Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 5/2011

Open Access 01-10-2011 | Research

Effect of spontaneous breathing on ventilator-induced lung injury in mechanically ventilated healthy rabbits: a randomized, controlled, experimental study

Authors: Jingen Xia, Bing Sun, Hangyong He, Heng Zhang, Chunting Wang, Qingyuan Zhan

Published in: Critical Care | Issue 5/2011

Login to get access

Abstract

Introduction

Ventilator-induced lung injury (VILI), one of the most serious complications of mechanical ventilation (MV), can impact patients' clinical prognoses. Compared to control ventilation, preserving spontaneous breathing can improve many physiological features in ventilated patients, such as gas distribution, cardiac performance, and ventilation-perfusion matching. However, the effect of spontaneous breathing on VILI is unknown. The goal of this study was to compare the effects of spontaneous breathing and control ventilation on lung injury in mechanically-ventilated healthy rabbits.

Methods

Sixteen healthy New Zealand white rabbits were randomly placed into a spontaneous breathing group (SB Group) and a control ventilation group (CV Group). Both groups were ventilated for eight hours using biphasic positive airway pressure (BIPAP) with similar ventilator parameters: inspiration pressure (PI) resulting in a tidal volume (VT) of 10 to 15 ml/kg, inspiratory-to-expiratory ratio of 1:1, positive end-expiration pressure (PEEP) of 2 cmH2O, and FiO2 of 0.5. Inflammatory markers in blood serum, lung homogenates and bronchoalveolar lavage fluid (BALF), total protein levels in BALF, mRNA expressions of selected cytokines in lung tissue, and lung injury histopathology scores were determined.

Results

Animals remained hemodynamically stable throughout the entire experiment. After eight hours of MV, compared to the CV Group, the SB Group had lower PaCO2 values and ratios of dead space to tidal volume, and higher lung compliance. The levels of cytokines in blood serum and BALF in both groups were similar, but spontaneous breathing led to significantly lower cytokine mRNA expressions in lung tissues and lower lung injury histological scores.

