Critical care medicine · 2011
Impact of pressure profile and duration of recruitment maneuvers on morphofunctional and biochemical variables in experimental lung injury.
Сравнительное исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Silva Pedro L, Moraes Lillian, Santos Raquel S, Samary Cynthia, Ornellas Debora S, Maron-Gutierrez Tatiana, Morales Marcelo M, Saddy Felipe, Capelozzi Vera L, Pelosi Paolo, Marini John J, Gama de Abreu Marcelo, Rocco Patricia R M
Аннотация
OBJECTIVE: To investigate the effects of the rate of airway pressure increase and duration of recruitment maneuvers on lung function and activation of inflammation, fibrogenesis, and apoptosis in experimental acute lung injury.
DESIGN: Prospective, randomized, controlled experimental study.
SETTING: University research laboratory.
SUBJECTS: Thirty-five Wistar rats submitted to acute lung injury induced by cecal ligation and puncture.
INTERVENTIONS: After 48 hrs, animals were randomly distributed into five groups (seven animals each): 1) nonrecruited (NR); 2) recruitment maneuvers (RMs) with continuous positive airway pressure (CPAP) for 15 secs (CPAP15); 3) RMs with CPAP for 30 secs (CPAP30); 4) RMs with stepwise increase in airway pressure (STEP) to targeted maximum within 15 secs (STEP15); and 5) RMs with STEP within 30 secs (STEP30). To perform STEP RMs, the ventilator was switched to a CPAP mode and positive end-expiratory pressure level was increased stepwise. At each step, airway pressure was held constant. RMs were targeted to 30 cm H2O. Animals were then ventilated for 1 hr with tidal volume of 6 mL/kg and positive end-expiratory pressure of 5 cm H2O.
MEASUREMENTS AND MAIN RESULTS: Blood gases, lung mechanics, histology (light and electronic microscopy), interleukin-6, caspase 3, and type 3 procollagen mRNA expressions in lung tissue. All RMs improved oxygenation and lung static elastance and reduced alveolar collapse compared to NR. STEP30 resulted in optimal performance, with: 1) improved lung static elastance vs. NR, CPAP15, and STEP15; 2) reduced alveolar-capillary membrane detachment and type 2 epithelial and endothelial cell injury scores vs. CPAP15 (p < .05); and 3) reduced gene expression of interleukin-6, type 3 procollagen, and caspase 3 in lung tissue vs. other RMs.
CONCLUSIONS: Longer-duration RMs with slower airway pressure increase efficiently improved lung function, while minimizing the biological impact on lungs.
DESIGN: Prospective, randomized, controlled experimental study.
SETTING: University research laboratory.
SUBJECTS: Thirty-five Wistar rats submitted to acute lung injury induced by cecal ligation and puncture.
INTERVENTIONS: After 48 hrs, animals were randomly distributed into five groups (seven animals each): 1) nonrecruited (NR); 2) recruitment maneuvers (RMs) with continuous positive airway pressure (CPAP) for 15 secs (CPAP15); 3) RMs with CPAP for 30 secs (CPAP30); 4) RMs with stepwise increase in airway pressure (STEP) to targeted maximum within 15 secs (STEP15); and 5) RMs with STEP within 30 secs (STEP30). To perform STEP RMs, the ventilator was switched to a CPAP mode and positive end-expiratory pressure level was increased stepwise. At each step, airway pressure was held constant. RMs were targeted to 30 cm H2O. Animals were then ventilated for 1 hr with tidal volume of 6 mL/kg and positive end-expiratory pressure of 5 cm H2O.
MEASUREMENTS AND MAIN RESULTS: Blood gases, lung mechanics, histology (light and electronic microscopy), interleukin-6, caspase 3, and type 3 procollagen mRNA expressions in lung tissue. All RMs improved oxygenation and lung static elastance and reduced alveolar collapse compared to NR. STEP30 resulted in optimal performance, with: 1) improved lung static elastance vs. NR, CPAP15, and STEP15; 2) reduced alveolar-capillary membrane detachment and type 2 epithelial and endothelial cell injury scores vs. CPAP15 (p < .05); and 3) reduced gene expression of interleukin-6, type 3 procollagen, and caspase 3 in lung tissue vs. other RMs.
CONCLUSIONS: Longer-duration RMs with slower airway pressure increase efficiently improved lung function, while minimizing the biological impact on lungs.
Предметные рубрики MeSH
Acute Lung InjuryAnimalsCaspase 3Continuous Positive Airway PressureDisease Models, AnimalInterleukin-6LungMaleMicroscopy, Electron, TransmissionProcollagenPulmonary AlveoliRandom AllocationRatsRats, WistarRespiratory MechanicsReverse Transcriptase Polymerase Chain ReactionSensitivity and SpecificitySepsisSurvival RateTime Factors