Prone Position Minimizes the Exacerbation of Effort-dependent Lung Injury: Exploring the Mechanism in Pigs and Evaluating Injury in Rabbits
Prone Position Minimizes the Exacerbation of Effort-dependent Lung Injury: Exploring the Mechanism in Pigs and Evaluating Injury in Rabbits
复制标题
俯卧位可最大限度地减少努力依赖性肺损伤的恶化：探索猪的机制并评估兔子的损伤
DOI：
10.1097/aln.0000000000004165
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发表时间：
2022
期刊：
影响因子：
8.8
通讯作者：
Fujino Yuji
中科院分区：
文献类型：
--
作者：
Yoshida Takeshi;Engelberts Doreen;Chen Han;Li Xuehan;Katira Bhushan H.;Otulakowski Gail;Fujino Yuji
研究背景剧烈的自发性活动可能加重肺损伤。本研究假设，俯卧位将减少肺应力和膨胀后，血管收缩和减少自发性努力，从而减少肺injure.MethodsA严重急性呼吸窘迫综合征模型建立耗尽表面活性物质和损伤性机械通气在6只雄性猪（“机制”协议）和12只雄性家兔（“肺损伤”协议）。在机制协议中，区域吸气负胸膜压力摆动（支气管内球囊测压）和相应的肺充气（电阻抗断层扫描）与位置（仰卧或俯卧）和呼气末正压（高或低）匹配的自发努力的强度的组合进行了测量。在肺损伤方案中，自发努力的强度（食管测压）和区域肺损伤进行了比较，在仰卧位与俯卧位。ResultsThe机制协议（猪）发现，在俯卧位，没有腹背梯度负胸膜压力摆动后，痉挛性收缩，不管呼气末正压水平如何（低呼气末正压时-10.3 ± 3.3 cm H2O vs. -11.7 ± 2.4 cm H2O，P = 0.115;在高呼气末正压下，-10.4 ± 3.4 cm H2O vs. -10.8 ± 2.3 cm H2O，P = 0.715），实现均匀充气。然而，在仰卧位，低呼气末正压时自发性努力在负性胸膜压力摆动中具有最大的腹背梯度（-9.8 ± 2.9 cm H2O vs. -18.1 ± 4.0 cm H2O，P2O vs. -13.3 ± 2.3 cm H2O，P vs.背肺，74.0 ± 30.9 μm · min-1 · mg-1蛋白vs 61.0 ± 23.0 μm · min-1 · mg-1蛋白，P = 0.951）。在仰卧位，更强的自发性努力增加背侧肺损伤（腹肺与背肺髓过氧化物酶活性分别为67.5 ± 38.1 μm · min-1 · mg-1蛋白质与167.7 ± 65.5 μm · min-1 · mg-1蛋白质，P = 0.003）。减少了由自发努力所施加的肺应力和充气的分布不均，并减轻自发努力，导致较少的努力依赖性肺损伤。
BackgroundVigorous spontaneous effort can potentially worsen lung injury. This study hypothesized that the prone position would diminish a maldistribution of lung stress and inflation after diaphragmatic contraction and reduce spontaneous effort, resulting in less lung injury.MethodsA severe acute respiratory distress syndrome model was established by depleting surfactant and injurious mechanical ventilation in 6 male pigs (“mechanism” protocol) and 12 male rabbits (“lung injury” protocol). In the mechanism protocol, regional inspiratory negative pleural pressure swing (intrabronchial balloon manometry) and the corresponding lung inflation (electrical impedance tomography) were measured with a combination of position (supine or prone) and positive end-expiratory pressure (high or low) matching the intensity of spontaneous effort. In the lung injury protocol, the intensities of spontaneous effort (esophageal manometry) and regional lung injury were compared in the supine position versus prone position.ResultsThe mechanism protocol (pigs) found that in the prone position, there was no ventral-to-dorsal gradient in negative pleural pressure swing after diaphragmatic contraction, irrespective of the positive end-expiratory pressure level (–10.3 ± 3.3 cm H2O vs. –11.7 ± 2.4 cm H2O at low positive end-expiratory pressure, P = 0.115; –10.4 ± 3.4 cm H2O vs. –10.8 ± 2.3 cm H2O at high positive end-expiratory pressure, P = 0.715), achieving homogeneous inflation. In the supine position, however, spontaneous effort during low positive end-expiratory pressure had the largest ventral-to-dorsal gradient in negative pleural pressure swing (–9.8 ± 2.9 cm H2O vs. –18.1 ± 4.0 cm H2O, P 2O vs. –13.3 ± 2.3 cm H2O, P vs. dorsal lung, 74.0 ± 30.9 μm · min–1 · mg–1 protein vs. 61.0 ± 23.0 μm · min–1 · mg–1 protein, P = 0.951). In the supine position, stronger spontaneous effort increased dorsal lung injury (lung myeloperoxidase activity in ventral vs. dorsal lung, 67.5 ± 38.1 μm · min–1 · mg–1 protein vs. 167.7 ± 65.5 μm · min–1 · mg–1 protein, P = 0.003).ConclusionsProne position, independent of positive end-expiratory pressure levels, diminishes a maldistribution of lung stress and inflation imposed by spontaneous effort and mitigates spontaneous effort, resulting in less effort-dependent lung injury.