Top

Published in:

01-06-2009 | Experimental

Effects of frequency and inspiratory plateau pressure during recruitment manoeuvres on lung and distal organs in acute lung injury

Authors: Paula W. Steimback, Gisele P. Oliveira, Andréia F. Rzezinski, Pedro L. Silva, Cristiane S. N. B. Garcia, Graziela Rangel, Marcelo M. Morales, José R. Lapa e Silva, Vera L. Capelozzi, Paolo Pelosi, Patricia R. M. Rocco

Published in: Intensive Care Medicine | Issue 6/2009

Abstract

Purpose

To evaluate the effects of frequency and inspiratory plateau pressure (Pplat) during recruitment manoeuvres (RMs) on lung and distal organs in acute lung injury (ALI).

Methods

We studied paraquat-induced ALI rats. At 24 h, rats were anesthetized and RMs were applied using continuous positive airway pressure (CPAP, 40 cmH₂O/40 s) or three-different sigh strategies: (a) 180 sighs/h and Pplat = 40 cmH₂O (S180/40), (b) 10 sighs/h and Pplat = 40 cmH₂O (S10/40), and (c) 10 sighs/h and Pplat = 20 cmH₂O (S10/20).

Results

S180/40 yielded alveolar hyperinflation and increased lung and kidney epithelial cell apoptosis as well as type III procollagen (PCIII) mRNA expression. S10/40 resulted in a reduction in epithelial cell apoptosis and PCIII expression. Static elastance and alveolar collapse were higher in S10/20 than S10/40.

Conclusions

The reduction in sigh frequency led to a protective effect on lung and distal organs, while the combination with reduced Pplat worsened lung mechanics and histology.

Available only for authorised users

Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, Takagaki TY, Carvalho CR (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338:347–354PubMedCrossRef

Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308

Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ, Davies AR, Hand LE, Zhou Q, Thabane L, Austin P, Lapinsky S, Baxter A, Russell J, Skrobik Y, Ronco JJ, Stewart TE, Lung Open Ventilation Study Investigators (2008) Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 299:637–645PubMedCrossRef

Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL, Lefrant JY, Prat G, Richecoeur J, Nieszkowska A, Gervais C, Baudot J, Bouadma L, Brochard L, Expiratory Pressure (Express) Study Group (2008) Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 299:646–655PubMedCrossRef

Pelosi P, Goldner M, McKibben A, Adams A, Eccher G, Caironi P, Losappio S, Gattinoni L, Marini JJ (2001) Recruitment and derecruitment during acute respiratory failure: an experimental study. Am J Respir Crit Care Med 164:122–130PubMed

Nieszkowska A, Lu Q, Vieira S, Elman M, Fetita C, Rouby JJ (2004) Incidence and regional distribution of lung overinflation during mechanical ventilation with positive end-expiratory pressure. Crit Care Med 32:1496–1503PubMedCrossRef

Imai Y, Parodo J, Kajikawa O, de Perrot M, Fischer S, Edwards V, Cutz E, Liu M, Keshavjee S, Martin TR, Marshall JC, Ranieri VM, Slutsky AS (2003) Injurious mechanical ventilation and end-organ epithelial cell apoptosis and organ dysfunction in an experimental model of acute respiratory distress syndrome. JAMA 289:2104–2112PubMedCrossRef

Piacentini E, Villagrá A, López-Aguilar J, Blanch L (2004) Clinical review: the implications of experimental and clinical studies of recruitment maneuvers in acute lung injury. Crit Care 8:115–121PubMedCrossRef

Grasso S, Mascia L, Del Turco M, Malacarne P, Giunta F, Brochard L, Slutsky AS, Ranieri VM (2002) Effects of recruiting maneuvers in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy. Anesthesiology 96:795–802PubMedCrossRef

10.

Musch G, Harris RS, Vidal Melo MF, O’Neill KR, Layfield JD, Winkler T, Venegas JG (2004) Mechanism by which a sustained inflation can worsen oxygenation in acute lung injury. Anesthesiology 100:323–330PubMedCrossRef

11.

Oczenski W, Hörmann C, Keller C, Lorenzl N, Kepka A, Schwarz S, Fitzgerald RD (2004) Recruitment maneuvers after a positive end expiratory pressure trial do not induce sustained effects in early adult respiratory distress syndrome. Anesthesiology 101:620–625PubMedCrossRef

12.