Conclusions

Preserving spontaneous breathing can not only improve ventilatory function, but can also attenuate selected markers of VILI in the mechanically-ventilated healthy lung.
Appendix
Available only for authorised users
Literature
1.
2.
Dreyfuss D, Saumon G: Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med 1998, 157: 294-323.CrossRefPubMed
3.
Chiumello D, Pristine G, Slutsky AS: Mechanical ventilation affects local and systemic cytokines in an animal model of acute respiratory distress syndrome. Am J Respir Crit Care Med 1999, 160: 109-116.CrossRefPubMed
4.
Ranieri VM, Suter PM, Tortorella C, De Tullio R, Dayer JM, Brienza A, Bruno F, Slutsky AS: Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA 1999, 282: 54-61. 10.1001/jama.282.1.54CrossRefPubMed
5.
Ranieri VM, Giunta F, Suter PM, Slutsky AS: Mechanical ventilation as a mediator of multisystem organ failure in acute respiratory distress syndrome. JAMA 2000, 284: 43-44. 10.1001/jama.284.1.43CrossRefPubMed
6.
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: Injurious mechanical ventilation and end-organ epithelial cell apoptosis and organ dysfunction in an experimental model of acute respiratory distress syndrome. JAMA 2003, 289: 2104-2112. 10.1001/jama.289.16.2104CrossRefPubMed
7.
Frank JA, Parsons PE, Matthay MA: Pathogenetic significance of biological markers of ventilator-associated lung injury in experimental and clinical studies. Chest 2006, 130: 1906-1914. 10.1378/chest.130.6.1906PubMedCentralCrossRefPubMed
8.
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: Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998, 338: 347-354. 10.1056/NEJM199802053380602CrossRefPubMed
9.
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network N Engl J Med 2000, 342: 1301-1308.
10.
Villar J, Kacmarek RM, Perez-Mendez L, Aguirre-Jaime A: A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized, controlled trial. Crit Care Med 2006, 34: 1311-1318. 10.1097/01.CCM.0000215598.84885.01CrossRefPubMed
11.
Froese AB, Bryan AC: Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 1974, 41: 242-255. 10.1097/00000542-197409000-00006CrossRefPubMed
12.
Wrigge H, Zinserling J, Neumann P, Defosse J, Magnusson A, Putensen C, Hedenstierna G: Spontaneous breathing improves lung aeration in oleic acid-induced lung injury. Anesthesiology 2003, 99: 376-384. 10.1097/00000542-200308000-00019CrossRefPubMed
13.
Wrigge H, Zinserling J, Neumann P, Muders T, Magnusson A, Putensen C, Hedenstierna G: Spontaneous breathing with airway pressure release ventilation favors ventilation in dependent lung regions and counters cyclic alveolar collapse in oleic-acid-induced lung injury: a randomized controlled computed tomography trial. Crit Care 2005, 9: R780-R789. 10.1186/cc3908PubMedCentralCrossRefPubMed
14.
Neumann P, Wrigge H, Zinserling J, Hinz J, Maripuu E, Andersson LG, Putensen C, Hedenstierna G: Spontaneous breathing affects the spatial ventilation and perfusion distribution during mechanical ventilatory support. Crit Care Med 2005, 33: 1090-1095. 10.1097/01.CCM.0000163226.34868.0ACrossRefPubMed
15.
Putensen C, Mutz NJ, Putensen-Himmer G, Zinserling J: Spontaneous breathing during ventilatory support improves ventilation-perfusion distributions in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 1999, 159: 1241-1248.CrossRefPubMed
16.
Kaplan LJ, Bailey H, Formosa V: Airway pressure release ventilation increases cardiac performance in patients with acute lung injury/adult respiratory distress syndrome. Crit Care 2001, 5: 221-226. 10.1186/cc1027PubMedCentralCrossRefPubMed
17.
Tokics L, Hedenstierna G, Svensson L, Brismar B, Cederlund T, Lundquist H, Strandberg A: V/Q distribution and correlation to atelectasis in anesthetized paralyzed humans. J Appl Physiol 1996, 81: 1822-1833.PubMed
18.
Gayan-Ramirez G, Testelmans D, Maes K, Racz GZ, Cadot P, Zador E, Wuytack F, Decramer M: Intermittent spontaneous breathing protects the rat diaphragm from mechanical ventilation effects. Crit Care Med 2005, 33: 2804-2809. 10.1097/01.CCM.0000191250.32988.A3CrossRefPubMed
19.
Levine S, Nguyen T, Taylor N, Friscia ME, Budak MT, Rothenberg P, Zhu J, Sachdeva R, Sonnad S, Kaiser LR, Rubinstein NA, Powers SK, Shrager JB: Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med 2008, 358: 1327-1335. 10.1056/NEJMoa070447CrossRefPubMed
20.
Hedenstierna G, Tokics L, Lundquist H, Andersson T, Strandberg A, Brismar B: Phrenic nerve stimulation during halothane anesthesia. Effects of atelectasis. Anesthesiology 1994, 80: 751-760. 10.1097/00000542-199404000-00006CrossRefPubMed
21.
Sarge T, Talmor D: Targeting transpulmonary pressure to prevent ventilator induced lung injury. Minerva Anestesiol 2009, 75: 293-299.PubMed
22.
Lopez-Aguilar J, Piacentini E, Villagra A, Murias G, Pascotto S, Saenz-Valiente A, Fernandez-Segoviano P, Hotchkiss JR, Blanch L: Contributions of vascular flow and pulmonary capillary pressure to ventilator-induced lung injury. Crit Care Med 2006, 34: 1106-1112. 10.1097/01.CCM.0000205757.66971.DACrossRefPubMed
23.
Vaporidi K, Voloudakis G, Priniannakis G, Kondili E, Koutsopoulos A, Tsatsanis C, Georgopoulos D: Effects of respiratory rate on ventilator-induced lung injury at a constant PaCO2 in a mouse model of normal lung. Crit Care Med 2008, 36: 1277-1283. 10.1097/CCM.0b013e318169f30eCrossRefPubMed
24.
Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L: Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 2006, 32: 1515-1522. 10.1007/s00134-006-0301-8CrossRefPubMed
