Recruitment Maneuvers Modulate Epithelial and Endothelial Cell Response According to Acute Lung Injury Etiology*

Silva, Pedro L.; Moraes, Lillian; Santos, Rodrigues dos; Samary, Cynthia S.; Ramos, Mateus Pinheiro; Santos, Carlos Antônio Cabral; Morales, Marcelo M.; Capelozzi, Vera Luíza; Garcia, Cristiane Sousa Nascimento Baez; Abreu, Marcelo Gama de; Pelosi, Paolo; Marini, John J.; Rocco, Patricia R. M.

doi:10.1097/ccm.0b013e31828a3c13

Cited by 57 publications

(46 citation statements)

References 27 publications

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“…A previous study has proposed to set PEEP according to the level of IAP in experimental ALI in pigs [19]. Another recent study has suggested that PEEP higher than IAP maintains functional residual capacity and prevents alveolar collapse [11]. In this line, in the present study, not even the highest PEEP value (10 cmH 2 O = 7.4 mmHg), which was lower than IAP (15 mmHg), was able to prevent alveolar collapse in our animals, independent of ALI etiology.…”

Section: Discussionmentioning

confidence: 99%

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The biological effects of higher and lower positive end-expiratory pressure in pulmonary and extrapulmonary acute lung injury with intra-abdominal hypertension

et al. 2014

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IntroductionMechanical ventilation with high positive end-expiratory pressure (PEEP) has been used in patients with acute respiratory distress syndrome (ARDS) and intra-abdominal hypertension (IAH), but the role of PEEP in minimizing lung injury remains controversial. We hypothesized that in the presence of acute lung injury (ALI) with IAH: 1) higher PEEP levels improve pulmonary morphofunction and minimize lung injury; and 2) the biological effects of higher PEEP are more effective in extrapulmonary (exp) than pulmonary (p) ALI.MethodsIn 48 adult male Wistar rats, ALIp and ALIexp were induced by Escherichia coli lipopolysaccharide intratracheally and intraperitoneally, respectively. After 24 hours, animals were anesthetized and mechanically ventilated (tidal volume of 6 mL/kg). IAH (15 mmHg) was induced and rats randomly assigned to PEEP of 5 (PEEP5), 7 (PEEP7) or 10 (PEEP10) cmH2O for 1 hour.ResultsIn both ALIp and ALIexp, higher PEEP levels improved oxygenation. PEEP10 increased alveolar hyperinflation and epithelial cell damage compared to PEEP5, independent of ALI etiology. In ALIp, PEEP7 and PEEP10 increased lung elastance compared to PEEP5 (4.3 ± 0.7 and 4.3 ± 0.9 versus 3.1 ± 0.3 cmH2O/mL, respectively, P <0.01), without changes in alveolar collapse, interleukin-6, caspase-3, type III procollagen, receptor for advanced glycation end-products, and vascular cell adhesion molecule-1 expressions. Moreover, PEEP10 increased diaphragmatic injury compared to PEEP5. In ALIexp, PEEP7 decreased lung elastance and alveolar collapse compared to PEEP5 (2.3 ± 0.5 versus 3.6 ± 0.7 cmH2O/mL, P <0.02, and 27.2 (24.7 to 36.8) versus 44.2 (39.7 to 56.9)%, P <0.05, respectively), while PEEP7 and PEEP10 increased interleukin-6 and type III procollagen expressions, as well as type II epithelial cell damage compared to PEEP5.ConclusionsIn the current models of ALI with IAH, in contrast to our primary hypothesis, higher PEEP is more effective in ALIp than ALIexp as demonstrated by the activation of biological markers. Therefore, higher PEEP should be used cautiously in the presence of IAH and ALI, mainly in ALIexp.

