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Critical Care
Published in: Critical Care 3/2014

Open Access 01-06-2014 | Research

The biological effects of higher and lower positive end-expiratory pressure in pulmonary and extrapulmonary acute lung injury with intra-abdominal hypertension

Authors: Cíntia Lourenco Santos, Lillian Moraes, Raquel Souza Santos, Cynthia dos Santos Samary, Johnatas Dutra Silva, Marcelo Marcos Morales, Vera Lucia Capelozzi, Marcelo Gama de Abreu, Alberto Schanaider, Pedro Leme Silva, CristianeSousaNascimento Baez Garcia, Paolo Pelosi, PatriciaRieken Macedo Rocco

Published in: Critical Care | Issue 3/2014

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Abstract

Introduction

Mechanical ventilation with high positive end-expiratory pressure (PEEP) has been used in patients with acute respiratory distress syndrome (ARDS) and intra-abdominal hypertension (IAH), but the role of PEEP in minimizing lung injury remains controversial. We hypothesized that in the presence of acute lung injury (ALI) with IAH: 1) higher PEEP levels improve pulmonary morphofunction and minimize lung injury; and 2) the biological effects of higher PEEP are more effective in extrapulmonary (exp) than pulmonary (p) ALI.

Methods

In 48 adult male Wistar rats, ALIp and ALIexp were induced by Escherichia coli lipopolysaccharide intratracheally and intraperitoneally, respectively. After 24 hours, animals were anesthetized and mechanically ventilated (tidal volume of 6 mL/kg). IAH (15 mmHg) was induced and rats randomly assigned to PEEP of 5 (PEEP5), 7 (PEEP7) or 10 (PEEP10) cmH2O for 1 hour.

Results

In both ALIp and ALIexp, higher PEEP levels improved oxygenation. PEEP10 increased alveolar hyperinflation and epithelial cell damage compared to PEEP5, independent of ALI etiology. In ALIp, PEEP7 and PEEP10 increased lung elastance compared to PEEP5 (4.3 ± 0.7 and 4.3 ± 0.9 versus 3.1 ± 0.3 cmH2O/mL, respectively, P <0.01), without changes in alveolar collapse, interleukin-6, caspase-3, type III procollagen, receptor for advanced glycation end-products, and vascular cell adhesion molecule-1 expressions. Moreover, PEEP10 increased diaphragmatic injury compared to PEEP5. In ALIexp, PEEP7 decreased lung elastance and alveolar collapse compared to PEEP5 (2.3 ± 0.5 versus 3.6 ± 0.7 cmH2O/mL, P <0.02, and 27.2 (24.7 to 36.8) versus 44.2 (39.7 to 56.9)%, P <0.05, respectively), while PEEP7 and PEEP10 increased interleukin-6 and type III procollagen expressions, as well as type II epithelial cell damage compared to PEEP5.

Conclusions

In the current models of ALI with IAH, in contrast to our primary hypothesis, higher PEEP is more effective in ALIp than ALIexp as demonstrated by the activation of biological markers. Therefore, higher PEEP should be used cautiously in the presence of IAH and ALI, mainly in ALIexp.
Appendix
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Metadata
Title
The biological effects of higher and lower positive end-expiratory pressure in pulmonary and extrapulmonary acute lung injury with intra-abdominal hypertension
Authors
Cíntia Lourenco Santos
Lillian Moraes
Raquel Souza Santos
Cynthia dos Santos Samary
Johnatas Dutra Silva
Marcelo Marcos Morales
Vera Lucia Capelozzi
Marcelo Gama de Abreu
Alberto Schanaider
Pedro Leme Silva
CristianeSousaNascimento Baez Garcia
Paolo Pelosi
PatriciaRieken Macedo Rocco
Publication date
01-06-2014
Publisher
BioMed Central
Published in
Critical Care / Issue 3/2014
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc13920

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