Real-time effects of PEEP and tidal volume on regional ventilation and perfusion in experimental lung injury
Abstract Background Real-time bedside information on regional ventilation and perfusion during mechanical ventilation (MV) may help to elucidate the physiological and pathophysiological effects of MV settings in healthy and injured lungs. We aimed to study the effects of positive end-expiratory pres...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-02-01
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| Series: | Intensive Care Medicine Experimental |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40635-020-0298-2 |
| _version_ | 1811323314597003264 |
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| author | João Batista Borges John N. Cronin Douglas C. Crockett Göran Hedenstierna Anders Larsson Federico Formenti |
| author_facet | João Batista Borges John N. Cronin Douglas C. Crockett Göran Hedenstierna Anders Larsson Federico Formenti |
| author_sort | João Batista Borges |
| collection | DOAJ |
| description | Abstract Background Real-time bedside information on regional ventilation and perfusion during mechanical ventilation (MV) may help to elucidate the physiological and pathophysiological effects of MV settings in healthy and injured lungs. We aimed to study the effects of positive end-expiratory pressure (PEEP) and tidal volume (V T) on the distributions of regional ventilation and perfusion by electrical impedance tomography (EIT) in healthy and injured lungs. Methods One-hit acute lung injury model was established in 6 piglets by repeated lung lavages (injured group). Four ventilated piglets served as the control group. A randomized sequence of any possible combination of three V T (7, 10, and 15 ml/kg) and four levels of PEEP (5, 8, 10, and 12 cmH2O) was performed in all animals. Ventilation and perfusion distributions were computed by EIT within three regions-of-interest (ROIs): nondependent, middle, dependent. A mixed design with one between-subjects factor (group: intervention or control), and two within-subjects factors (PEEP and V T) was used, with a three-way mixed analysis of variance (ANOVA). Results Two-way interactions between PEEP and group, and V T and group, were observed for the dependent ROI (p = 0.035 and 0.012, respectively), indicating that the increase in the dependent ROI ventilation was greater at higher PEEP and VT in the injured group than in the control group. A two-way interaction between PEEP and V T was observed for perfusion distribution in each ROI: nondependent (p = 0.030), middle (p = 0.006), and dependent (p = 0.001); no interaction was observed between injured and control groups. Conclusions Large PEEP and V T levels were associated with greater pulmonary ventilation of the dependent lung region in experimental lung injury, whereas they affected pulmonary perfusion of all lung regions both in the control and in the experimental lung injury groups. |
| first_indexed | 2024-04-13T13:52:54Z |
| format | Article |
| id | doaj.art-129a922910384993a7b6c24db575370e |
| institution | Directory Open Access Journal |
| issn | 2197-425X |
| language | English |
| last_indexed | 2024-04-13T13:52:54Z |
| publishDate | 2020-02-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Intensive Care Medicine Experimental |
| spelling | doaj.art-129a922910384993a7b6c24db575370e2022-12-22T02:44:17ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2020-02-018111210.1186/s40635-020-0298-2Real-time effects of PEEP and tidal volume on regional ventilation and perfusion in experimental lung injuryJoão Batista Borges0John N. Cronin1Douglas C. Crockett2Göran Hedenstierna3Anders Larsson4Federico Formenti5Centre for Human and Applied Physiological Sciences, King’s College LondonCentre for Human and Applied Physiological Sciences, King’s College LondonNuffield Division of Anaesthetics, University of OxfordHedenstierna Laboratory, Department of Medical Sciences, Uppsala UniversityHedenstierna Laboratory, Department of Surgical Sciences, Uppsala UniversityCentre for Human and Applied Physiological Sciences, King’s College LondonAbstract Background Real-time bedside information on regional ventilation and perfusion during mechanical ventilation (MV) may help to elucidate the physiological and pathophysiological effects of MV settings in healthy and injured lungs. We aimed to study the effects of positive end-expiratory pressure (PEEP) and tidal volume (V T) on the distributions of regional ventilation and perfusion by electrical impedance tomography (EIT) in healthy and injured lungs. Methods One-hit acute lung injury model was established in 6 piglets by repeated lung lavages (injured group). Four ventilated piglets served as the control group. A randomized sequence of any possible combination of three V T (7, 10, and 15 ml/kg) and four levels of PEEP (5, 8, 10, and 12 cmH2O) was performed in all animals. Ventilation and perfusion distributions were computed by EIT within three regions-of-interest (ROIs): nondependent, middle, dependent. A mixed design with one between-subjects factor (group: intervention or control), and two within-subjects factors (PEEP and V T) was used, with a three-way mixed analysis of variance (ANOVA). Results Two-way interactions between PEEP and group, and V T and group, were observed for the dependent ROI (p = 0.035 and 0.012, respectively), indicating that the increase in the dependent ROI ventilation was greater at higher PEEP and VT in the injured group than in the control group. A two-way interaction between PEEP and V T was observed for perfusion distribution in each ROI: nondependent (p = 0.030), middle (p = 0.006), and dependent (p = 0.001); no interaction was observed between injured and control groups. Conclusions Large PEEP and V T levels were associated with greater pulmonary ventilation of the dependent lung region in experimental lung injury, whereas they affected pulmonary perfusion of all lung regions both in the control and in the experimental lung injury groups.http://link.springer.com/article/10.1186/s40635-020-0298-2Respiratory distress syndrome, AdultMechanical ventilationElectrical impedance tomographyPulmonary circulationVentilation-perfusion ratio |
| spellingShingle | João Batista Borges John N. Cronin Douglas C. Crockett Göran Hedenstierna Anders Larsson Federico Formenti Real-time effects of PEEP and tidal volume on regional ventilation and perfusion in experimental lung injury Intensive Care Medicine Experimental Respiratory distress syndrome, Adult Mechanical ventilation Electrical impedance tomography Pulmonary circulation Ventilation-perfusion ratio |
| title | Real-time effects of PEEP and tidal volume on regional ventilation and perfusion in experimental lung injury |
| title_full | Real-time effects of PEEP and tidal volume on regional ventilation and perfusion in experimental lung injury |
| title_fullStr | Real-time effects of PEEP and tidal volume on regional ventilation and perfusion in experimental lung injury |
| title_full_unstemmed | Real-time effects of PEEP and tidal volume on regional ventilation and perfusion in experimental lung injury |
| title_short | Real-time effects of PEEP and tidal volume on regional ventilation and perfusion in experimental lung injury |
| title_sort | real time effects of peep and tidal volume on regional ventilation and perfusion in experimental lung injury |
| topic | Respiratory distress syndrome, Adult Mechanical ventilation Electrical impedance tomography Pulmonary circulation Ventilation-perfusion ratio |
| url | http://link.springer.com/article/10.1186/s40635-020-0298-2 |
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