OBJECTIVE: To determine whether elevations in pulmonary vascular pressure induced by mechanical ventilation are more injurious than elevations of pulmonary vascular pressure of similar magnitude occurring in the absence of mechanical ventilation. DESIGN: Prospective comparative laboratory investigation. SETTING: University research laboratory. SUBJECTS: Male New Zealand white rabbits. INTERVENTIONS: Three groups of isolated, perfused rabbit lungs were exposed to cyclic elevation of pulmonary artery pressures arising from either intermittent positive pressure mechanical ventilation or from pulsatile perfusion of lungs held motionless by continuous positive airway pressure. Peak, mean, and nadir pulmonary artery pressures and mean airway pressure were matched between groups (35, 27.4 +/- 0.74, and 20.8 +/- 1.5 mm Hg, and 17.7 +/- 0.22 cm H2O, respectively). MEASUREMENTS AND MAIN RESULTS: Lungs exposed to elevated pulmonary artery pressures attributable to intermittent positive pressure mechanical ventilation formed more edema (6.8 +/- 1.3 vs. 1.1 +/- 0.9 g/g of lung), displayed more perivascular (61 +/- 26 vs. 15 +/- 13 vessels) and alveolar hemorrhage (76 +/- 11% vs. 26 +/- 18% of alveoli), and underwent larger fractional declines in static compliance (88 +/- 4.4% vs. 48 +/- 25.1% decline) than lungs exposed to similar peak and mean pulmonary artery pressures in the absence of tidal positive pressure ventilation. CONCLUSIONS: Isolated phasic elevations of pulmonary artery pressure may cause less damage than those occurring during intermittent positive pressure mechanical ventilation, suggesting that cyclic changes in perivascular pressure surrounding extra-alveolar vessels may be important in the genesis of ventilator-induced lung injury.
OBJECTIVE: To determine whether elevations in pulmonary vascular pressure induced by mechanical ventilation are more injurious than elevations of pulmonary vascular pressure of similar magnitude occurring in the absence of mechanical ventilation. DESIGN: Prospective comparative laboratory investigation. SETTING: University research laboratory. SUBJECTS: Male New Zealand white rabbits. INTERVENTIONS: Three groups of isolated, perfused rabbit lungs were exposed to cyclic elevation of pulmonary artery pressures arising from either intermittent positive pressure mechanical ventilation or from pulsatile perfusion of lungs held motionless by continuous positive airway pressure. Peak, mean, and nadir pulmonary artery pressures and mean airway pressure were matched between groups (35, 27.4 +/- 0.74, and 20.8 +/- 1.5 mm Hg, and 17.7 +/- 0.22 cm H2O, respectively). MEASUREMENTS AND MAIN RESULTS: Lungs exposed to elevated pulmonary artery pressures attributable to intermittent positive pressure mechanical ventilation formed more edema (6.8 +/- 1.3 vs. 1.1 +/- 0.9 g/g of lung), displayed more perivascular (61 +/- 26 vs. 15 +/- 13 vessels) and alveolar hemorrhage (76 +/- 11% vs. 26 +/- 18% of alveoli), and underwent larger fractional declines in static compliance (88 +/- 4.4% vs. 48 +/- 25.1% decline) than lungs exposed to similar peak and mean pulmonary artery pressures in the absence of tidal positive pressure ventilation. CONCLUSIONS: Isolated phasic elevations of pulmonary artery pressure may cause less damage than those occurring during intermittent positive pressure mechanical ventilation, suggesting that cyclic changes in perivascular pressure surrounding extra-alveolar vessels may be important in the genesis of ventilator-induced lung injury.
Authors: Thomas Kiss; Thomas Bluth; Anja Braune; Robert Huhle; Axel Denz; Moritz Herzog; Johannes Herold; Luigi Vivona; Marco Millone; Alice Bergamaschi; Michael Andreeff; Martin Scharffenberg; Jakob Wittenstein; Marcos F Vidal Melo; Thea Koch; Patricia R M Rocco; Paolo Pelosi; Jörg Kotzerke; Marcelo Gama de Abreu Journal: Crit Care Med Date: 2019-04 Impact factor: 7.598
Authors: Luciano Gattinoni; John J Marini; Antonio Pesenti; Michael Quintel; Jordi Mancebo; Laurent Brochard Journal: Intensive Care Med Date: 2016-01-18 Impact factor: 17.440
Authors: Ary Serpa Neto; Nicole P Juffermans; Sabrine N T Hemmes; Carmen S V Barbas; Martin Beiderlinden; Michelle Biehl; Ana Fernandez-Bustamante; Emmanuel Futier; Ognjen Gajic; Samir Jaber; Alf Kozian; Marc Licker; Wen-Qian Lin; Stavros G Memtsoudis; Dinis Reis Miranda; Pierre Moine; Domenico Paparella; Marco Ranieri; Federica Scavonetto; Thomas Schilling; Gabriele Selmo; Paolo Severgnini; Juraj Sprung; Sugantha Sundar; Daniel Talmor; Tanja Treschan; Carmen Unzueta; Toby N Weingarten; Esther K Wolthuis; Hermann Wrigge; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J Schultz Journal: Ann Transl Med Date: 2018-01