Low tidal volume and high positive end-expiratory pressure mechanical ventilation results in increased inflammation and ventilator-associated lung injury in normal lungs

Caron M. Hong, Da Zhong Xu, Qi Lu, Yunhui Cheng, Vadim Pisarenko, Danielle Doucet, Margaret Brown, Seena Aisner, Chunxiang Zhang, Edwin A. Deitch, Ellise S. Delphin

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Protective mechanical ventilation with low tidal volume (VT) and low plateau pressure reduces mortality and decreases the length of mechanical ventilation in patients with acute respiratory distress syndrome. Mechanical ventilation that will protect normal lungs during major surgical procedures of long duration may improve postoperative outcomes. We performed an animal study comparing 3 ventilation strategies used in the operating room in normal lungs. We compared the effects on pulmonary mechanics, inflammatory mediators, and lung tissue injury. METHODS: Female pigs were randomized into 3 groups. Group H-VT/3 (n = 6) was ventilated with a VT of 15 mL/kg predicted body weight (PBW)/positive end-expiratory pressure (PEEP) of 3 cm H2O, group L-VT/3 (n = 6) with a VT of 6 mL/kg PBW/PEEP of 3 cm H2O, and group L-VT/10 (n = 6) with a VT of 6 mL/kg PBW/PEEP of 10 cm H2O, for 8 hours. Hemodynamics, airway mechanics, arterial blood gases, and inflammatory markers were monitored. Bronchoalveolar lavage (BAL) was analyzed for inflammatory markers and protein concentration. The right lower lobe was assayed for mRNA of specific cytokines. The right lower lobe and right upper lobe were evaluated histologically. RESULTS: In contrast to groups H-VT/3 and L-VT/3, group L-VT/10 exhibited a 6-fold increase in inflammatory mediators in BAL (P < 0.001). Cytokines in BAL were similar in groups H-VT/3 and L-VT/3. Group H-VT/3 had a significantly lower lung injury score than groups L-VT/3 and L-VT/10. CONCLUSION: Comparing intraoperative strategies, ventilation with high PEEP resulted in increased production of inflammatory markers. Low PEEP resulted in lower levels of inflammatory markers. High VT/low PEEP resulted in less histologic lung injury.

Original languageEnglish (US)
Pages (from-to)1652-1660
Number of pages9
JournalAnesthesia and Analgesia
Volume110
Issue number6
DOIs
StatePublished - Jun 2010
Externally publishedYes

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Positive-Pressure Respiration
Tidal Volume
Lung Injury
Mechanical Ventilators
Artificial Respiration
Inflammation
Lung
Bronchoalveolar Lavage
Body Weight
Mechanics
Ventilation
Cytokines
Adult Respiratory Distress Syndrome
Operating Rooms
Swine
Gases
Hemodynamics
Pressure
Messenger RNA
Mortality

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Low tidal volume and high positive end-expiratory pressure mechanical ventilation results in increased inflammation and ventilator-associated lung injury in normal lungs. / Hong, Caron M.; Xu, Da Zhong; Lu, Qi; Cheng, Yunhui; Pisarenko, Vadim; Doucet, Danielle; Brown, Margaret; Aisner, Seena; Zhang, Chunxiang; Deitch, Edwin A.; Delphin, Ellise S.

In: Anesthesia and Analgesia, Vol. 110, No. 6, 06.2010, p. 1652-1660.

Research output: Contribution to journalArticle

Hong, Caron M. ; Xu, Da Zhong ; Lu, Qi ; Cheng, Yunhui ; Pisarenko, Vadim ; Doucet, Danielle ; Brown, Margaret ; Aisner, Seena ; Zhang, Chunxiang ; Deitch, Edwin A. ; Delphin, Ellise S. / Low tidal volume and high positive end-expiratory pressure mechanical ventilation results in increased inflammation and ventilator-associated lung injury in normal lungs. In: Anesthesia and Analgesia. 2010 ; Vol. 110, No. 6. pp. 1652-1660.
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T1 - Low tidal volume and high positive end-expiratory pressure mechanical ventilation results in increased inflammation and ventilator-associated lung injury in normal lungs

AU - Hong, Caron M.

