Airway pressure release ventilation reduces conducting airway micro-strain in lung injury.
Airway pressure release ventilation reduces conducting airway micro-strain in lung injury.
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DOI：
10.1016/j.jamcollsurg.2014.09.011
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发表时间：
2014-11
影响因子：
5.2
通讯作者：
Gatto, Louis A.
中科院分区：
文献类型：
--
作者：
Kollisch-Singule, Michaela;Emr, Bryanna;Smith, Bradford;Ruiz, Cynthia;Roy, Shreyas;Meng, Qinghe;Jain, Sumeet;Satalin, Joshua;Snyder, Kathy;Ghosh, Auyon;Marx, William H.;Andrews, Penny;Habashi, Nader;Nieman, Gary F.;Gatto, Louis A.
机械通气不当可加重急性肺损伤，导致继发性呼吸机相关性肺损伤(VILI)。我们假设可以通过改变呼吸波形的特定成分(机械呼吸)来减少VILI，并研究了气道压力释放(APRV)和受控强制通气(CMV)对肺微观解剖(肺泡和传导气道)的影响。计算吸气和呼气过程中气体的分布和机械通气过程中产生的应变(微应变)。大鼠麻醉，手术准备，随机分为未损伤对照组(n=2)和四组肺损伤组：1)APRV 75%(n=2)-呼气末时间(TLow)设定为呼气峰值流速(PEFR)的75%；2)APRV 10%(n=2)-Tlow设定为PEFR的10%；3)CMV+PEEP 5cmH2O(PEEP 5；n=2)或4)PEEP 16cmH2O(PEEP 16；n=2)。实验组用吐温灌胃诱导肺损伤，并在不同的环境下进行机械通气。肺固定在吸气高峰和呼气末，以进行标准组织学检查。测量传导气道和肺泡空隙面积，计算传导气道微应变。所有肺损伤组将吸入的气体从肺泡重新分配到传导气道。APRV 75%最大限度地减少了气体在导气管内的再分配和微应变，并在吸气和呼气时提供了与对照组最相似的肺泡空间占有率。在受损的肺中，75%的APRV维持了与正常肺相似的微观解剖气体分布。在以前的研究中，使用75%的APRV显示了肺保护作用，这可能是由于气体在微观解剖水平上的分布更加均匀，以及传导气道微应变的减少。
Improper mechanical ventilation can exacerbate acute lung damage causing a secondary ventilator induced lung injury (VILI). We hypothesize that VILI can be reduced by modifying specific components of the ventilation waveform (mechanical breath) and studied the impact of airway pressure release ventilation (APRV) and controlled mandatory ventilation (CMV) on the lung micro-anatomy (alveoli and conducting airways). The distribution of gas during inspiration and expiration and the strain generated during mechanical ventilation in the micro-anatomy (micro-strain) were calculated. Rats were anesthetized, surgically prepared and randomized into one uninjured Control group (n=2) and four groups with lung injury: 1)APRV 75% (n=2)–time at expiration (TLow) set to terminate appropriately at 75% of Peak Expiratory Flow Rate (PEFR); 2)APRV 10% (n=2)-TLow set to terminate inappropriately at 10% of PEFR; 3)CMV with PEEP 5cmH2O (PEEP 5;n=2) or 4)PEEP 16cmH2O (PEEP 16;n=2). Lung injury was induced in the experimental groups by Tween lavage and ventilated with their respective settings. Lungs were fixed at peak inspiration and end expiration for standard histology. Conducting airway and alveolar air space areas were quantified and conducting airway micro-strain calculated. All lung injury groups redistributed inspired gas away from alveoli into the conducting airways. APRV 75% minimized gas redistribution and micro-strain in the conducting airways and provided the alveolar air space occupancy most similar to Control at both inspiration and expiration. In an injured lung, APRV 75% maintained micro-anatomical gas distribution similar to that of the normal lung. The lung protection demonstrated in previous studies using APRV 75% may be due to a more homogeneous distribution of gas at the micro-anatomical level as well as a reduction in conducting airway micro-strain.
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DOI：
10.1186/cc9036
发表时间：
2010
期刊：
Critical care (London, England)
影响因子：
--
作者：
Bikker IG;Leonhardt S;Reis Miranda D;Bakker J;Gommers D
通讯作者：
Gommers D
DOI：
10.1164/rccm.200710-1589oc
发表时间：
2008-08-15
影响因子：
24.7
作者：
Chiumello, Davide;Carlesso, Eleonora;Gattinoni, Luciano
通讯作者：
Gattinoni, Luciano
影响因子：
3.3
作者：
BACHOFEN, H;GEHR, P;WEIBEL, ER
通讯作者：
WEIBEL, ER
影响因子：
8.8
作者：
Protti, Alessandro;Andreis, Davide T.;Gattinoni, Luciano
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Gattinoni, Luciano
DOI：
10.1055/s-0033-1350105
发表时间：
2013-09-01
影响因子：
1.8
作者：
Kampschulte, M.;Schneider, C. R.;Langheinrich, A. C.
通讯作者：
Langheinrich, A. C.