Top

Published in:

01-11-2009 | Experimental

Neurally adjusted ventilatory assist decreases ventilator-induced lung injury and non-pulmonary organ dysfunction in rabbits with acute lung injury

Authors: Lukas Brander, Christer Sinderby, François Lecomte, Howard Leong-Poi, David Bell, Jennifer Beck, James N. Tsoporis, Rosanna Vaschetto, Marcus J. Schultz, Thomas G. Parker, Jesús Villar, Haibo Zhang, Arthur S. Slutsky

Published in: Intensive Care Medicine | Issue 11/2009

Abstract

Objective

To determine if neurally adjusted ventilatory assist (NAVA) that delivers pressure in proportion to diaphragm electrical activity is as protective to acutely injured lungs (ALI) and non-pulmonary organs as volume controlled (VC), low tidal volume (Vt), high positive end-expiratory pressure (PEEP) ventilation.

Design

Prospective, randomized, laboratory animal study.

Subjects

Twenty-seven male New Zealand white rabbits.

Interventions

Anesthetized rabbits with hydrochloric acid-induced ALI were randomized (n = 9 per group) to 5.5 h NAVA (non-paralyzed), VC (paralyzed; Vt 6-ml/kg), or VC (paralyzed; Vt 15-ml/kg). PEEP was adjusted to hemodynamic goals in NAVA and VC6-ml/kg, and was 1 cmH₂O in VC15-ml/kg.

Measurements and main results

PaO₂/FiO₂; lung wet-to-dry ratio; lung histology; interleukin-8 (IL-8) concentrations in broncho-alveolar-lavage (BAL) fluid, plasma, and non-pulmonary organs; plasminogen activator inhibitor type-1 and tissue factor in BAL fluid and plasma; non-pulmonary organ apoptosis rate; creatinine clearance; echocardiography. PEEP was similar in NAVA and VC6-ml/kg. During NAVA, Vt was lower (3.1 ± 0.9 ml/kg), whereas PaO₂/FiO₂, respiratory rate, and PaCO₂ were higher compared to VC6-ml/kg (p < 0.05 for all). Variables assessing ventilator-induced lung injury (VILI), IL-8 levels, non-pulmonary organ apoptosis rate, and kidney as well as cardiac performance were similar in NAVA compared to VC6-ml/kg. VILI and non-pulmonary organ dysfunction was attenuated in both groups compared to VC15-ml/kg.

Conclusions

In anesthetized rabbits with early experimental ALI, NAVA is as effective as VC6-ml/kg in preventing VILI, in attenuating excessive systemic and remote organ inflammation, and in preserving cardiac and kidney function.

Available only for authorised users

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

Slutsky AS (1999) Lung injury caused by mechanical ventilation. Chest 116:9S–15SCrossRefPubMed

dos Santos CC, Slutsky AS (2006) The contribution of biophysical lung injury to the development of biotrauma. Annu Rev Physiol 68:585–618CrossRefPubMed

Tremblay L, Valenza F, Ribeiro SP, Li J, Slutsky AS (1997) Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model. J Clin Invest 99:944–952CrossRefPubMed

Ranieri VM, Suter PM, Tortorella C, De Tullio R, Dayer JM, Brienza A, Bruno F, Slutsky AS (1999) Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA 282:54–61CrossRefPubMed

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 289:2104–2112CrossRefPubMed

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

Slutsky AS, Tremblay LN (1998) Multiple system organ failure. Is mechanical ventilation a contributing factor? Am J Respir Crit Care Med 157:1721–1725PubMed

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 338:347–354CrossRefPubMed

10.

The Acute Respiratory Distress Syndrome Network (2000) 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 342:1301–1308CrossRef

11.

Sinderby C, Navalesi P, Beck J, Skrobik Y, Comtois N, Friberg S, Gottfried SB, Lindstrom L (1999) Neural control of mechanical ventilation in respiratory failure. Nat Med 5:1433–1436CrossRefPubMed

12.

Allo JC, Beck JC, Brander L, Brunet F, Slutsky AS, Sinderby CA (2006) Influence of neurally adjusted ventilatory assist and positive end-expiratory pressure on breathing pattern in rabbits with acute lung injury. Crit Care Med 34:2997–3004PubMed

13.

