Ectasis and pallor of peripheral airways during mechanical ventilation.

STUDY

OBJECTIVE

To evaluate morphologic changes in peripheral airways associated with positive-pressure ventilation (PPV).

DESIGN

Single-blind study.

SETTING

Intensive care unit of a university hospital.

PATIENTS: Ten patients who required mechanical ventilation due to acute respiratory failure but had no history of prior pulmonary disease.

INTERVENTIONS: Seventeen fiberoptic bronchoscopy procedures were performed using a fine fiberoptic bronchoscope of 1.8 mm outside diameter.

MEASUREMENTS AND MAIN

RESULTS

The main morphologic findings were pallor and ectasis. Increased secretions, pigmentation, and stenosis or collapse in peripheral airways also were observed. Patients with ectasis were more likely to have had prolonged mechanical ventilation (17 +/- 9 days) as compared with those patients without ectasis (9 +/- 5 days).

CONCLUSION

The structural alterations in peripheral airways noted in patients on prolonged PPV suggest that barotrauma may be more widespread than previously recognized.