Oleic acid vs saline solution lung lavage-induced acute lung injury - Effects on lung morphology, pressure-volume relationships, and response to positive end-expiratory pressure
Oleic acid vs saline solution lung lavage-induced acute lung injury - Effects on lung morphology, pressure-volume relationships, and response to positive end-expiratory pressure
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DOI：
10.1378/chest.130.2.392
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发表时间：
2006-08-01
期刊：
影响因子：
9.6
通讯作者：
Pelosi, Paolo
中科院分区：
文献类型：
--
作者：
Luecke, Thomas;Meinhardt, Juergen P.;Pelosi, Paolo
目的：比较两种肺损伤模型（油酸[OA]和生理盐水冲洗[SW]）的肺形态、局部充气和静态压力-容积（PV）曲线中的肺复张，以及低于和高于下拐点（Pflex）的呼气末正压（PEEP）的影响。使用CT测量肺体积。同时行肺尖、肺底CT扫描，获得肺静脉曲线。分数膨胀和招聘进行了比较，PEEP的数据高于和低于Pflex.Results：肺损伤的严重程度是可比的。在零PEEP时，SW显示水肿量增加和通气不良的肺容量，吸气时复张，PEEP时氧合反应更好。两种模型的全肺PV曲线相似，反映了肺泡充气或放气的变化。在吸气肺静脉分支上，复张和充气在同一条线上，而在呼气分支上，放气和去复张之间存在实质性差异。结论：（1）OA和SW模型在力学上具有可比性，但在肺损伤特征上无可比性;（2）吸气和呼气全肺PV曲线均不能作为PEEP选择的依据;（3）肺复张后，高PEEP组SW肺基底段的去复张程度无明显差异，而低PEEP组SW肺基底段的塌陷程度较低PEEP组明显。
Objective: To compare two lung injury models (oleic acid [OA] and saline solution washout [SW]) regarding lung morphology, regional inflation, and recruitment during static pressure-volume (PV) curves, and the effects of positive end-expiratory pressure (PEEP) below and above the lower inflection point (Pflex).Methods: Fourteen adult pigs underwent OA or SW lung injury. Lung volumes were measured using CT. PV curves were obtained with simultaneous CT scanning at lung apex and base. Fractional inflation and recruitment were compared to data on PEEP above and below Pflex.Results: Severity of lung injury was comparable. At zero PEEP, SW showed an increased amount of edema and poorly aerated lung volume, recruitment during inspiration, and a better oxygenation response with PEEP. Whole-lung PV curves were similar in both models, reflecting changes in alveolar inflation or deflation. On the inspiratory PV limb, recruitment and inflation were on the same line, while there was a substantial difference between deflation and derecruitment on the expiratory limb. PEEP-induced recruitment at lung apex and base was at or above the derecruitment line on the expiratory limb and showed no relationship to the whole-lung expiratory PV curve.Conclusions: The following conclusions were made: (1) OA and SW models are comparable in mechanics but not in lung injury characteristics; (2) neither inspiratory nor expiratory whole-lung PV curves are useful to select PEEP in order to optimize recruitment; and (3) after recruitment, there is no difference in derecruitment between the models at high PEEP, while more collapse occurs at lower PEEP in the basal sections of SW lungs.