High Peep Decreases Hyaline Membrane Formation in Surfactant Deficient Lungs

Argiras, E.; Blakeley, C.R.; Dunnill, M. S.; Otremski, S.; Sykes, M.K.

doi:10.1093/bja/59.10.1278

Cited by 119 publications

(56 citation statements)

References 29 publications

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“…These high ventilation pressures, achieved with conventional V T (e.g., 10 to 12 ml/kg), have been related to pulmonary injury in different experimental models (9,10). Despite the wide variations among different animal species, these results can be, at least in part, extrapolated to clinical practice, as shown by some studies that achieved good results with protective strategies during mechanical ventilation (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Ventilation with high tidal volume induces inflammatory lung injury

Bueno

Santos

et al. 2002

Braz J Med Biol Res

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Mechanical ventilation with high tidal volumes (V T ) has been shown to induce lung injury. We examined the hypothesis that this procedure induces lung injury with inflammatory features. Anesthetized male Wistar rats were randomized into three groups: group 1 (N = 12): V T = 7 ml/kg, respiratory rate (RR) = 50 breaths/min; group 2 (N = 10): V T = 21 ml/kg, RR = 16 breaths/min; group 3 (N = 11): V T = 42 ml/kg, RR = 8 breaths/min. The animals were ventilated with fraction of inspired oxygen of 1 and positive end-expiratory pressure of 2 cmH 2 O. After 4 h of ventilation, group 3, compared to groups 1 and 2, had lower PaO 2 [280 (range 73-458) vs 517 (range 307-596), and 547 mmHg (range 330-662), respectively, P<0.05], higher wet lung weight [3.62 ± 0.91 vs 1.69 ± 0.48 and 1.44 ± 0.20 g, respectively, P<0.05], and higher wet lung weight/dry lung weight ratio [18.14 (range 11.55-26.31) vs 7.80 (range 4.79-12.18), and 6.34 (range 5.92-7.04), respectively, P<0.05]. Total cell and neutrophil counts were higher in group 3 compared to groups 1 and 2 (P<0.05), as were baseline TNF-α concentrations [134 (range <10-386) vs 16 (range <10-24), and 17 pg/ml (range <10-23), respectively, P<0.05]. Serum TNF-α concentrations reached a higher level in group 3, but without statistical significance. These results suggest that mechanical ventilation with high V T induces lung injury with inflammatory characteristics. This ventilatory strategy can affect the release of TNF-α in the lungs and can reach the systemic circulation, a finding that may have relevance for the development of a systemic inflammatory response.

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Section: Introductionmentioning

confidence: 99%

Ventilation with high tidal volume induces inflammatory lung injury

Bueno

Santos

et al. 2002

Braz J Med Biol Res

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“…This is because PEEP increases lung volume (8 -11), surface area, and compliance (6,8,12). Increasing the PEEP lowers expiratory resistance (12), conserves surfactant (6), and reduces hyaline membrane formation (12)(13)(14), alveolar collapse, and the expression of proinflammatory mediators (15). Without PEEP, the lung volume falls in intubated ventilated infants (16).…”

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confidence: 99%

Positive End Expiratory Pressure during Resuscitation of Premature Lambs Rapidly Improves Blood Gases without Adversely Affecting Arterial Pressure

