Background
Ventilator strategies that maintain an “open lung” have shown promise in treating
hypoxemic patients. We compared three “open lung” strategies with standard of care
low tidal volume ventilation and hypothesized that each would diminish physiologic
and histopathologic evidence of ventilator induced lung injury (VILI).
Materials and Methods
Acute lung injury (ALI) was induced in 22 pigs via 5% Tween and 30-min of injurious ventilation. Animals were separated into four groups:
(1) low tidal volume ventilation (LowVt -6 mL/kg); (2) high-frequency oscillatory
ventilation (HFOV); (3) airway pressure release ventilation (APRV); or (4) recruitment
and decremental positive-end expiratory pressure (PEEP) titration (RM+OP) and followed
for 6 h. Lung and hemodynamic function was assessed on the half-hour. Bronchoalveolar
lavage fluid (BALF) was analyzed for cytokines. Lung tissue was harvested for histologic
analysis.
Results
APRV and HFOV increased PaO2/FiO2 ratio and improved ventilation. APRV reduced BALF TNF-α and IL-8. HFOV caused an
increase in airway hemorrhage. RM+OP decreased SvO2, increased PaCO2, with increased inflammation of lung tissue.
Conclusion
None of the “open lung” techniques were definitively superior to LowVt with respect
to VILI; however, APRV oxygenated and ventilated more effectively and reduced cytokine
concentration compared with LowVt with nearly indistinguishable histopathology. These
data suggest that APRV may be of potential benefit to critically ill patients but
other “open lung” strategies may exacerbate injury.
Key Words
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Article info
Publication history
Published online: November 15, 2010
Received:
July 26,
2010
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