Farias LL, Faffe DS, Xisto DG, Santana MC, Lassance R, Prota LF, Amato MB, Morales MM, Zin WA, Rocco PR (2005) Positive end-expiratory pressure prevents lung mechanical stress caused by recruitment/derecruitment. J Appl Physiol 98:53–61PubMedCrossRef

13.

Riva DR, Oliveira MB, Rzezinski AF, Rangel G, Capelozzi VL, Zin WA, Morales MM, Pelosi P, Rocco PR (2008) Recruitment maneuver in pulmonary and extrapulmonary experimental acute lung injury. Crit Care Med 36:1900–1908PubMedCrossRef

14.

Pelosi P, Cadringher P, Bottino N, Panigada M, Carrieri F, Riva E, Lissoni A, Gattinoni L (1999) Sigh in acute respiratory distress syndrome. Am J Respir Crit Care Med 159:872–880PubMed

15.

Pelosi P, Bottino N, Chiumello D, Caironi P, Panigada M, Gamberoni C, Colombo G, Bigatello LM, Gattinoni L (2003) Sigh in supine and prone position during acute respiratory distress syndrome. Am J Respir Crit Care Med 167:521–527PubMedCrossRef

16.

Fujino Y, Goddon S, Dolhnikoff M, Hess D, Amato MB, Kacmarek RM (2001) Repetitive high-pressure recruitment maneuvers required to maximally recruit lung in a sheep model of acute respiratory distress syndrome. Crit Care Med 29:1579–1586PubMedCrossRef

17.

Allen GB, Suratt BT, Rinaldi L, Petty JM, Bates JH (2006) Choosing the frequency of deep inflation in mice: balancing recruitment against ventilator-induced lung injury. Am J Physiol Lung Cell Mol Physiol 91:710–717CrossRef

18.

Steimback PW, Silva PL, Oliveira GP, Rangel G, Capelozzi VL, Morales MM, Pelosi P, Rocco PR (2007) Sigh induced lung mechanical stress in acute lung injury. Am J Resp Crit Care A22

19.

Weibel ER (1990) Morphometry: stereological theory and practical methods. In: Gil J (ed) Models of lung disease—microscopy and structural methods. Marcel Dekker, New York, pp 199–247

20.

Menezes SL, Bozza PT, Neto HC, Laranjeira AP, Negri EM, Capelozzi VL, Zin WA, Rocco PR (2005) Pulmonary and extrapulmonary acute lung injury: inflammatory and ultrastructural analyses. J Appl Physiol 98:1777–1783PubMedCrossRef

21.

Baptista AL, Parra ER, Filho JV, Kairalla RA, de Carvalho CR, Capelozzi VL (2006) Structural features of epithelial remodeling in usual interstitial pneumonia histologic pattern. Lung 184:239–244PubMedCrossRef

22.

Rocco PR, Negri EM, Kurtz PM, Vasconcellos FP, Silva GH, Capelozzi VL, Romero PV, Zin WA (2001) Lung tissue mechanics and extracellular matrix remodeling in acute lung injury. Am J Respir Crit Care Med 164:1067–1071PubMed

23.

Fabisiak JP, Kagan VE, Tyurina YY, Tyurin VA, Lazo JS (1998) Paraquat-induced phosphatidylserine oxidation and apoptosis are independent of activation of PLA2. Am J Physiol 274:793–802

24.

Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, Russo S, Patroniti N, Cornejo R, Bugedo G (2006) Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 354:1775–1786PubMedCrossRef

25.

Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, Tallarini F, Cozzi P, Cressoni M, Colombo A, Marini JJ, Gattinoni L (2008) Lung stress and strain during mechanical ventilation of the acute respiratory distress syndrome. Am J Respir Crit Care Med 178:346–355PubMedCrossRef

26.

Gattinoni L, Carlesso E, Cadringher P, Valenza F, Vagginelli F, Chiumello D (2003) Physical and biological triggers of ventilator-induced lung injury and its prevention. Eur Respir J 47:15s–25sCrossRef

27.

