Impact of airway closure and lung collapse on inhaled nitric oxide effect in acute lung injury: an experimental study
Abstract Background Efficacy of inhaled therapy such as Nitric Oxide (iNO) during mechanical ventilation may depend on airway patency. We hypothesized that airway closure and lung collapse, countered by positive end-expiratory pressure (PEEP), influence iNO efficacy. This could support the role of a...
| Huvudupphovsmän: | , , , , , , |
|---|---|
| Materialtyp: | Artikel |
| Språk: | English |
| Publicerad: |
SpringerOpen
2024-09-01
|
| Serie: | Annals of Intensive Care |
| Ämnen: | |
| Länkar: | https://doi.org/10.1186/s13613-024-01378-z |
| _version_ | 1827098415420407808 |
|---|---|
| author | Mariangela Pellegrini Mayson L. A. Sousa Sebastian Dubo Luca S. Menga Vanessa Hsing Martin Post Laurent J. Brochard |
| author_facet | Mariangela Pellegrini Mayson L. A. Sousa Sebastian Dubo Luca S. Menga Vanessa Hsing Martin Post Laurent J. Brochard |
| author_sort | Mariangela Pellegrini |
| collection | DOAJ |
| description | Abstract Background Efficacy of inhaled therapy such as Nitric Oxide (iNO) during mechanical ventilation may depend on airway patency. We hypothesized that airway closure and lung collapse, countered by positive end-expiratory pressure (PEEP), influence iNO efficacy. This could support the role of an adequate PEEP titration for inhalation therapy. The main aim of this study was to assess the effect of iNO with PEEP set above or below the airway opening pressure (AOP) generated by airway closure, on hemodynamics and gas exchange in swine models of acute respiratory distress syndrome. Fourteen pigs randomly underwent either bilateral or asymmetrical two-hit model of lung injury. Airway closure and lung collapse were measured with electrical impedance tomography as well as ventilation/perfusion ratio (V/Q). After AOP detection, the effect of iNO (10ppm) was studied with PEEP set randomly above or below regional AOP. Respiratory mechanics, hemodynamics, and gas-exchange were recorded. Results All pigs presented airway closure (AOP > 0.5cmH2O) after injury. In bilateral injury, iNO was associated with an improved mean pulmonary pressure from 49 ± 8 to 42 ± 7mmHg; (p = 0.003), and ventilation/perfusion matching, caused by a reduction in pixels with low V/Q and shunt from 16%[IQR:13–19] to 9%[IQR:4–12] (p = 0.03) only at PEEP set above AOP. iNO had no effect on hemodynamics or gas exchange for PEEP below AOP (low V/Q 25%[IQR:16–30] to 23%[IQR:14–27]; p = 0.68). In asymmetrical injury, iNO improved pulmonary hemodynamics and ventilation/perfusion matching independently from the PEEP set. iNO was associated with improved oxygenation in all cases. Conclusions In an animal model of bilateral lung injury, PEEP level relative to AOP markedly influences iNO efficacy on pulmonary hemodynamics and ventilation/perfusion match, independently of oxygenation. |
| first_indexed | 2025-03-20T07:47:12Z |
| format | Article |
| id | doaj.art-6162bf44baa74f5fa12df901b5832b17 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2025-03-20T07:47:12Z |
| publishDate | 2024-09-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-6162bf44baa74f5fa12df901b5832b172024-09-29T11:39:29ZengSpringerOpenAnnals of Intensive Care2110-58202024-09-0114111210.1186/s13613-024-01378-zImpact of airway closure and lung collapse on inhaled nitric oxide effect in acute lung injury: an experimental studyMariangela Pellegrini0Mayson L. A. Sousa1Sebastian Dubo2Luca S. Menga3Vanessa Hsing4Martin Post5Laurent J. Brochard6Anesthesiology and Intensive Care Medicine, Uppsala University HospitalKeenan Centre for Biomedical Research, Critical Care Department, St. Michael’s Hospital, Unity Health TorontoKeenan Centre for Biomedical Research, Critical Care Department, St. Michael’s Hospital, Unity Health TorontoKeenan Centre for Biomedical Research, Critical Care Department, St. Michael’s Hospital, Unity Health TorontoTranslational Medicine Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick ChildrenTranslational Medicine Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick ChildrenKeenan Centre for Biomedical Research, Critical Care Department, St. Michael’s