Brander L, Leong-Poi H, Beck J, Brunet F, Hutchison SJ, Slutsky AS, Sinderby C (2008) Titration and implementation of neurally adjusted ventilatory assist in critically Ill patients. Chest 135:695–703CrossRefPubMed

14.

Lecomte F, Brander L, Jalde F, Beck J, Qui H, Elie C, Slutsky AS, Brunet F, Sinderby C (2009) Physiological response to increasing levels of neurally adjusted ventilatory assist (NAVA). Respir Physiol Neurobiol 166(2):117–124

15.

Beck J, Campoccia F, Allo JC, Brander L, Brunet F, Slutsky AS, Sinderby C (2007) Improved synchrony and respiratory unloading by neurally adjusted ventilatory assist (NAVA) in lung-injured rabbits. Pediatr Res 61:289–294CrossRefPubMed

16.

Sinderby C, Beck J, Spahija J, de MM, Lacroix J, Navalesi P, Slutsky AS (2007) Inspiratory muscle unloading by neurally adjusted ventilatory assist during maximal inspiratory efforts in healthy subjects. Chest 131:711–717CrossRefPubMed

17.

Colombo D, Cammarota G, Bergamaschi V, De LM, Corte FD, Navalesi P (2008) Physiologic response to varying levels of pressure support and neurally adjusted ventilatory assist in patients with acute respiratory failure. Intensive Care Med 34:2010–2018CrossRefPubMed

18.

Spahija J, Beck J, de Marchie M, Comtois A, Sinderby C (2005) Closed-loop control of respiratory drive using pressure-support ventilation: target drive ventilation. Am J Respir Crit Care Med 171:1009–1014CrossRefPubMed

19.

Beck J, Tucci M, Emeriaud G, Lacroix J, Sinderby C (2004) Prolonged neural expiratory time induced by mechanical ventilation in infants. Pediatr Res 55:747–754CrossRefPubMed

20.

Sinderby C, Spahija J, Beck J (2001) Changes in respiratory effort sensation over time are linked to the frequency content of diaphragm electrical activity. Am J Respir Crit Care Med 163:905–910PubMed

21.

Crimi E, Zhang H, Han RN, Del Sorbo L, Ranieri VM, Slutsky AS (2006) Ischemia and reperfusion increases susceptibility to ventilator-induced lung injury in rats. Am J Respir Crit Care Med 174:178–186CrossRefPubMed

22.

Hirsch J, Hansen KC, Sapru A, Frank JA, Chalkley RJ, Fang X, Trinidad JC, Baker P, Burlingame AL, Matthay MA (2007) Impact of low and high tidal volumes on the rat alveolar epithelial type II cell proteome. Am J Respir Crit Care Med 175:1006–1013CrossRefPubMed

23.

Frank JA, Gutierrez JA, Jones KD, Allen L, Dobbs L, Matthay MA (2002) Low tidal volume reduces epithelial and endothelial injury in acid-injured rat lungs. Am J Respir Crit Care Med 165:242–249PubMed

24.

Froese AB, Bryan AC (1974) Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 41:242–255CrossRefPubMed

25.

Neumann P, Wrigge H, Zinserling J, Hinz J, Maripuu E, Andersson LG, Putensen C, Hedenstierna G (2005) Spontaneous breathing affects the spatial ventilation and perfusion distribution during mechanical ventilatory support. Crit Care Med 33:1090–1095CrossRefPubMed

26.

Putensen C, Rasanen J, Lopez FA (1994) Ventilation-perfusion distributions during mechanical ventilation with superimposed spontaneous breathing in canine lung injury. Am J Respir Crit Care Med 150:101–108PubMed

27.

Putensen C, Mutz NJ, Putensen-Himmer G, Zinserling J (1999) Spontaneous breathing during ventilatory support improves ventilation-perfusion distributions in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 159:1241–1248PubMed

28.

Putensen C, Zech S, Wrigge H, Zinserling J, Stuber F, von Spiegel T, Mutz N (2001) Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med 164:43–49PubMed

29.