AU - Xu, Da Zhong

AU - Lu, Qi

AU - Cheng, Yunhui

AU - Pisarenko, Vadim

AU - Doucet, Danielle

AU - Brown, Margaret

AU - Aisner, Seena

AU - Zhang, Chunxiang

AU - Deitch, Edwin A.

AU - Delphin, Ellise S.

PY - 2010/6

Y1 - 2010/6

N2 - BACKGROUND: Protective mechanical ventilation with low tidal volume (VT) and low plateau pressure reduces mortality and decreases the length of mechanical ventilation in patients with acute respiratory distress syndrome. Mechanical ventilation that will protect normal lungs during major surgical procedures of long duration may improve postoperative outcomes. We performed an animal study comparing 3 ventilation strategies used in the operating room in normal lungs. We compared the effects on pulmonary mechanics, inflammatory mediators, and lung tissue injury. METHODS: Female pigs were randomized into 3 groups. Group H-VT/3 (n = 6) was ventilated with a VT of 15 mL/kg predicted body weight (PBW)/positive end-expiratory pressure (PEEP) of 3 cm H2O, group L-VT/3 (n = 6) with a VT of 6 mL/kg PBW/PEEP of 3 cm H2O, and group L-VT/10 (n = 6) with a VT of 6 mL/kg PBW/PEEP of 10 cm H2O, for 8 hours. Hemodynamics, airway mechanics, arterial blood gases, and inflammatory markers were monitored. Bronchoalveolar lavage (BAL) was analyzed for inflammatory markers and protein concentration. The right lower lobe was assayed for mRNA of specific cytokines. The right lower lobe and right upper lobe were evaluated histologically. RESULTS: In contrast to groups H-VT/3 and L-VT/3, group L-VT/10 exhibited a 6-fold increase in inflammatory mediators in BAL (P < 0.001). Cytokines in BAL were similar in groups H-VT/3 and L-VT/3. Group H-VT/3 had a significantly lower lung injury score than groups L-VT/3 and L-VT/10. CONCLUSION: Comparing intraoperative strategies, ventilation with high PEEP resulted in increased production of inflammatory markers. Low PEEP resulted in lower levels of inflammatory markers. High VT/low PEEP resulted in less histologic lung injury.

AB - BACKGROUND: Protective mechanical ventilation with low tidal volume (VT) and low plateau pressure reduces mortality and decreases the length of mechanical ventilation in patients with acute respiratory distress syndrome. Mechanical ventilation that will protect normal lungs during major surgical procedures of long duration may improve postoperative outcomes. We performed an animal study comparing 3 ventilation strategies used in the operating room in normal lungs. We compared the effects on pulmonary mechanics, inflammatory mediators, and lung tissue injury. METHODS: Female pigs were randomized into 3 groups. Group H-VT/3 (n = 6) was ventilated with a VT of 15 mL/kg predicted body weight (PBW)/positive end-expiratory pressure (PEEP) of 3 cm H2O, group L-VT/3 (n = 6) with a VT of 6 mL/kg PBW/PEEP of 3 cm H2O, and group L-VT/10 (n = 6) with a VT of 6 mL/kg PBW/PEEP of 10 cm H2O, for 8 hours. Hemodynamics, airway mechanics, arterial blood gases, and inflammatory markers were monitored. Bronchoalveolar lavage (BAL) was analyzed for inflammatory markers and protein concentration. The right lower lobe was assayed for mRNA of specific cytokines. The right lower lobe and right upper lobe were evaluated histologically. RESULTS: In contrast to groups H-VT/3 and L-VT/3, group L-VT/10 exhibited a 6-fold increase in inflammatory mediators in BAL (P < 0.001). Cytokines in BAL were similar in groups H-VT/3 and L-VT/3. Group H-VT/3 had a significantly lower lung injury score than groups L-VT/3 and L-VT/10. CONCLUSION: Comparing intraoperative strategies, ventilation with high PEEP resulted in increased production of inflammatory markers. Low PEEP resulted in lower levels of inflammatory markers. High VT/low PEEP resulted in less histologic lung injury.

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