Rothen HU, Sporre B, Engberg G, Wegenius G, Reber A, Hedenstierna G (1995) Prevention of atelectasis during general anaesthesia. Lancet 345:1387–1391PubMedCrossRef

28.

Kulkarni AC, Kuppusamy P, Parinandi N (2007) Oxygen, the lead actor in the pathophysiologic drama: enactment of the trinity of normoxia, hypoxia, and hyperoxia in disease and therapy. Antioxid Redox Signal 9:1717–1730PubMedCrossRef

29.

Dreyfuss D, Saumon G (1998) Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med 157:294–323PubMed

30.

Garcia CS, Rocco PR, Facchinetti LD, Lassance RM, Caruso P, Deheinzelin D, Morales MM, Romero PV, Faffe DS, Zin WA (2004) What increases type III procollagen mRNA levels in lung tissue: stress induced by changes in force or amplitude? Respir Physiol Neurobiol 144:59–70PubMedCrossRef

31.

de Carvalho ME, Dolhnikoff M, Meireles SI, Reis LF, Martins MA, Deheinzelin D (2007) Effects of overinflation on procollagen type III expression in experimental acute lung injury. Crit Care 11:R23PubMedCrossRef

32.

Berg JT, Fu Z, Breen EC, Tran HC, Mathieu-Costello O, West JB (1997) High lung inflation increases mRNA levels of ECM components and growth factors in lung parenchyma. J Appl Physiol 83:120–128PubMed

33.

Nakos G, Batistatou A, Galiatsou E, Konstanti E, Koulouras V, Kanavaros P, Doulis A, Kitsakos A, Karachaliou A, Lekka ME, Bai M (2006) Lung and ‘end organ’ injury due to mechanical ventilation in animals: comparison between the prone and supine positions. Crit Care 10:R38PubMedCrossRef

34.

Ranieri VM, Giunta F, Suter PM, Slutsky AS (2000) Mechanical ventilation as a mediator of multisystem organ failure in acute respiratory distress syndrome. JAMA 284:43–44PubMedCrossRef

35.

Koyner JL, Murray PT (2008) Mechanical ventilation and lung–kidney interactions. Clin J Am Soc Nephrol 3:562–570PubMedCrossRef

36.

Martin TR (2008) Interactions between mechanical and biological processes in acute lung injury. Proc Am Thorac Soc 5:291–296PubMedCrossRef

37.

Conrad SA, Zhang S, Arnold TC, Scott LK, Carden DL (2005) Protective effects of low respiratory frequency in experimental ventilator-associated lung injury. Crit Care Med 33:835–840PubMedCrossRef

38.

Garcia CS, Abreu SC, Soares RM, Prota LF, Figueira RC, Morales MM, Capelozzi VL, Zin WA, Rocco PR (2008) Pulmonary morphofunctional effects of mechanical ventilation with high inspiratory air flow. Crit Care Med 36:232–239PubMed

39.

Vaporidi K, Voloudakis G, Priniannakis G, Kondili E, Koutsopoulos A, Tsatsanis C, Georgopoulos D (2008) Effects of respiratory rate on ventilator-induced lung injury at a constant PaCO₂ in a mouse model of normal lung. Crit Care Med 36:1277–1283PubMedCrossRef

Title: Effects of frequency and inspiratory plateau pressure during recruitment manoeuvres on lung and distal organs in acute lung injury
Authors: Paula W. Steimback
Gisele P. Oliveira
Andréia F. Rzezinski
Pedro L. Silva
Cristiane S. N. B. Garcia
Graziela Rangel
Marcelo M. Morales
José R. Lapa e Silva
Vera L. Capelozzi
Paolo Pelosi
Patricia R. M. Rocco
Publication date: 01-06-2009
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 6/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-009-1439-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Effects of frequency and inspiratory plateau pressure during recruitment manoeuvres on lung and distal organs in acute lung injury

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2009

Case-mix-adjusted length of stay and mortality in 23 Finnish ICUs

Water content of delivered gases during non-invasive ventilation in healthy subjects

What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure?

Reply to Fontana et al.

Facial necrotizing fasciitis in an infant caused by a five toxin-secreting methicillin-susceptible Staphylococcus aureus

Determining small intestinal transit time and pathomorphology in critically ill patients using video capsule technology