Effects of Positive End-Expiratory Pressure and Spontaneous Breathing Activity on Regional Lung Inflammation in Experimental Acute Respiratory Distress Syndrome

Kiss, Thomas; Bluth, Thomas; Braune, Anja; Huhle, Robert; Denz, Axel; Herzog, Moritz; Herold, Johannes; Vivona, Luigi; Millone, Marco; Bergamaschi, Alice; Andreeff, Michael; Scharffenberg, Martin; Wittenstein, Jakob; Melo, Marcos F. Vidal; Koch, Thea; Rocco, Patrícia Rieken Macêdo; Pelosi, Paolo; Kotzerke, Jörg; Abreu, Marcelo Gama de

doi:10.1097/ccm.0000000000003649

Cited by 28 publications

(32 citation statements)

References 38 publications

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“…The present paper stresses the importance of the choice of PEEP during the modalities of ventilation that allows SB. As shown in a very recent PET study, SB per se does not increase lung inflammation when compared with controlled ventilation with an analogous ventilatory setup; it is the choice of PEEP that can deviate the clinical course toward an inflammatory status (Kiss et al, 2019).…”

Section: Discussionmentioning

confidence: 98%

The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment–Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome

et al. 2019

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BackgroundWhether spontaneous breathing (SB) should be used in early acute respiratory distress syndrome (ARDS) is questioned because it may cause ventilator-induced lung injury (VILI) by tidal high strain/stress and recruitment/derecruitment (R/D). However, SB has shown beneficial effects when used appropriately. We hypothesized that high levels of positive end-expiratory pressure (PEEP), during assisted SB, would prevent tidal R/D, reducing ventilatory variation and respiratory rate while potentially increasing transpulmonary pressure (PTP). The aim was to test this hypothesis in experimental mild ARDS during continuous SB using neurally adjusted ventilator assist (NAVA) and uninterrupted computed tomography (CT) exposure.MethodsMild experimental ARDS (PaO2/FiO2-ratio of 250) was induced in anesthetized pigs (n = 5), ventilated using uninterrupted NAVA. PEEP was changed in steps of 3 cmH2O, from 0 to 15 and back to 0 cmH2O. Dynamic CT scans, ventilatory parameters, and esophageal pressure were acquired simultaneously. PTP and R/D were calculated and compared among PEEP levels.ResultsWhen increasing PEEP from 0 to 15 cmH2O, tidal R/D decreased from 4.3 ± 5.9 to 1.1 ± 0.7% (p < 0.01), breath-to-breath variability decreased, and PTP increased from 11.4 ± 3.7 to 29.7 ± 14.1 cmH2O (R2 = 0.96).ConclusionThis study shows that injurious phenomena like R/D and high PTP are present in NAVA at the two extremes of the PEEP spectrum. Willing to titrate PEEP to limit these phenomena, the physician must choose the best compromise between restraining the R/D or PTP.

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Section: Discussionmentioning

confidence: 98%

The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment–Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome

et al. 2019

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“…In order to measure regional transpulmonary pressures, three custom-made pressure sensors were attached to the parietal pleura in the following regions of the left hemithorax: (1) ventral (4-5th rib parasternal), (2) dorsal (4-5th rib paravertebral), and (3) caudal (8-9th rib paravertebral) as described in detail before (Kiss et al, 2019). Briefly, animals were positioned in the right lateral decubitus position.…”

Section: Experimental Protocolmentioning

confidence: 99%

“…Airway/tracheal pressure (P), airflow, and volume were recorded for 5 min at the end of each time point. Airway pressure and pleural pressure signals in ventral, dorsal, and caudal regions were obtained from pressure transducers [17] (163PC01D48-PCB, First-Sensors AG, Berlin, Germany). Respiratory system compliance and resistance were determined using multiple linear regression of the linear equation of motion composed of resistance R and compliance C two-compartmental model of the respiratory system.…”

Section: Respiratory Signals and Regional Pleural Pressurementioning

confidence: 99%

Comparative effects of flow vs. volume-controlled one-lung ventilation on gas exchange and respiratory system mechanics in pigs

