em pediatria

Rotta¹,

Steinhorn²

2007

J. Pediatr. (Rio J.)

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“…Por outro lado, a exata contribuição exercida pelo colapso expiratório cíclico alternado à reabertura inspiratória de unidades alveolares no agravamento da lesão pulmonar (atelectrauma) 9 é menos óbvia. Apesar da comprovação de que o emprego de estratégias ventilatórias que evitam o atelectrauma através da aplicação de pressão expiratória final (PEEP) adequada resulta em atenuação dos marcadores biológicos de lesão pulmonar 10,11 , um recente estudo clínico comparando o uso de PEEP alta e PEEP baixa em pacientes com SDRA foi encerrado por futilidade, devido à ausência de diferenças significativas entre os dois grupos 12 .…”

Section: Introductionunclassified

The impact of mechanical ventilation strategies that minimize atelectrauma in an experimental model of acute lung injury

Viana¹,

Sargentelli²,

Arruda³

et al. 2004

J Pediatr (Rio J)

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Objective: To evaluate whether ventilation strategies that target alveolar stabilization and prevention of atelectrauma would be associated with more favorable physiologic outcomes in a combined model of acute lung injury.Methods: Thirty-nine rabbits were instrumented and ventilated with FiO 2 of 1.0. Combined lung injury was induced by an infusion of lipopolysaccharide and tracheal saline lavage. Animals were randomized to receive conventional ventilation with tidal volume of 10 ml/kg, PEEP of 4 cm H 2 O; conventional ventilation with surfactant (Infasurf, 3 mg/kg IT); partial liquid ventilation (18 ml/kg of perflubron IT); or high-frequency oscillatory ventilation with mean airway pressure of 14 cm H 2 O and frequency of 4 Hz. Uninjured ventilated animals served as controls. Conventional ventilation with surfactant, partial liquid ventilation and control groups were ventilated with settings identical to the conventional ventilation group. Animals were studied for 4 hours, during which serial blood gas measurements were obtained. After sacrifice, lungs were harvested for injury grading by a microscopic lung injury score and measurement of 4-hydroxy-nonenal, a marker of lipid peroxidation.Results: Conventional ventilation resulted in hypoxia and greater evidence of lung injury. Animals treated with partial liquid ventilation, high-frequency oscillatory ventilation or conventional ventilation with surfactant had adequate oxygenation, but conventional ventilation with surfactant resulted in higher lung injury scores and increased pulmonary oxidative damage. Conclusion:Strategies that minimize atelectrauma (partial liquid ventilation and high-frequency oscillatory ventilation) are associated with adequate oxygenation and attenuated lung injury. Surfactant improves oxygenation in comparison to conventional ventilation alone but resulted in increased injury, presumably because the inadequately low PEEP was insufficient to stabilize the alveoli during expiration. ResumoObjetivo: Avaliar se estratégias ventilatórias que buscam a estabilização alveolar e a prevenção do atelectrauma estão associadas a desfechos fisiológicos mais favoráveis em um modelo experimental de lesão pulmonar aguda combinada.Métodos: Trinta e nove coelhos foram instrumentados e ventilados com uma fração inspirada de oxigênio (FiO 2 ) de 1,0. A lesão pulmonar foi induzida pela infusão venosa de lipopolissacarídeo de E. coli e por repetidas lavagens traqueais com solução salina. Os animais foram randomizados a receber ventilação mecânica convencional com volume corrente de 10 ml/kg, pressão expiratória final (PEEP) de 4 cm H 2 O; ventilação mecânica convencional com surfactante (Infasurf, 3 mg/kg, ET); ventilação líquida parcial (18 ml/kg de perflubron, ET); ou ventilação oscilatória de alta freqüência, com pressão média de via aérea de 14 cm H 2 O e freqüência de 10 Hz. Animais sadios submetidos a instrumentação e ventilação convencional serviram como controles. Os grupos ventilação mecânica convencional com surfactante, ventilação líquida...

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Bilirubin influence on oxidative lung damage and surfactant surface tension properties

Dani

Martelli

Tronchin

et al. 2004

Pediatric Pulmonology

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Summary. To study the hypothesis that hyperbilirubinemia might reduce in vivo oxidative lung damage while also diminishing lung surfactant surface tension properties during acute lung injury, we performed a randomized study in a rabbit model of acute lung injury. Twenty rabbits were randomized to receive bilirubin or saline intravenously. Acute lung injury was induced by lung lavages with saline. Lung tissue oxidation was evaluated by measuring total hydroperoxide (TH), advanced oxidation protein products (AOPP), and protein carbonyls (PC) in bronchial aspirate (BA) samples. Surface surfactant activity was studied in BA samples using a capillary surfactometer. Bilirubin BA concentration increased in bilirubin-treated rabbits, while it remained undetectable in controls. A similar increase in TH, AOPP, and PC bronchial aspirate concentrations was found in both the study and control groups, while surfactant surface activity was lower in the bilirubin than in the control group. We conclude that during hyperbilirubinemia, bilirubin enters the lung tissue, where it can be detected in BA fluid. Bilirubin is not effective as an antioxidant agent and exerts a detrimental effect on lung surfactant surface tension properties. These findings may have relevance to the management of premature neonates suffering from respiratory distress syndrome and hyperbilirubinemia.

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Comparison of lung protective ventilation strategies in a rabbit model of acute lung injury

Cited by 109 publications

References 42 publications

Ventilação mecânica convencional em pediatria

Ventilação mecânica convencional em pediatria

The impact of mechanical ventilation strategies that minimize atelectrauma in an experimental model of acute lung injury

Bilirubin influence on oxidative lung damage and surfactant surface tension properties

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