Gunawardena S, Ravi K, Longhurst JC, Kaufman MP, Ma A, Bravo M, Kappagoda CT (2002) Responses of C fiber afferents of the rabbit airways and lungs to changes in extra-vascular fluid volume. Respir Physiol Neurobiol 132:239–251CrossRefPubMed

30.

Ma A, Bravo M, Kappagoda CT (2003) Responses of bronchial C-fiber afferents of the rabbit to changes in lung compliance. Respir Physiol Neurobiol 138:155–163CrossRefPubMed

31.

Trippenbach T, Kelly G, Marlot D (1985) Effects of tonic vagal input on breathing pattern in newborn rabbits. J Appl Physiol 59:223–228PubMed

32.

Tsubone H (1986) Characteristics of vagal afferent activity in rats: three types of pulmonary receptors responding to collapse, inflation, and deflation of the lung. Exp Neurol 92:541–552CrossRefPubMed

33.

Wang AL, Blackford TL, Lee LY (1996) Vagal bronchopulmonary C-fibers and acute ventilatory response to inhaled irritants. Respir Physiol 104:231–239CrossRefPubMed

34.

Broccard AF, Hotchkiss JR, Vannay C, Markert M, Sauty A, Feihl F, Schaller MD (2001) Protective effects of hypercapnic acidosis on ventilator-induced lung injury. Am J Respir Crit Care Med 164:802–806PubMed

35.

Kregenow DA, Rubenfeld GD, Hudson LD, Swenson ER (2006) Hypercapnic acidosis and mortality in acute lung injury. Crit Care Med 34:1–7CrossRefPubMed

36.

Sinclair SE, Kregenow DA, Lamm WJ, Starr IR, Chi EY, Hlastala MP (2002) Hypercapnic acidosis is protective in an in vivo model of ventilator-induced lung injury. Am J Respir Crit Care Med 166:403–408CrossRefPubMed

37.

Dahlem P, Bos AP, Haitsma JJ, Schultz MJ, Meijers JC, Lachmann B (2005) Alveolar fibrinolytic capacity suppressed by injurious mechanical ventilation. Intensive Care Med 31:724–732CrossRefPubMed

38.

Dahlem P, Bos AP, Haitsma JJ, Schultz MJ, Wolthuis EK, Meijers JC, Lachmann B (2006) Mechanical ventilation affects alveolar fibrinolysis in LPS-induced lung injury. Eur Respir J 28:992–998CrossRefPubMed

39.

Hall SV, Johnson EE, Hedley-Whyte J (1974) Renal hemodynamics and function with continuous positive-pressure ventilation in dogs. Anesthesiology 41:452–461CrossRefPubMed

40.

Moore ES, Galvez MB, Paton JB, Fisher DE, Behrman RE (1974) Effects of positive pressure ventilation on intrarenal blood flow in infant primates. Pediatr Res 8:792–796PubMed

Title: Neurally adjusted ventilatory assist decreases ventilator-induced lung injury and non-pulmonary organ dysfunction in rabbits with acute lung injury
Authors: Lukas Brander
Christer Sinderby
François Lecomte
Howard Leong-Poi
David Bell
Jennifer Beck
James N. Tsoporis
Rosanna Vaschetto
Marcus J. Schultz
Thomas G. Parker
Jesús Villar
Haibo Zhang
Arthur S. Slutsky
Publication date: 01-11-2009
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 11/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-009-1626-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Neurally adjusted ventilatory assist decreases ventilator-induced lung injury and non-pulmonary organ dysfunction in rabbits with acute lung injury

Abstract

Objective

Design

Subjects

Interventions

Measurements and main results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Subjects

Interventions

Measurements and main results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2009

Quality of life and functional outcome at 3, 6 and 12 months after acute necrotising pancreatitis

The effects of etomidate on adrenal responsiveness and mortality in patients with septic shock

Detection of carbon dioxide thresholds using low-flow sidestream capnography in ventilated preterm infants

Increased levels of pro-AVP and pro-ADM in septic shock patients: what could it mean?

Unilateral pulmonary edema and shock: a diagnostic challenge

Bacteraemia following single-stage percutaneous dilatational tracheostomy