Variable Ventilation Improved Respiratory System Mechanics and Ameliorated Pulmonary Damage in a Rat Model of Lung Ischemia-Reperfusion

Overview

Journal Front Physiol

Date 2017 May 18

PMID 28512431

Citations 1

Authors

Andre Soluri-Martins

Lillian Moraes

Raquel S Santos

Cintia L Santos

Robert Huhle

Vera L Capelozzi

Paolo Pelosi

Pedro L Silva

Marcelo Gama de Abreu

Patricia R M Rocco

Affiliations

Soon will be listed here.

Abstract

Lung ischemia-reperfusion injury remains a major complication after lung transplantation. Variable ventilation (VV) has been shown to improve respiratory function and reduce pulmonary histological damage compared to protective volume-controlled ventilation (VCV) in different models of lung injury induced by endotoxin, surfactant depletion by saline lavage, and hydrochloric acid. However, no study has compared the biological impact of VV vs. VCV in lung ischemia-reperfusion injury, which has a complex pathophysiology different from that of other experimental models. Thirty-six animals were randomly assigned to one of two groups: (1) ischemia-reperfusion (IR), in which the left pulmonary hilum was completely occluded and released after 30 min; and (2) Sham, in which animals underwent the same surgical manipulation but without hilar clamping. Immediately after surgery, the left (IR-injured) and right (contralateral) lungs from 6 animals per group were removed, and served as non-ventilated group (NV) for molecular biology analysis. IR and Sham groups were further randomized to one of two ventilation strategies: VCV ( = 6/group) [tidal volume (V) = 6 mL/kg, positive end-expiratory pressure (PEEP) = 2 cmHO, fraction of inspired oxygen (FiO) = 0.4]; or VV, which was applied on a breath-to-breath basis as a sequence of randomly generated V values ( = 1200; mean V = 6 mL/kg), with a 30% coefficient of variation. After 5 min of ventilation and at the end of a 2-h period (Final), respiratory system mechanics and arterial blood gases were measured. At Final, lungs were removed for histological and molecular biology analyses. Respiratory system elastance and alveolar collapse were lower in VCV than VV (mean ± SD, VCV 3.6 ± 1.3 cmH0/ml and 2.0 ± 0.8 cmH0/ml, = 0.005; median [interquartile range], VCV 20.4% [7.9-33.1] and VV 5.4% [3.1-8.8], = 0.04, respectively). In left lungs of IR animals, VCV increased the expression of interleukin-6 and intercellular adhesion molecule-1 compared to NV, with no significant differences between VV and NV. Compared to VCV, VV increased the expression of surfactant protein-D, suggesting protection from type II epithelial cell damage. In conclusion, in this experimental lung ischemia-reperfusion model, VV improved respiratory system elastance and reduced lung damage compared to VCV.

Citing Articles

Variability in Tidal Volume Affects Lung and Cardiovascular Function Differentially in a Rat Model of Experimental Emphysema.

Wierzchon C, Padilha G, Rocha N, Huhle R, Coelho M, Santos C Front Physiol. 2018; 8:1071.

PMID: 29326605 PMC: 5741669. DOI: 10.3389/fphys.2017.01071.

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