We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Risk factors for ventilator-induced-lung injury develop three to five times faster after a single episode of lung injury.
- Authors
Rohrs, Elizabeth C.; Bassi, Thiago G.; Nicholas, Michelle; Wittmann, Jessica; Ornowska, Marlena; Fernandez, Karl C.; Gani, Matt; Reynolds, Steven C.
- Abstract
Introduction: Mechanical ventilator breaths provided to deeply sedated patients have an abnormal volume distribution, encouraging alveolar collapse in dependent regions and promoting alveolar overdistention in non-dependent regions. Collapse and overdistention both start with the first breath and worsen over time, driving ventilator-induced lung injury (VILI). This is exacerbated when the lung is already injured or has increased heterogeneity. Our study investigated the impact of a single episode of lung injury on lung mechanics and the risk factors for ventilator-induced injury, compared with non-injured lungs. Methods: Two groups of pigs were sedated and ventilated using lung-protective volume-controlled mode at 8 mL/kg, positive end-expiratory pressure (PEEP) 5 cmH2O, with respiratory rate and FiO2 set to maintain normal blood gas values. Animals in one group were ventilated for 50 h (50-Hour MV group, n=10). Animals in the second group had lung injury induced using oleic acid and were ventilated for 12 h post-injury (LI MV group, n=6). Both groups were compared with a never-ventilated control group (NV, n=6). Lung mechanics and injury were measured using electrical impedance tomography, esophageal pressure monitoring and tissue histology. Results: End-expiratory lung-volume loss was greater in the 50-Hour MV group (P<0.05). Plateau pressure, driving pressure and lung injury score were higher in the LI MV group, (P<0.05). Conclusion: Risk factors for VILI developed three- to five-times faster in the group with injured lungs, demonstrating that a single lung-injury episode substantially increased the risk of VILI, compared with normal lungs, despite using a lung-protective mechanical ventilation protocol.
- Subjects
LUNG physiology; LUNG injuries; KRUSKAL-Wallis Test; STATISTICS; ANESTHESIA; CHEST X rays; MECHANICAL ventilators; ANIMAL experimentation; POSITIVE end-expiratory pressure; LUNGS; ONE-way analysis of variance; MULTIPLE regression analysis; SWINE; OXYGEN saturation; QUANTITATIVE research; MANN Whitney U Test; RISK assessment; COMPARATIVE studies; ARTIFICIAL respiration; PULMONARY function tests; DESCRIPTIVE statistics; RESEARCH funding; COMPUTED tomography; HISTOLOGY; HEMODYNAMICS; DATA analysis; DISEASE risk factors; SYMPTOMS
- Publication
Canadian Journal of Respiratory Therapy, 2023, Vol 59, p103
- ISSN
1205-9838
- Publication type
Article
- DOI
10.29390/cjrt-2022-075