Risk factors for ventilator-induced-lung injury develop three to five times faster after a single episode of lung injury
Introduction: Mechanical ventilator breaths provided to deeply sedated patients have an abnormal volume distribution, encouraging alveolar collapse in dependent regions and promoting alveolar overdistention in non-dependent regions. Collapse and overdistention both start with the first breath and wo...
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| Format: | Article |
| Language: | English |
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Canadian Society of Respiratory Therapists
2023-04-01
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| Series: | Canadian Journal of Respiratory Therapy |
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| Online Access: | https://www.cjrt.ca/wp-content/uploads/cjrt-2022-075.pdf |
| _version_ | 1827968638601134080 |
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| author | Thiago G. Bassi Michelle Nicholas Jessica Wittmann Marlena Ornowska Karl C. Fernandez Matt Gani Steven C. Reynolds |
| author_facet | Thiago G. Bassi Michelle Nicholas Jessica Wittmann Marlena Ornowska Karl C. Fernandez Matt Gani Steven C. Reynolds |
| author_sort | Thiago G. Bassi |
| collection | DOAJ |
| description | Introduction: Mechanical ventilator breaths provided to deeply sedated patients have an abnormal volume distribution, encouraging alveolar collapse in dependent regions and promoting alveolar overdistention in non-dependent regions. Collapse and overdistention both start with the first breath and worsen over time, driving ventilator-induced lung injury (VILI). This is exacerbated when the lung is already injured or has increased heterogeneity. Our study investigated the impact of a single episode of lung injury on lung mechanics and the risk factors for ventilator-induced injury, compared with non-injured lungs.
Methods: Two groups of pigs were sedated and ventilated using lung-protective volume-controlled mode at 8 mL/kg, positive end-expiratory pressure (PEEP) 5 cmH2O, with respiratory rate and FiO2 set to maintain normal blood gas values. Animals in one group were ventilated for 50 h (50-Hour MV group, n=10). Animals in the second group had lung injury induced using oleic acid and were ventilated for 12 h post-injury (LI MV group, n=6). Both groups were compared with a never-ventilated control group (NV, n=6). Lung mechanics and injury were measured using electrical impedance tomography, esophageal pressure monitoring and tissue histology.
Results: End-expiratory lung-volume loss was greater in the 50-Hour MV group (P<0.05). Plateau pressure, driving pressure and lung injury score were higher in the LI MV group, (P<0.05).
Conclusion: Risk factors for VILI developed three- to five-times faster in the group with injured lungs, demonstrating that a single lung-injury episode
substantially increased the risk of VILI, compared with normal lungs, despite using a lung-protective mechanical ventilation protocol. |
| first_indexed | 2024-04-09T18:25:50Z |
| format | Article |
| id | doaj.art-c084b2477c104753b8e490cb53c2c589 |
| institution | Directory Open Access Journal |
| issn | 2368-6820 |
| language | English |
| last_indexed | 2024-04-09T18:25:50Z |
| publishDate | 2023-04-01 |
| publisher | Canadian Society of Respiratory Therapists |
| record_format | Article |
| series | Canadian Journal of Respiratory Therapy |
| spelling | doaj.art-c084b2477c104753b8e490cb53c2c5892023-04-11T21:13:15ZengCanadian Society of Respiratory TherapistsCanadian Journal of Respiratory Therapy2368-68202023-04-015910311010.29390/cjrt-2022-075Risk factors for ventilator-induced-lung injury develop three to five times faster after a single episode of lung injuryThiago G. Bassihttps://orcid.org/0000-0001-5570-5057Michelle Nicholashttps://orcid.org/0000-0003-1944-3250Jessica Wittmannhttps://orcid.org/0000-0002-6585-4272Marlena Ornowskahttps://orcid.org/0000-0002-2635-1189Karl C. Fernandezhttps://orcid.org/0000-0002-9518-2323Matt Ganihttps://orcid.org/0009-0004-2127-0154Steven C. Reynoldshttps://orcid.org/0000-0002-2624-640XIntroduction: Mechanical ventilator breaths provided to deeply sedated patients have an abnormal volume distribution, encouraging alveolar collapse in dependent regions and promoting alveolar overdistention in non-dependent regions. Collapse and overdistention both start with the first breath and worsen over time, driving ventilator-induced lung injury (VILI). This is exacerbated when the lung is already injured or has increased heterogeneity. Our study investigated the impact of a single episode of lung injury on lung mechanics and the risk factors for ventilator-induced injury, compared with non-injured lungs. Methods: Two groups of pigs were sedated and ventilated using lung-protective volume-controlled mode at 8 mL/kg, positive end-expiratory pressure (PEEP) 5 cmH2O, with respiratory rate and FiO2 set to maintain normal blood gas values. Animals in one group were ventilated for 50 h (50-Hour MV group, n=10). Animals in the second group had lung injury induced using oleic acid and were ventilated for 12 h post-injury (LI MV group, n=6). Both groups were compared with a never-ventilated control group (NV, n=6). Lung mechanics and injury were measured using electrical impedance tomography, esophageal pressure monitoring and tissue histology. Results: End-expiratory lung-volume loss was greater in the 50-Hour MV group (P<0.05). Plateau pressure, driving pressure and lung injury score were higher in the LI MV group, (P<0.05). Conclusion: Risk factors for VILI developed three- to five-times faster in the group with injured lungs, demonstrating that a single lung-injury episode substantially increased the risk of VILI, compared with normal lungs, despite using a lung-protective mechanical ventilation protocol.https://www.cjrt.ca/wp-content/uploads/cjrt-2022-075.pdfacute lung injurymechanical ventilationventilator-induced lung injury |
| spellingShingle | Thiago G. Bassi Michelle Nicholas Jessica Wittmann Marlena Ornowska Karl C. Fernandez Matt Gani Steven C. Reynolds Risk factors for ventilator-induced-lung injury develop three to five times faster after a single episode of lung injury Canadian Journal of Respiratory Therapy acute lung injury mechanical ventilation ventilator-induced lung injury |
| title | Risk factors for ventilator-induced-lung injury develop three to five times faster after a single episode of lung injury |
| title_full | Risk factors for ventilator-induced-lung injury develop three to five times faster after a single episode of lung injury |
| title_fullStr | Risk factors for ventilator-induced-lung injury develop three to five times faster after a single episode of lung injury |
| title_full_unstemmed | Risk factors for ventilator-induced-lung injury develop three to five times faster after a single episode of lung injury |
| title_short | Risk factors for ventilator-induced-lung injury develop three to five times faster after a single episode of lung injury |
| title_sort | risk factors for ventilator induced lung injury develop three to five times faster after a single episode of lung injury |
| topic | acute lung injury mechanical ventilation ventilator-induced lung injury |
| url | https://www.cjrt.ca/wp-content/uploads/cjrt-2022-075.pdf |
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