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Critical Care
Published in: Critical Care 2/2014

Open Access 01-04-2014 | Research

Open lung approach with low tidal volume mechanical ventilation attenuates lung injury in rats with massive brain damage

Authors: Joerg Krebs, Charalambos Tsagogiorgas, Paolo Pelosi, Patricia RM Rocco, Maximilia Hottenrott, Carsten Sticht, Benito Yard, Thomas Luecke

Published in: Critical Care | Issue 2/2014

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Abstract

Introduction

The ideal ventilation strategy for patients with massive brain damage requires better elucidation. We hypothesized that in the presence of massive brain injury, a ventilation strategy using low (6 milliliters per kilogram ideal body weight) tidal volume (VT) ventilation with open lung positive end-expiratory pressure (LVT/OLPEEP) set according to the minimal static elastance of the respiratory system, attenuates the impact of massive brain damage on gas-exchange, respiratory mechanics, lung histology and whole genome alterations compared with high (12 milliliters per kilogram ideal body weight) VT and low positive end-expiratory pressure ventilation (HVT/LPEEP).

Methods

In total, 28 adult male Wistar rats were randomly assigned to one of four groups: 1) no brain damage (NBD) with LVT/OLPEEP; 2) NBD with HVT/LPEEP; 3) brain damage (BD) with LVT/OLPEEP; and 4) BD with HVT/LPEEP. All animals were mechanically ventilated for six hours. Brain damage was induced by an inflated balloon catheter into the epidural space. Hemodynamics was recorded and blood gas analysis was performed hourly. At the end of the experiment, respiratory system mechanics and lung histology were analyzed. Genome wide gene expression profiling and subsequent confirmatory quantitative polymerase chain reaction (qPCR) for selected genes were performed.

Results

In NBD, both LVT/OLPEEP and HVT/LPEEP did not affect arterial blood gases, as well as whole genome expression changes and real-time qPCR. In BD, LVT/OLPEEP, compared to HVT/LPEEP, improved oxygenation, reduced lung damage according to histology, genome analysis and real-time qPCR with decreased interleukin 6 (IL-6), cytokine-induced neutrophil chemoattractant 1 (CINC)-1 and angiopoietin-4 expressions. LVT/OLPEEP compared to HVT/LPEEP improved overall survival.

Conclusions

In BD, LVT/OLPEEP minimizes lung morpho-functional changes and inflammation compared to HVT/LPEEP.
Appendix
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Metadata
Title
Open lung approach with low tidal volume mechanical ventilation attenuates lung injury in rats with massive brain damage
Authors
Joerg Krebs
Charalambos Tsagogiorgas
Paolo Pelosi
Patricia RM Rocco
Maximilia Hottenrott
Carsten Sticht
Benito Yard
Thomas Luecke
Publication date
01-04-2014
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2014
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc13813

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