Adjusting tidal volume to stress index in an open lung condition optimizes ventilation and prevents overdistension in an experimental model of lung injury and reduced chest wall compliance

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• 作者：Carlos Ferrando (1)
  Fernando Su谩rez-Sipmann (2) (3)
  Andrea Gutierrez (1)
  Gerardo Tusman (4)
  Jose Carbonell (1)
  Marisa Garc铆a (1)
  Laura Piqueras (5)
  Desamparados Compa帽 (6)
  Susanie Flores (7)
  Marina Soro (1)
  Alicia Llombart (8)
  Francisco Javier Belda (1)
  
  1. Anesthesiology and Critical Care Department ; Hospital Cl铆nico Universitario of Valencia ; Av. Blasco Iba帽ez ; 17 ; Valencia ; CP ; 46010 ; Spain
  2. Section of Anesthesiology and Critical Care ; Uppsala University Hospital Uppsala ; Uppsala ; Sweden
  3. CIBER de Enfermedades Respiratorias ; Instituto de Salud Carlos III ; Madrid ; Spain
  4. Department of Anesthesiology ; Hospital Privado de Comunidad ; Mar de Plata ; Argentina
  5. Clinical Research Foundation ; Hospital Cl铆nico Universitario of Valencia ; Valencia ; Spain
  6. Pathological Anatomy Department ; Hospital Cl铆nico Universitario of Valencia ; Valencia ; Spain
  7. Radiology Department ; Hospital Clinico Universitario of Valencia ; Valencia ; Spain
  8. Clinical Research Foundation ; Hospital Cl铆nico Universitario of Valencia ; Valencia ; Spain
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：1,544 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction The stress index (SI), a parameter derived from the shape of the pressure-time curve, can identify injurious mechanical ventilation. We tested the hypothesis that adjusting tidal volume (VT) to a non-injurious SI in an open lung condition avoids hypoventilation while preventing overdistension in an experimental model of combined lung injury and low chest-wall compliance (Ccw). Methods Lung injury was induced by repeated lung lavages using warm saline solution, and Ccw was reduced by controlled intra-abdominal air-insufflation in 22 anesthetized, paralyzed and mechanically ventilated pigs. After injury animals were recruited and submitted to a positive end-expiratory pressure (PEEP) titration trial to find the PEEP level resulting in maximum compliance. During a subsequent four hours of mechanical ventilation, VT was adjusted to keep a plateau pressure (Pplat) of 30 cmH2O (Pplat-group, n鈥?鈥?1) or to a SI between 0.95 and 1.05 (SI-group, n鈥?鈥?1). Respiratory rate was adjusted to maintain a 鈥榥ormal鈥?PaCO2 (35 to 65聽mmHg). SI, lung mechanics, arterial-blood gases haemodynamics pro-inflammatory cytokines and histopathology were analyzed. In addition Computed Tomography (CT) data were acquired at end expiration and end inspiration in six animals. Results PaCO2 was significantly higher in the Pplat-group (82 versus 53聽mmHg, P鈥?鈥?.01), with a resulting lower pH (7.19 versus 7.34, P鈥?鈥?.01). We observed significant differences in VT (7.3 versus 5.4 mlKg鈭?, P鈥?鈥?.002) and Pplat values (30 versus 35 cmH2O, P鈥?鈥?.001) between the Pplat-group and SI-group respectively. SI (1.03 versus 0.99, P鈥?鈥?.42) and end-inspiratory transpulmonary pressure (PTP) (17 versus 18 cmH2O, P鈥?鈥?.42) were similar in the Pplat- and SI-groups respectively, without differences in overinflated lung areas at end- inspiration in both groups. Cytokines and histopathology showed no differences. Conclusions Setting tidal volume to a non-injurious stress index in an open lung condition improves alveolar ventilation and prevents overdistension without increasing lung injury. This is in comparison with limited Pplat protective ventilation in a model of lung injury with low chest-wall compliance.