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Section: Discussionmentioning

confidence: 99%

“…Airflow, airway (P,aw) and esophageal pressures (Pes) were continuously recorded throughout the experiments with a computer running custom software written in LabVIEW® (National Instruments, Austin, TX, USA) [11]. V T was calculated by digital integration of the flow signal.…”

Section: Methodsmentioning

confidence: 99%

The biological effects of higher and lower positive end-expiratory pressure in pulmonary and extrapulmonary acute lung injury with intra-abdominal hypertension

et al. 2014

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“…Gradual recruitment (step) maneuvers have been quite effective when applied to heterogeneous lung parenchyma, with different time constants for small airways opening, thus promoting lower biological impact when compared with the abrupt pressure increase 41 . The step can be obtained through a slow and gradual increase of PEEP or also by increasing inspiratory driving pressure up to a threshold pressure, in general 40cm H 2 O.…”

Section: Methods Methods Methods Methodsmentioning

confidence: 99%

“…The step can be obtained through a slow and gradual increase of PEEP or also by increasing inspiratory driving pressure up to a threshold pressure, in general 40cm H 2 O. Furthermore, in step there are smaller hemodynamic effects, since the average pressure achieved during this maneuver is lower 41 .…”

Section: Methods Methods Methods Methodsmentioning

confidence: 99%

Pulmonar recruitment in acute respiratory distress syndrome. What is the best strategy?

Santos

Samary

Júnior

et al. 2015

Rev. Col. Bras. Cir.

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Supporting patients with acute respiratory distress syndrome (ARDS), using a protective mechanical ventilation strategy characterized by low tidal volume and limitation of positive end-expiratory pressure (PEEP) is a standard practice in the intensive care unit. However, these strategies can promote lung de-recruitment, leading to the cyclic closing and reopening of collapsed alveoli and small airways. Recruitment maneuvers (RM) can be used to augment other methods, like positive end-expiratory pressure and positioning, to improve aerated lung volume. Clinical practice varies widely, and the optimal method and patient selection for recruitment maneuvers have not been determined, considerable uncertainty remaining regarding the appropriateness of RM. This review aims to discuss recent findings about the available types of RM, and compare the effectiveness, indications and adverse effects among them, as well as their impact on morbidity and mortality in ARDS patients. Recent developments include experimental and clinical evidence that a stepwise extended recruitment maneuver may cause an improvement in aerated lung volume and decrease the biological impact seen with the traditionally used sustained inflation, with less adverse effects. Prone positioning can reduce mortality in severe ARDS patients and may be an useful adjunct to recruitment maneuvers and advanced ventilatory strategies, such noisy ventilation and BIVENT, which have been useful in providing lung recruitment.

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“…27 Takođe, u eksperimentalnom, endotoksinom indukovanom ARDS-u, stepeničasti RM, u poređenju sa kontinuiranim pozitivnim pritiskom, dovodi do manjeg stepena oštećenja pneumocita tipa II (alveolarne ćelije koje produkuju plućni surfaktant) i smanjene ekspresije markera koji su udruženi sa nastankom fibroze i oštećenjem endotelnih ćelija u ARDS-u. 28 Posebna prednost stepeničastog (staircase) RM predstavlja mogućnost određivanja optimalne, individualizovane vrednosti PEEP-a za svakog bolesnika.…”

Section: Metode Izvođenja Rekrutment Manevaraunclassified

Recruitment maneuver in intraoperative mechanical ventilation: Possibility to prevent atelectasis open lung concept

Vasković¹,

Stamenković²,

Stojić³

et al. 2016

Serb J Anest Inten Therapy

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Recruitment Maneuvers Modulate Epithelial and Endothelial Cell Response According to Acute Lung Injury Etiology*

Cited by 57 publications

References 27 publications

The biological effects of higher and lower positive end-expiratory pressure in pulmonary and extrapulmonary acute lung injury with intra-abdominal hypertension

The biological effects of higher and lower positive end-expiratory pressure in pulmonary and extrapulmonary acute lung injury with intra-abdominal hypertension

Pulmonar recruitment in acute respiratory distress syndrome. What is the best strategy?

Recruitment maneuver in intraoperative mechanical ventilation: Possibility to prevent atelectasis open lung concept

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