Ventilator-Induced Lug Injury and Acute Respiratory Distress Syndrome: A Basic Science Review

Ronchi, Carlos Fernando

doi:10.4172/2161-105x.s12-001

Cited by 2 publications

(1 citation statement)

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“…[ 8 ] Furthermore, several recent studies have documented that failure to recognize ARDS and implement timely lung protective strategies remains a widespread problem in intensive care units. [ 9 , 10 ] Studies detailing the temporal evolution of ventilator-induced acute lung injury are still lacking in the current literature, and limited clinical studies are conflicting regarding the importance of early institution of low-tidal volume ventilation (LTV) in determining clinical outcomes. [ 11 , 12 ]…”

Section: Introductionmentioning

confidence: 99%

Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model

et al. 2017

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BackgroundPositive-pressure mechanical ventilation is an essential therapeutic intervention, yet it causes the clinical syndrome known as ventilator-induced lung injury. Various lung protective mechanical ventilation strategies have attempted to reduce or prevent ventilator-induced lung injury but few modalities have proven effective. A model that isolates the contribution of mechanical ventilation on the development of acute lung injury is needed to better understand biologic mechanisms that lead to ventilator-induced lung injury.ObjectivesTo evaluate the effects of positive end-expiratory pressure and recruitment maneuvers in reducing lung injury in a ventilator-induced lung injury murine model in short- and longer-term ventilation.Methods5–12 week-old female BALB/c mice (n = 85) were anesthetized, placed on mechanical ventilation for either 2 hrs or 4 hrs with either low tidal volume (8 ml/kg) or high tidal volume (15 ml/kg) with or without positive end-expiratory pressure and recruitment maneuvers.ResultsAlteration of the alveolar-capillary barrier was noted at 2 hrs of high tidal volume ventilation. Standardized histology scores, influx of bronchoalveolar lavage albumin, proinflammatory cytokines, and absolute neutrophils were significantly higher in the high-tidal volume ventilation group at 4 hours of ventilation. Application of positive end-expiratory pressure resulted in significantly decreased standardized histology scores and bronchoalveolar absolute neutrophil counts at low- and high-tidal volume ventilation, respectively. Recruitment maneuvers were essential to maintain pulmonary compliance at both 2 and 4 hrs of ventilation.ConclusionsSigns of ventilator-induced lung injury are evident soon after high tidal volume ventilation (as early as 2 hours) and lung injury worsens with longer-term ventilation (4 hrs). Application of positive end-expiratory pressure and recruitment maneuvers are protective against worsening VILI across all time points. Dynamic compliance can be used guide the frequency of recruitment maneuvers to help ameloriate ventilator-induced lung injury.

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