Positive end-expiratory pressure and prone position alter the capacity of force generation from diaphragm in acute respiratory distress syndrome: an animal experiment
Abstract Background Spontaneous breathing potentially injures lungs and diaphragm when spontaneous effort is vigorous in acute respiratory distress syndrome (ARDS) while immobility also has risks of Intensive Care Unit (ICU) acquired weakness and diaphragm atrophy. Thus, ventilatory strategy to miti...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-022-01921-0 |
| _version_ | 1797985589066203136 |
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| author | Andi Muhammad Fadlillah Firstiogusran Takeshi Yoshida Haruka Hashimoto Hirofumi Iwata Yuji Fujino |
| author_facet | Andi Muhammad Fadlillah Firstiogusran Takeshi Yoshida Haruka Hashimoto Hirofumi Iwata Yuji Fujino |
| author_sort | Andi Muhammad Fadlillah Firstiogusran |
| collection | DOAJ |
| description | Abstract Background Spontaneous breathing potentially injures lungs and diaphragm when spontaneous effort is vigorous in acute respiratory distress syndrome (ARDS) while immobility also has risks of Intensive Care Unit (ICU) acquired weakness and diaphragm atrophy. Thus, ventilatory strategy to mitigate strong spontaneous effort should be promptly established without a systemic use of neuromuscular blocking agent. Here, we investigated the impacts of positive end-expiratory pressure (PEEP) and body position on the capacity of force generation from diaphragm following bilateral phrenic nerve stimulations in a rabbit ARDS model. Methods Using lung-injured rabbits, we measured 1) transdiaphragmatic pressure by bilateral phrenic nerve stimulation and 2) end-expiratory lung volume using computed tomography, under two different levels of PEEP (high, low) and body positions (supine, prone). Results Overall, transdiaphragmatic pressure was the highest at low PEEP in supine position and the lowest at high PEEP in prone position. Compared to values in low PEEP + supine, transdiaphragmatic pressure was significantly reduced by either prone alone (the same PEEP) or increasing PEEP alone (the same position) or both combinations. End-expiratory lung volume was significantly increased with increasing PEEP in both positions, but it was not altered by body position. Interpretation The capacity of force generation from diaphragm was modulated by PEEP and body position during mechanical ventilation in ARDS. Higher PEEP or prone position per se or both was effective to decrease the force generation from diaphragm. |
| first_indexed | 2024-04-11T07:19:29Z |
| format | Article |
| id | doaj.art-04f401d3f45b46e8b3d387d20e372ad1 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-04-11T07:19:29Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-04f401d3f45b46e8b3d387d20e372ad12022-12-22T04:37:48ZengBMCBMC Anesthesiology1471-22532022-12-012211810.1186/s12871-022-01921-0Positive end-expiratory pressure and prone position alter the capacity of force generation from diaphragm in acute respiratory distress syndrome: an animal experimentAndi Muhammad Fadlillah Firstiogusran0Takeshi Yoshida1Haruka Hashimoto2Hirofumi Iwata3Yuji Fujino4The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of MedicineThe Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of MedicineThe Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of MedicineThe Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of MedicineThe Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of MedicineAbstract Background Spontaneous breathing potentially injures lungs and diaphragm when spontaneous effort is vigorous in acute respiratory distress syndrome (ARDS) while immobility also has risks of Intensive Care Unit (ICU) acquired weakness and diaphragm atrophy. Thus, ventilatory strategy to mitigate strong spontaneous effort should be promptly established without a systemic use of neuromuscular blocking agent. Here, we investigated the impacts of positive end-expiratory pressure (PEEP) and body position on the capacity of force generation from diaphragm following bilateral phrenic nerve stimulations in a rabbit ARDS model. Methods Using lung-injured rabbits, we measured 1) transdiaphragmatic pressure by bilateral phrenic nerve stimulation and 2) end-expiratory lung volume using computed tomography, under two different levels of PEEP (high, low) and body positions (supine, prone). Results Overall, transdiaphragmatic pressure was the highest at low PEEP in supine position and the lowest at high PEEP in prone position. Compared to values in low PEEP + supine, transdiaphragmatic pressure was significantly reduced by either prone alone (the same PEEP) or increasing PEEP alone (the same position) or both combinations. End-expiratory lung volume was significantly increased with increasing PEEP in both positions, but it was not altered by body position. Interpretation The capacity of force generation from diaphragm was modulated by PEEP and body position during mechanical ventilation in ARDS. Higher PEEP or prone position per se or both was effective to decrease the force generation from diaphragm.https://doi.org/10.1186/s12871-022-01921-0Spontaneous breathingProne positionPEEPARDS |
| spellingShingle | Andi Muhammad Fadlillah Firstiogusran Takeshi Yoshida Haruka Hashimoto Hirofumi Iwata Yuji Fujino Positive end-expiratory pressure and prone position alter the capacity of force generation from diaphragm in acute respiratory distress syndrome: an animal experiment BMC Anesthesiology Spontaneous breathing Prone position PEEP ARDS |
| title | Positive end-expiratory pressure and prone position alter the capacity of force generation from diaphragm in acute respiratory distress syndrome: an animal experiment |
| title_full | Positive end-expiratory pressure and prone position alter the capacity of force generation from diaphragm in acute respiratory distress syndrome: an animal experiment |
| title_fullStr | Positive end-expiratory pressure and prone position alter the capacity of force generation from diaphragm in acute respiratory distress syndrome: an animal experiment |
| title_full_unstemmed | Positive end-expiratory pressure and prone position alter the capacity of force generation from diaphragm in acute respiratory distress syndrome: an animal experiment |
| title_short | Positive end-expiratory pressure and prone position alter the capacity of force generation from diaphragm in acute respiratory distress syndrome: an animal experiment |
| title_sort | positive end expiratory pressure and prone position alter the capacity of force generation from diaphragm in acute respiratory distress syndrome an animal experiment |
| topic | Spontaneous breathing Prone position PEEP ARDS |
| url | https://doi.org/10.1186/s12871-022-01921-0 |
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