et al. 2004

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Positive end expiratory pressure (PEEP) is important for neonatal ventilation but is not considered in guidelines for resuscitation. Our aim was to investigate the effects of PEEP on cardiorespiratory parameters during resuscitation of very premature lambs delivered by hysterotomy at~125 d gestation (term 147 d). Before delivery, they were intubated and lung fluid was drained. Immediately after delivery, they were ventilated with a Dräger Babylog plus ventilator in volume guarantee mode with a tidal volume of 5 mL/kg. Lambs were randomized to receive 0, 4, 8, or 12 cm H 2 O of PEEP. They were ventilated for a 15-min resuscitation period followed by 2 h of stabilization at the same PEEP. Tidal volume, peak inspiratory pressure, PEEP, arterial pressure, oxygen saturation, and blood gases were measured regularly, and respiratory system compliance and alveolar/ arterial oxygen differences were calculated. Lambs that received 12 cm H 2 O of PEEP died from pneumothoraces; all others survived without pneumothoraces. Oxygenation was significantly improved by 8 and 12 cm H 2 O of PEEP compared with 0 and 4 cm H 2 O of PEEP. Lambs with 0 PEEP did not oxygenate adequately. The compliance of the respiratory system was significantly higher at 4 and 8 cm H 2 O of PEEP than at 0 PEEP. There were no significant differences in partial pressure of carbon dioxide in arterial blood between groups. Arterial pressure was highest with 8 cm H 2 O of PEEP, and there was no cardiorespiratory compromise at any level of PEEP. Applying PEEP during resuscitation of very premature infants might be advantageous and merits further investigation. At birth, the lungs of premature infants are completely airless, fluid filled, surfactant deficient, and noncompliant. It is common for these infants to require ventilation after birth. The recommended technique of resuscitating infants is with a neonatal resuscitation bag (1,2) connected to a face mask or endotracheal tube. The most common devices used do not provide positive end expiratory pressure (PEEP) and therefore may contribute to atelectasis, acute lung injury (3), and hyaline membrane formation. Although PEEP valves are available for self-inflating resuscitation bags, they are not in common use or recommended. PEEP and continuous positive airway pressure (CPAP)

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“…This was fully defined in animal models, but the significance in humans has not been established. Several studies suggest that the adverse effects of mechanical ventilation can be reduced by the application of PEEP (Webb HH et al 1974;Argiras EP et al 1987;Dreyfuss D et al 1988;Sandhar BK et al 1988;Yardimci Ç et al, 2001). Ventilation washed isolated rat lung airways with low volume (5-6 mL/kg) and low PEEP or PEEP equal to zero, causing lung injury that can be reduced by high levels of PEEP (Muscedere JG et al, 1994).…”

Section: # Paco2 -The Partial Pressure Of Carbon Dioxide In Arterial mentioning

confidence: 99%

Comparative analysis of changes in the lungs of experimental animals’ induced conventional and lung protective ventilation

Videnović

Mladenović²,

Videnovic³

et al. 2018

J Hellenic Vet Med Soc

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Mechanical ventilation has long been the leader in the treatment of critically ill and injured patients in an intensive care unit. The aim of this study was to examine the impact of the application of positive end-expiratory pressure on histopathological findings and on the parameters of ventilation, oxygenation and acid-base status. The experimental study included 42 animals (piglets), which were divided into of tree groups, each containing 14. The animals of the control group (conventional ventilation) were ventilated with the tidal volume of 10-15 mL/kg. Tidal volume of 6 mL/kg was applied in the low tidal ventilation group, whereas the ventilation strategy in the lung protective ventilation group meant the application of a tidal volume of 6 mL/kg and the 7 mbar of positive end-expiratory pressure. Mechanical ventilation in each animal lasted for 4 hours. After conducting mechanical ventilation, samples were taken from the lung tissue, which were sent for histopathological examination. The parameters of ventilation, oxygenation and acid-base status were measured after each hour’s duration of mechanical ventilation. Application of positive end-expiratory pressure 5-10 mbar during mechanical ventilation is a safe and useful method which is not followed by the occurrence of significant abnormalities in the structure of the ventilated lung. However, a low tidal volume without positive end-expiratory pressure causes significant changes in the histological structure of healthy lungs. Positive end-expiratory pressure keeps the alveoli open throughout the respiratory cycle which allows the lungs to maintain homeostasis in terms of adequate ventilation, oxygenation and acid-base status.

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High Peep Decreases Hyaline Membrane Formation in Surfactant Deficient Lungs

Cited by 119 publications

References 29 publications

Ventilation with high tidal volume induces inflammatory lung injury

Ventilation with high tidal volume induces inflammatory lung injury

Positive End Expiratory Pressure during Resuscitation of Premature Lambs Rapidly Improves Blood Gases without Adversely Affecting Arterial Pressure

Comparative analysis of changes in the lungs of experimental animals’ induced conventional and lung protective ventilation

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