One-Lung Ventilation with High Tidal Volumes and Zero Positive End-Expiratory Pressure Is Injurious in the Isolated Rabbit Lung Model

Abreu, Marcelo Gama de; Heintz, Manuel; Heller, Axel R.; Széchényi, Roswitha; Albrecht, D. M.; Koch, Thea

doi:10.1097/00000539-200301000-00045

Cited by 47 publications

(27 citation statements)

References 31 publications

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“…Only few studies using differential lung ventilation in small animals with healthy lungs have been published. In agreement with our findings, they demonstrated that detrimental pulmonary effects occur if high V T is applied to one lung only (10,15).…”

Section: Discussionsupporting

confidence: 93%

A Novel Model of Selective Lung Ventilation to Investigate the Long-Term Effects of Ventilation-Induced Lung Injury

Schreiber

Niemann²,

Schmidt³

et al. 2006

Shock

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Mechanical ventilation (MV) with large tidal volumes (V(T)) causes ventilator induced lung injury. Whereas immediate effects of short-term injurious ventilation are well studied, little is known about its long-term effects. We aimed to establish an animal model of selective injurious MV, permitting assessment of the long-term course of ventilation-induced lung injury. In anesthetized and instrumented rats (n = 26), laryngoscopy was performed, and one cannula for MV was placed in the left main bronchus and a second one in the trachea. Two ventilators were used to ventilate the left lung with high (20 mL/kg) and the right lung with low (4 mL/kg) V(T). In control animals, both lungs received low V(T). After 2 h of MV, animals were extubated and observed for 24 h and then killed. Left and right lungs were excised and sampled for further investigations. Survival in animals ventilated with the high V(T) was 90%. Twenty-four hours after MV, alveolar levels of humoral (tumor necrosis factor alpha, interleukin 6) and cellular (polymorphonuclear leukocytes) inflammatory markers were increased, and histological alterations were present in lungs ventilated with high V(T). A delayed decrease in PaO2 was noted 24 h after MV, with high V(T) delivered to one lung as compared with low V(T) delivered to both lungs. This animal model permits assessment of the long-term course of ventilation-induced lung injury and shows that pulmonary inflammation and histological alterations are present 24 h after unilateral injurious ventilation.

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Section: Discussionsupporting

confidence: 93%

A Novel Model of Selective Lung Ventilation to Investigate the Long-Term Effects of Ventilation-Induced Lung Injury

Schreiber

Niemann²,

Schmidt³

et al. 2006

Shock

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“…23,24 This maintenance corresponds to a high-volume ventilation with potentially deleterious effects, even for a period of Ͻ90 min. 25,26 Normalizating of CO 2 at the expense of inducing undue lung stretch may not be appropriate. In mechanically ventilated intensive care unit patients reduced V t with an associated increased CO 2 (permissive hypercapnia) has become an accepted practice.…”

Section: Discussionmentioning

confidence: 99%

The Therapeutic Potential of Intraoperative Hypercapnia During Video-Assisted Thoracoscopy in Pediatric Patients

Mukhtar¹,

Obayah²,

Elmasry³

et al. 2008

Anesthesia &Amp; Analgesia

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“…In a rabbit model of OLV during isolated perfusion, large tidal volume (8 ml/kg) ventilation produced a picture of ALI that was absent in animals randomised to a lung-protective ventilation pattern (4 ml/kg plus PEEP). 45 Large pulmonary resections (pneumonectomy or bi-lobectomy) should be considered to be associated with some degree of ALI. ALI was diagnosed radiographically in 42% of pneumonectomy patients who had been ventilated with peak airway pressures > 40 cmH 2 O.…”

Section: One-lung Ventilationmentioning

confidence: 99%

Are lung-protective ventilation strategies worth the effort?

Slinger

2013

Southern African Journal of Anaesthesia and Analgesia

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Nonphysiological ventilation in healthy lungs induces acute lung injury (ALI). Protective lung ventilation in patients with ALI improves outcome. Protective lung ventilation in noninjured lungs and in the absence of a primary pulmonary insult may initiate ventilation-induced lung injury (VILI), as evidenced by inflammatory markers. VILI has important implications that are remote to the lungs and may be associated with significant morbidity and mortality. Volatile anaesthetics can have a lungprotective effect. Excess fluids may contribute to perioperative lung injury. Anaesthesiologists manage a heterogeneous group of patients in the perioperative period, from patients with healthy lungs and patients with at-risk lungs through to patients with established ALI. More patients are at risk for ALI during surgery than previously thought. Appropriate perioperative management may prevent or ameliorate this lung injury. Although evidence is lacking from randomised controlled trials, applying protective ventilatory strategies seems to be a reasonable approach, based on the current understanding of mechanical ventilation and lung injury.

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One-Lung Ventilation with High Tidal Volumes and Zero Positive End-Expiratory Pressure Is Injurious in the Isolated Rabbit Lung Model

Cited by 47 publications

References 31 publications

A Novel Model of Selective Lung Ventilation to Investigate the Long-Term Effects of Ventilation-Induced Lung Injury

A Novel Model of Selective Lung Ventilation to Investigate the Long-Term Effects of Ventilation-Induced Lung Injury

The Therapeutic Potential of Intraoperative Hypercapnia During Video-Assisted Thoracoscopy in Pediatric Patients

Are lung-protective ventilation strategies worth the effort?

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