Individualizing mechanical ventilation: titration of driving pressure to pulmonary elastance through Young’s modulus in an acute respiratory distress syndrome animal model
Abstract Background Mechanical ventilation increases the risk of lung injury (VILI). Some authors propose that the way to reduce VILI is to find the threshold of driving pressure below which VILI is minimized. In this study, we propose a method to titrate the driving pressure to pulmonary elastance...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-022-04184-w |
| _version_ | 1811250056918990848 |
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| author | Álvaro Mingote Ramsés Marrero García Martín Santos González Raquel Castejón Clara Salas Antón Juan Antonio Vargas Nuñez Javier García-Fernández |
| author_facet | Álvaro Mingote Ramsés Marrero García Martín Santos González Raquel Castejón Clara Salas Antón Juan Antonio Vargas Nuñez Javier García-Fernández |
| author_sort | Álvaro Mingote |
| collection | DOAJ |
| description | Abstract Background Mechanical ventilation increases the risk of lung injury (VILI). Some authors propose that the way to reduce VILI is to find the threshold of driving pressure below which VILI is minimized. In this study, we propose a method to titrate the driving pressure to pulmonary elastance in an acute respiratory distress syndrome model using Young’s modulus and its consequences on ventilatory-induced lung injury. Material and methods 20 Wistar Han male rats were used. After generating an acute respiratory distress syndrome, two groups were studied: (a) standard protective mechanical ventilation: 10 rats received 150 min of mechanical ventilation with driving pressure = 14 cm H2O, tidal volume < 6 mL/kg) and (b) individualized mechanical ventilation: 10 rats received 150 min of mechanical ventilation with an individualized driving pressure according to their Young’s modulus. In both groups, an individualized PEEP was programmed in the same manner. We analyzed the concentration of IL-6, TNF-α, and IL-1ß in BAL and the acute lung injury score in lung tissue postmortem. Results Global driving pressure was different between the groups (14 vs 11 cm H2O, p = 0.03). The individualized mechanical ventilation group had lower concentrations in bronchoalveolar lavage of IL-6 (270 pg/mL vs 155 pg/mL, p = 0.02), TNF-α (292 pg/mL vs 139 pg/mL, p < 0.01) and IL-1ß (563 pg/mL vs 131 pg/mL, p = 0.05). They presented lower proportion of lymphocytes (96% vs 79%, p = 0.05) as well as lower lung injury score (6.0 points vs 2.0 points, p = 0.02). Conclusion In our model, individualization of DP to pulmonary elastance through Young’s modulus decreases lung inflammation and structural lung injury without a significant impact on oxygenation. |
| first_indexed | 2024-04-12T15:58:30Z |
| format | Article |
| id | doaj.art-a25baf03f5c9489c83b1ef13e7bd6d58 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-12T15:58:30Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-a25baf03f5c9489c83b1ef13e7bd6d582022-12-22T03:26:17ZengBMCCritical Care1364-85352022-10-012611710.1186/s13054-022-04184-wIndividualizing mechanical ventilation: titration of driving pressure to pulmonary elastance through Young’s modulus in an acute respiratory distress syndrome animal modelÁlvaro Mingote0Ramsés Marrero García1Martín Santos González2Raquel Castejón3Clara Salas Antón4Juan Antonio Vargas Nuñez5Javier García-Fernández6Anaesthesia, Critical Care and Pain Unit, Puerta de Hierro Majadahonda Universitary HospitalAnaesthesia, Critical Care Department and Pain Unit, Clinic HospitalMedical and Surgical Research Unit, Puerta de Hierro Majadahonda Universitary HospitalInternal Medicine Laboratory, Puerta de Hierro Majadahonda Universitary Hospital Research InstitutePathology Unit, Puerta de Hierro Majadahonda Universitary HospitalInternal Medicine Unit, Puerta de Hierro Majadahonda Universitary HospitalAnaesthesia, Critical Care and Pain Unit, Puerta de Hierro Majadahonda Universitary HospitalAbstract Background Mechanical ventilation increases the risk of lung injury (VILI). Some authors propose that the way to reduce VILI is to find the threshold of driving pressure below which VILI is minimized. In this study, we propose a method to titrate the driving pressure to pulmonary elastance in an acute respiratory distress syndrome model using Young’s modulus and its consequences on ventilatory-induced lung injury. Material and methods 20 Wistar Han male rats were used. After generating an acute respiratory distress syndrome, two groups were studied: (a) standard protective mechanical ventilation: 10 rats received 150 min of mechanical ventilation with driving pressure = 14 cm H2O, tidal volume < 6 mL/kg) and (b) individualized mechanical ventilation: 10 rats received 150 min of mechanical ventilation with an individualized driving pressure according to their Young’s modulus. In both groups, an individualized PEEP was programmed in the same manner. We analyzed the concentration of IL-6, TNF-α, and IL-1ß in BAL and the acute lung injury score in lung tissue postmortem. Results Global driving pressure was different between the groups (14 vs 11 cm H2O, p = 0.03). The individualized mechanical ventilation group had lower concentrations in bronchoalveolar lavage of IL-6 (270 pg/mL vs 155 pg/mL, p = 0.02), TNF-α (292 pg/mL vs 139 pg/mL, p < 0.01) and IL-1ß (563 pg/mL vs 131 pg/mL, p = 0.05). They presented lower proportion of lymphocytes (96% vs 79%, p = 0.05) as well as lower lung injury score (6.0 points vs 2.0 points, p = 0.02). Conclusion In our model, individualization of DP to pulmonary elastance through Young’s modulus decreases lung inflammation and structural lung injury without a significant impact on oxygenation.https://doi.org/10.1186/s13054-022-04184-wAcute respiratory distress syndromeDriving pressureElastic modulusMechanical ventilationPulmonary elastanceVentilator induced lung injury |
| spellingShingle | Álvaro Mingote Ramsés Marrero García Martín Santos González Raquel Castejón Clara Salas Antón Juan Antonio Vargas Nuñez Javier García-Fernández Individualizing mechanical ventilation: titration of driving pressure to pulmonary elastance through Young’s modulus in an acute respiratory distress syndrome animal model Critical Care Acute respiratory distress syndrome Driving pressure Elastic modulus Mechanical ventilation Pulmonary elastance Ventilator induced lung injury |
| title | Individualizing mechanical ventilation: titration of driving pressure to pulmonary elastance through Young’s modulus in an acute respiratory distress syndrome animal model |
| title_full | Individualizing mechanical ventilation: titration of driving pressure to pulmonary elastance through Young’s modulus in an acute respiratory distress syndrome animal model |
| title_fullStr | Individualizing mechanical ventilation: titration of driving pressure to pulmonary elastance through Young’s modulus in an acute respiratory distress syndrome animal model |
| title_full_unstemmed | Individualizing mechanical ventilation: titration of driving pressure to pulmonary elastance through Young’s modulus in an acute respiratory distress syndrome animal model |
| title_short | Individualizing mechanical ventilation: titration of driving pressure to pulmonary elastance through Young’s modulus in an acute respiratory distress syndrome animal model |
| title_sort | individualizing mechanical ventilation titration of driving pressure to pulmonary elastance through young s modulus in an acute respiratory distress syndrome animal model |
| topic | Acute respiratory distress syndrome Driving pressure Elastic modulus Mechanical ventilation Pulmonary elastance Ventilator induced lung injury |
| url | https://doi.org/10.1186/s13054-022-04184-w |
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