25.
Spieth PM, Carvalho AR, Guldner A, Kasper M, Schubert R, Carvalho NC, Beda A, Dassow C, Uhlig S, Koch T, Pelosi P, Gama De Abreu M: Pressure support improves oxygenation and lung protection compared to pressure-controlled ventilation and is further improved by random variation of pressure support. Crit Care Med 2011, 39: 746-755. 10.1097/CCM.0b013e318206bda6CrossRefPubMed
26.
Saddy F, Oliveira GP, Garcia CS, Nardelli LM, Rzezinski AF, Ornellas DS, Morales MM, Capelozzi VL, Pelosi P, Rocco PR: Assisted ventilation modes reduce the expression of lung inflammatory and fibrogenic mediators in a model of mild acute lung injury. Intensive Care Med 2010, 36: 1417-1426. 10.1007/s00134-010-1808-6CrossRefPubMed
27.
Brander L, Sinderby C, Lecomte F, Leong-Poi H, Bell D, Beck J, Tsoporis JN, Vaschetto R, Schultz MJ, Parker TG, Villar J, Zhang H, Slutsky AS: Neurally adjusted ventilatory assist decreases ventilator-induced lung injury and non-pulmonary organ dysfunction in rabbits with acute lung injury. Intensive Care Med 2009, 35: 1979-1989. 10.1007/s00134-009-1626-xCrossRefPubMed
28.
Walsh BK, Crotwell DN, Restrepo RD: Capnography/Capnometry during mechanical ventilation: 2011. Respir Care 2011, 56: 503-509. 10.4187/respcare.01175CrossRefPubMed
29.
Frawley PM, Habashi NM: Airway pressure release ventilation: theory and practice. AACN Clin Issues 2001, 12: 234-246. 10.1097/00044067-200105000-00007CrossRefPubMed
30.
Hardman JG, Aitkenhead AR: Estimating alveolar dead space from the arterial to end-tidal CO(2) gradient: a modeling analysis. Anesth Analg 2003, 97: 1846-1851. 10.1213/01.ANE.0000090316.46604.89CrossRefPubMed
31.
32.
Livak KJ, Schmittgen TD: Analysis of relative gene expression data using real-time quantitative PCR and the 2(-Delta Delta C(T)) Method. Methods 2001, 25: 402-408. 10.1006/meth.2001.1262CrossRefPubMed
33.
Hong CM, Xu DZ, Lu Q, Cheng Y, Pisarenko V, Doucet D, Brown M, Aisner S, Zhang C, Deitch EA, Delphin E: Low tidal volume and high positive end-expiratory pressure mechanical ventilation results in increased inflammation and ventilator-associated lung injury in normal lungs. Anesth Analg 2010, 110: 1652-1660. 10.1213/ANE.0b013e3181cfc416CrossRefPubMed
34.
Wolthuis EK, Vlaar AP, Choi G, Roelofs JJ, Juffermans NP, Schultz MJ: Mechanical ventilation using non-injurious ventilation settings causes lung injury in the absence of pre-existing lung injury in healthy mice. Crit Care 2009, 13: R1. 10.1186/cc7688PubMedCentralCrossRefPubMed
35.
Broccard AF, Hotchkiss JR, Suzuki S, Olson D, Marini JJ: Effects of mean airway pressure and tidal excursion on lung injury induced by mechanical ventilation in an isolated perfused rabbit lung model. Crit Care Med 1999, 27: 1533-1541. 10.1097/00003246-199908000-00022CrossRefPubMed
36.
Moriondo A, Pelosi P, Passi A, Viola M, Marcozzi C, Severgnini P, Ottani V, Quaranta M, Negrini D: Proteoglycan fragmentation and respiratory mechanics in mechanically ventilated healthy rats. J Appl Physiol 2007, 103: 747-756. 10.1152/japplphysiol.00056.2007CrossRefPubMed
37.
Chu EK, Whitehead T, Slutsky AS: Effects of cyclic opening and closing at low- and high-volume ventilation on bronchoalveolar lavage cytokines. Crit Care Med 2004, 32: 168-174. 10.1097/01.CCM.0000104203.20830.AECrossRefPubMed
38.
Sinclair SE, Chi E, Lin HI, Altemeier WA: Positive end-expiratory pressure alters the severity and spatial heterogeneity of ventilator-induced lung injury: an argument for cyclical airway collapse. J Crit Care 2009, 24: 206-211. 10.1016/j.jcrc.2008.04.005PubMedCentralCrossRefPubMed
39.
De Smet HR, Bersten AD, Barr HA, Doyle IR: Hypercapnic acidosis modulates inflammation, lung mechanics, and edema in the isolated perfused lung. J Crit Care 2007, 22: 305-313. 10.1016/j.jcrc.2006.12.002CrossRefPubMed
40.
Broccard AF, Hotchkiss JR, Vannay C, Markert M, Sauty A, Feihl F, Schaller MD: Protective effects of hypercapnic acidosis on ventilator-induced lung injury. Am J Respir Crit Care Med 2001, 164: 802-806.CrossRefPubMed
41.
Peltekova V, Engelberts D, Otulakowski G, Uematsu S, Post M, Kavanagh BP: Hypercapnic acidosis in ventilator-induced lung injury. Intensive Care Med 2010, 36: 869-878. 10.1007/s00134-010-1787-7CrossRefPubMed
Metadata
Title
Effect of spontaneous breathing on ventilator-induced lung injury in mechanically ventilated healthy rabbits: a randomized, controlled, experimental study
Authors
Jingen Xia
Bing Sun
Hangyong He
Heng Zhang
Chunting Wang
Qingyuan Zhan
Publication date
01-10-2011
Publisher
BioMed Central
Published in
Critical Care / Issue 5/2011
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc10502

Other articles of this Issue 5/2011

Critical Care 5/2011 Go to the issue

Research

Population pharmacodynamic model of bicarbonate response to acetazolamide in mechanically ventilated chronic obstructive pulmonary disease patients

Commentary

A dynamic view of mHLA-DR expression in management of severe septic patients

Commentary

Haemodynamic optimisation: are we dynamic enough?

Research

Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and administration of buffer therapy. a prospective, multiple-center study

Research

Presence of tobramycin in blood and urine during selective decontamination of the digestive tract in critically ill patients, a prospective cohort study

Viewpoint

The tracheal tube: gateway to ventilator-associated pneumonia