Wittenstein

Scharffenberg

Ran

et al. 2020

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Background Flow-controlled ventilation (FCV) allows expiratory flow control, reducing the collapse of the airways during expiration. The performance of FCV during one-lung ventilation (OLV) under intravascular normo- and hypovolaemia is currently unknown. In this explorative study, we hypothesised that OLV with FCV improves PaO2 and reduces mechanical power compared to volume-controlled ventilation (VCV). Sixteen juvenile pigs were randomly assigned to one of two groups: (1) intravascular normovolaemia (n = 8) and (2) intravascular hypovolaemia (n = 8). To mimic inflammation due to major thoracic surgery, a thoracotomy was performed, and 0.5 μg/kg/h lipopolysaccharides from Escherichia coli continuously administered intravenously. Animals were randomly assigned to OLV with one of two sequences (60 min per mode): (1) VCV–FCV or (2) FCV–VCV. Variables of gas exchange, haemodynamics and respiratory signals were collected 20, 40 and 60 min after initiation of OLV with each mechanical ventilation mode. The distribution of ventilation was determined using electrical impedance tomography (EIT). Results Oxygenation did not differ significantly between modes (P = 0.881). In the normovolaemia group, the corrected expired minute volume (P = 0.022) and positive end-expiratory pressure (PEEP) were lower during FCV than VCV. The minute volume (P ≤ 0.001), respiratory rate (P ≤ 0.001), total PEEP (P ≤ 0.001), resistance of the respiratory system (P ≤ 0.001), mechanical power (P ≤ 0.001) and resistive mechanical power (P ≤ 0.001) were lower during FCV than VCV irrespective of the volaemia status. The distribution of ventilation did not differ between both ventilation modes (P = 0.103). Conclusions In a model of OLV in normo- and hypovolemic pigs, mechanical power was lower during FCV compared to VCV, without significant differences in oxygenation. Furthermore, the efficacy of ventilation was higher during FCV compared to VCV during normovolaemia.

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“…Global and regional lung metabolic activity were measured by 18 F-FDG uptake, a reliable biomarker of inflammation in the lung [ 32 ]. This marker is indicative of neutrophil activation in acute lung injury and ARDS [ 33 – 35 ]. Previous studies have shown that voxelwise ratio of lung parenchyma and air content influences 18 F-FDG uptake quantification, requiring normalization for the tissue fraction [ 26 , 36 ], which was performed in the current study.…”

Section: Discussionmentioning

confidence: 99%

Physiologically variable ventilation reduces regional lung inflammation in a pediatric model of acute respiratory distress syndrome

et al. 2020

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Background Benefits of variable mechanical ventilation based on the physiological breathing pattern have been observed both in healthy and injured lungs. These benefits have not been characterized in pediatric models and the effect of this ventilation mode on regional distribution of lung inflammation also remains controversial. Here, we compare structural, molecular and functional outcomes reflecting regional inflammation between PVV and conventional pressure-controlled ventilation (PCV) in a pediatric model of healthy lungs and acute respiratory distress syndrome (ARDS). Methods New-Zealand White rabbit pups (n = 36, 670 ± 20 g [half-width 95% confidence interval]), with healthy lungs or after induction of ARDS, were randomized to five hours of mechanical ventilation with PCV or PVV. Regional lung aeration, inflammation and perfusion were assessed using x-ray computed tomography, positron-emission tomography and single-photon emission computed tomography, respectively. Ventilation parameters, blood gases and respiratory tissue elastance were recorded hourly. Results Mechanical ventilation worsened respiratory elastance in healthy and ARDS animals ventilated with PCV (11 ± 8%, 6 ± 3%, p < 0.04), however, this trend was improved by PVV (1 ± 4%, − 6 ± 2%). Animals receiving PVV presented reduced inflammation as assessed by lung normalized [18F]fluorodeoxyglucose uptake in healthy (1.49 ± 0.62 standardized uptake value, SUV) and ARDS animals (1.86 ± 0.47 SUV) compared to PCV (2.33 ± 0.775 and 2.28 ± 0.3 SUV, respectively, p < 0.05), particularly in the well and poorly aerated lung zones. No benefit of PVV could be detected on regional blood perfusion or blood gas parameters. Conclusions Variable ventilation based on a physiological respiratory pattern, compared to conventional pressure-controlled ventilation, reduced global and regional inflammation in both healthy and injured lungs of juvenile rabbits.

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Effects of Positive End-Expiratory Pressure and Spontaneous Breathing Activity on Regional Lung Inflammation in Experimental Acute Respiratory Distress Syndrome

Abstract: Objective: To determine the impact of positive end-expiratory pressure (PEEP) during mechanical ventilation with and without spontaneous breathing (SB) activity on regional lung inflammation in experimental non-severe ARDS.

Cited by 28 publications

References 38 publications

The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment–Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome

The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment–Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome

Comparative effects of flow vs. volume-controlled one-lung ventilation on gas exchange and respiratory system mechanics in pigs

Physiologically variable ventilation reduces regional lung inflammation in a pediatric model of acute respiratory distress syndrome

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