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. 2009 Jun;24(2):206-11.
doi: 10.1016/j.jcrc.2008.04.005. Epub 2008 Jul 21.

Positive end-expiratory pressure alters the severity and spatial heterogeneity of ventilator-induced lung injury: an argument for cyclical airway collapse

Scott E Sinclair  1 , Emil Chi, Hen-I Lin, William A Altemeier
Affiliations

Positive end-expiratory pressure alters the severity and spatial heterogeneity of ventilator-induced lung injury: an argument for cyclical airway collapse

Scott E Sinclair et al. J Crit Care. 2009 Jun.

Abstract

Purpose: Ventilator-induced lung injury (VILI) is a recognized complication of mechanical ventilation. Although the specific mechanism by which mechanical ventilation causes lung injury remains an active area of study, both alveolar overdistension and cyclical airway collapse and recruitment have been suggested as contributing causes. We hypothesized that mechanical ventilation in the absence of positive end-expiratory pressure (PEEP) causes VILI to be more severe and regionally variable as compared with PEEP = 8 cm H(2)O.

Materials and methods: To test this hypothesis, anesthetized, supine rabbits were mechanically ventilated with an end-inspiratory pressure of 28 cm H(2)O and either 0 or 8 cm H(2)O PEEP for 4 hours. Regional lung injury was determined by histologic scoring.

Results: In the absence of PEEP, lung injury was regionally variable and greatest in the dorsal-caudal lung. This regional injury heterogeneity was abolished by the addition of PEEP = 8 cm H(2)O.

Conclusions: These results suggest that VILI is regionally heterogeneous and spatially correlates with regions in which cyclical airway collapse and recruitment is most likely to occur.

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Figures

Figure 1
Figure 1
Lung Divisions: Each lung was divided into five regions. The first region included all lung pieces in all ventral-dorsal sections that were adjacent to the diaphragm at any point. The remaining lung was divided into four regions as indicated based on bisecting transverse and coronal planes.
Figure 2
Figure 2
Gross appearance of lungs mechanically ventilated with to an end-inspiratory pressure of 28-cmH2O over for hours either in the absence (left) or presence (right) of PEEP = 8-cm H2O.
Figure 3
Figure 3
Total lung injury scores (A) and standard deviation of regional lung injury scores across the five lung divisions (B) for rabbits ventilated with 0- or 8-cmH2O PEEP.
Figure 4
Figure 4
Lung injury scores separated by lung region for rabbits ventilated with 0- or 8-cmH2O PEEP. * indicates a significant (p≤0.05) difference between 0- and 8-cmH2O PEEP.
See this image and copyright information in PMC

References

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