Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model.
Positive-pressure mechanical ventilation is an essential therapeutic intervention, yet it causes the clinical syndrome known as ventilator-induced lung injury. Various lung protective mechanical ventilation strategies have attempted to reduce or prevent ventilator-induced lung injury but few modalit...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2017-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5675408?pdf=render |
| _version_ | 1818133569895137280 |
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| author | Laura A Cagle Lisa M Franzi Angela L Linderholm Jerold A Last Jason Y Adams Richart W Harper Nicholas J Kenyon |
| author_facet | Laura A Cagle Lisa M Franzi Angela L Linderholm Jerold A Last Jason Y Adams Richart W Harper Nicholas J Kenyon |
| author_sort | Laura A Cagle |
| collection | DOAJ |
| description | Positive-pressure mechanical ventilation is an essential therapeutic intervention, yet it causes the clinical syndrome known as ventilator-induced lung injury. Various lung protective mechanical ventilation strategies have attempted to reduce or prevent ventilator-induced lung injury but few modalities have proven effective. A model that isolates the contribution of mechanical ventilation on the development of acute lung injury is needed to better understand biologic mechanisms that lead to ventilator-induced lung injury.To evaluate the effects of positive end-expiratory pressure and recruitment maneuvers in reducing lung injury in a ventilator-induced lung injury murine model in short- and longer-term ventilation.5-12 week-old female BALB/c mice (n = 85) were anesthetized, placed on mechanical ventilation for either 2 hrs or 4 hrs with either low tidal volume (8 ml/kg) or high tidal volume (15 ml/kg) with or without positive end-expiratory pressure and recruitment maneuvers.Alteration of the alveolar-capillary barrier was noted at 2 hrs of high tidal volume ventilation. Standardized histology scores, influx of bronchoalveolar lavage albumin, proinflammatory cytokines, and absolute neutrophils were significantly higher in the high-tidal volume ventilation group at 4 hours of ventilation. Application of positive end-expiratory pressure resulted in significantly decreased standardized histology scores and bronchoalveolar absolute neutrophil counts at low- and high-tidal volume ventilation, respectively. Recruitment maneuvers were essential to maintain pulmonary compliance at both 2 and 4 hrs of ventilation.Signs of ventilator-induced lung injury are evident soon after high tidal volume ventilation (as early as 2 hours) and lung injury worsens with longer-term ventilation (4 hrs). Application of positive end-expiratory pressure and recruitment maneuvers are protective against worsening VILI across all time points. Dynamic compliance can be used guide the frequency of recruitment maneuvers to help ameloriate ventilator-induced lung injury. |
| first_indexed | 2024-12-11T08:54:49Z |
| format | Article |
| id | doaj.art-9a19195bec9548dc97cb380c8897b421 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-11T08:54:49Z |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-9a19195bec9548dc97cb380c8897b4212022-12-22T01:13:55ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-011211e018741910.1371/journal.pone.0187419Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model.Laura A CagleLisa M FranziAngela L LinderholmJerold A LastJason Y AdamsRichart W HarperNicholas J KenyonPositive-pressure mechanical ventilation is an essential therapeutic intervention, yet it causes the clinical syndrome known as ventilator-induced lung injury. Various lung protective mechanical ventilation strategies have attempted to reduce or prevent ventilator-induced lung injury but few modalities have proven effective. A model that isolates the contribution of mechanical ventilation on the development of acute lung injury is needed to better understand biologic mechanisms that lead to ventilator-induced lung injury.To evaluate the effects of positive end-expiratory pressure and recruitment maneuvers in reducing lung injury in a ventilator-induced lung injury murine model in short- and longer-term ventilation.5-12 week-old female BALB/c mice (n = 85) were anesthetized, placed on mechanical ventilation for either 2 hrs or 4 hrs with either low tidal volume (8 ml/kg) or high tidal volume (15 ml/kg) with or without positive end-expiratory pressure and recruitment maneuvers.Alteration of the alveolar-capillary barrier was noted at 2 hrs of high tidal volume ventilation. Standardized histology scores, influx of bronchoalveolar lavage albumin, proinflammatory cytokines, and absolute neutrophils were significantly higher in the high-tidal volume ventilation group at 4 hours of ventilation. Application of positive end-expiratory pressure resulted in significantly decreased standardized histology scores and bronchoalveolar absolute neutrophil counts at low- and high-tidal volume ventilation, respectively. Recruitment maneuvers were essential to maintain pulmonary compliance at both 2 and 4 hrs of ventilation.Signs of ventilator-induced lung injury are evident soon after high tidal volume ventilation (as early as 2 hours) and lung injury worsens with longer-term ventilation (4 hrs). Application of positive end-expiratory pressure and recruitment maneuvers are protective against worsening VILI across all time points. Dynamic compliance can be used guide the frequency of recruitment maneuvers to help ameloriate ventilator-induced lung injury.http://europepmc.org/articles/PMC5675408?pdf=render |
| spellingShingle | Laura A Cagle Lisa M Franzi Angela L Linderholm Jerold A Last Jason Y Adams Richart W Harper Nicholas J Kenyon Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model. PLoS ONE |
| title | Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model. |
| title_full | Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model. |
| title_fullStr | Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model. |
| title_full_unstemmed | Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model. |
| title_short | Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model. |
| title_sort | effects of positive end expiratory pressure and recruitment maneuvers in a ventilator induced injury mouse model |
| url | http://europepmc.org/articles/PMC5675408?pdf=render |
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