Hospital, Unity Health TorontoAbstract Background Efficacy of inhaled therapy such as Nitric Oxide (iNO) during mechanical ventilation may depend on airway patency. We hypothesized that airway closure and lung collapse, countered by positive end-expiratory pressure (PEEP), influence iNO efficacy. This could support the role of an adequate PEEP titration for inhalation therapy. The main aim of this study was to assess the effect of iNO with PEEP set above or below the airway opening pressure (AOP) generated by airway closure, on hemodynamics and gas exchange in swine models of acute respiratory distress syndrome. Fourteen pigs randomly underwent either bilateral or asymmetrical two-hit model of lung injury. Airway closure and lung collapse were measured with electrical impedance tomography as well as ventilation/perfusion ratio (V/Q). After AOP detection, the effect of iNO (10ppm) was studied with PEEP set randomly above or below regional AOP. Respiratory mechanics, hemodynamics, and gas-exchange were recorded. Results All pigs presented airway closure (AOP > 0.5cmH2O) after injury. In bilateral injury, iNO was associated with an improved mean pulmonary pressure from 49 ± 8 to 42 ± 7mmHg; (p = 0.003), and ventilation/perfusion matching, caused by a reduction in pixels with low V/Q and shunt from 16%[IQR:13–19] to 9%[IQR:4–12] (p = 0.03) only at PEEP set above AOP. iNO had no effect on hemodynamics or gas exchange for PEEP below AOP (low V/Q 25%[IQR:16–30] to 23%[IQR:14–27]; p = 0.68). In asymmetrical injury, iNO improved pulmonary hemodynamics and ventilation/perfusion matching independently from the PEEP set. iNO was associated with improved oxygenation in all cases. Conclusions In an animal model of bilateral lung injury, PEEP level relative to AOP markedly influences iNO efficacy on pulmonary hemodynamics and ventilation/perfusion match, independently of oxygenation.https://doi.org/10.1186/s13613-024-01378-z(3 to 10) nitric oxideAcute respiratory distress syndromeMechanical ventilationAirway closure |
| spellingShingle | Mariangela Pellegrini Mayson L. A. Sousa Sebastian Dubo Luca S. Menga Vanessa Hsing Martin Post Laurent J. Brochard Impact of airway closure and lung collapse on inhaled nitric oxide effect in acute lung injury: an experimental study Annals of Intensive Care (3 to 10) nitric oxide Acute respiratory distress syndrome Mechanical ventilation Airway closure |
| title | Impact of airway closure and lung collapse on inhaled nitric oxide effect in acute lung injury: an experimental study |
| title_full | Impact of airway closure and lung collapse on inhaled nitric oxide effect in acute lung injury: an experimental study |
| title_fullStr | Impact of airway closure and lung collapse on inhaled nitric oxide effect in acute lung injury: an experimental study |
| title_full_unstemmed | Impact of airway closure and lung collapse on inhaled nitric oxide effect in acute lung injury: an experimental study |
| title_short | Impact of airway closure and lung collapse on inhaled nitric oxide effect in acute lung injury: an experimental study |
| title_sort | impact of airway closure and lung collapse on inhaled nitric oxide effect in acute lung injury an experimental study |
| topic | (3 to 10) nitric oxide Acute respiratory distress syndrome Mechanical ventilation Airway closure |
| url | https://doi.org/10.1186/s13613-024-01378-z |
| work_keys_str_mv | AT mariangelapellegrini impactofairwayclosureandlungcollapseoninhalednitricoxideeffectinacutelunginjuryanexperimentalstudy AT maysonlasousa impactofairwayclosureandlungcollapseoninhalednitricoxideeffectinacutelunginjuryanexperimentalstudy AT sebastiandubo impactofairwayclosureandlungcollapseoninhalednitricoxideeffectinacutelunginjuryanexperimentalstudy AT lucasmenga impactofairwayclosureandlungcollapseoninhalednitricoxideeffectinacutelunginjuryanexperimentalstudy AT vanessahsing impactofairwayclosureandlungcollapseoninhalednitricoxideeffectinacutelunginjuryanexperimentalstudy AT martinpost impactofairwayclosureandlungcollapseoninhalednitricoxideeffectinacutelunginjuryanexperimentalstudy AT laurentjbrochard impactofairwayclosureandlungcollapseoninhalednitricoxideeffectinacutelunginjuryanexperimentalstudy |