JOURNAL ARTICLE

Effects of variable versus nonvariable controlled mechanical ventilation on pulmonary inflammation in experimental acute respiratory distress syndrome in pigs

Jakob Wittenstein, Martin Scharffenberg, Anja Braune, Robert Huhle, Thomas Bluth, Moritz Herzog, Andreas Güldner, Lorenzo Ball, Francesca Simonassi, Ines Zeidler-Rentzsch, Marcos F Vidal Melo, Thea Koch, Patricia R M Rocco, Paolo Pelosi, Jörg Kotzerke, Marcelo Gama de Abreu, Thomas Kiss
British Journal of Anaesthesia 2020 February 4
32033744

BACKGROUND: Mechanical ventilation with variable tidal volumes (VT ) may improve lung function and reduce ventilator-induced lung injury in experimental acute respiratory distress syndrome (ARDS). However, previous investigations were limited to less than 6 h, and control groups did not follow clinical standards. We hypothesised that 24 h of mechanical ventilation with variable VT reduces pulmonary inflammation (as reflected by neutrophil infiltration), compared with standard protective, nonvariable ventilation.

METHODS: Experimental ARDS was induced in 14 anaesthetised pigs with saline lung lavage followed by injurious mechanical ventilation. Pigs (n=7 per group) were randomly assigned to using variable VT or nonvariable VT modes of mechanical ventilation for 24 h. In both groups, ventilator settings including positive end-expiratory pressure and oxygen inspiratory fraction were adjusted according to the ARDS Network protocol. Pulmonary inflammation (primary endpoint) and perfusion were assessed by positron emission tomography using 2-deoxy-2-[18 F]fluoro-d-glucose and 68 Gallium (68 Ga)-labelled microspheres, respectively. Gas exchange, respiratory mechanics, and haemodynamics were quantified. Lung aeration was determined using CT.

RESULTS: The specific global uptake rate of 18 F-FDG increased to a similar extent regardless of mode of mechanical ventilation (median uptake for variable VT =0.016 min-1 [inter-quartile range, 0.012-0.029] compared with median uptake for nonvariable VT =0.037 min-1 [0.008-0.053]; P=0.406). Gas exchange, respiratory mechanics, haemodynamics, and lung aeration and perfusion were similar in both variable and nonvariable VT ventilatory modes.

CONCLUSION: In a porcine model of ARDS, 24 h of mechanical ventilation with variable VT did not attenuate pulmonary inflammation compared with standard protective mechanical ventilation with nonvariable VT .

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