Comparative analysis of changes in the lungs of experimental animals’ induced conventional and lung protective ventilation

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DOI : https://doi.org/10.12681/jhvms.16423
N. VIDENOVIC
Department of Anesthesiology and Intensive Care, Faculty of Medicine, University in Kosovska Mitrovica
J. MLADENOVIC
Department of Surgery, Faculty of Medicine, University in Kosovska Mitrovica, Serbia Clinical Center in Gracanica
V. VIDENOVIC
Department of Neonatology, General Hospital in Leskovac
R. ZDRAVKOVIC
Department of Anesthesiology and Intensive Care, Faculty of Medicine, University in Kosovska Mitrovica, Serbia Clinical Center in Gracanica
Résumé

Mechanical ventilation has long been the leader in the treatment of critically ill and injured patients in an intensive care unit. The aim of this study was to examine the impact of the application of positive end-expiratory pressure on histopathological findings and on the parameters of ventilation, oxygenation and acid-base status. The experimental study included 42 animals (piglets), which were divided into of tree groups, each containing 14. The animals of the control group (conventional ventilation) were ventilated with the tidal volume of 10-15 mL/kg. Tidal volume of 6 mL/kg was applied in the low tidal ventilation group, whereas the ventilation strategy in the lung protective ventilation group meant the application of a tidal volume of 6 mL/kg and the 7 mbar of positive end-expiratory pressure. Mechanical ventilation in each animal lasted for 4 hours. After conducting mechanical ventilation, samples were taken from the lung tissue, which were sent for histopathological examination. The parameters of ventilation, oxygenation and acid-base status were measured after each hour’s duration of mechanical ventilation. Application of positive end-expiratory pressure 5-10 mbar during mechanical ventilation is a safe and useful method which is not followed by the occurrence of significant abnormalities in the structure of the ventilated lung. However, a low tidal volume without positive end-expiratory pressure causes significant changes in the histological structure of healthy lungs. Positive end-expiratory pressure keeps the alveoli open throughout the respiratory cycle which allows the lungs to maintain homeostasis in terms of adequate ventilation, oxygenation and acid-base status.

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Références
Argiras EP, Blakeley CR, Dunnill MS, Otremski S, Sykes MK (1987) High PEEP decreases hyaline membrane formation in surfactant deficient lungs. Br J Anaesth; 59:1278–85.
Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratorydistress in a adults. Lancet; 2:319.
Badet M, Bayle F, Richard JC, Guérin C (2009) Comparison of optimal positive end-expiratory pressure and recruitment maneuvers during lung-protective mechanical ventilation in patients with acute lung injury/acute respiratory distress syndrome. Respir Care; 54(7):847-54.
Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, Slutsky AS, Pullenayegum E, Zhou Q, Cook D, Brochard L, Richard JC, Lamontagne F, Bhatnagar N, Stewart TE, Guyatt G (2010) Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distresssyndrome: systematic review and meta analysis. JAMA; 303: 865–873.
Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, Schoenfeld D, Thompson BT; National Heart, Lung, and Blood Institute ARDS Clinical Trials Network (2004) National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med; 351: 327–336.
Ç Yardimci, G Meyanci, H Öz and I Paksoy (2001) The histopathological changes comparison in healthy rabbit lung ventilated with ZEEP, Sigh and PEEP. Crit Care; 5(Suppl 1): P 029.
Caironi P, Cressoni M, Chiumello D, Ranieri M, Quintel M, Russo SG, Cornejo R, Bugedo G, Carlesso E, Russo R, Caspani L, Gattinoni L (2010) Lung opening and closing Turing ventilation of acute respiratory distress syndrome. Am J Respir Crit Care Med; 181: 578–586.
Chaney MA, Nikolov MP, Blakeman BP, Bakhos M (2000) Protective ventilation attenuates postoperative pulmonary dysfunction in patients undergoing cardiopulmonary bypass. J Cardiothorac Vasc Anesth; 14:514-518.
Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, Tallarini F, Cozzi P, Cressoni M, Colombo A, Marini JJ, Gattinoni L (2008) Lung stress and strain Turing mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med; 178:346–55.
Contreras M, Masterson C, Laffey JG (2015) Permissive hypercapnia: what to remember. Curr Opin Anaesthesiol; 28(1):26-37.
De Prost N, Ricard JD, Saumon G, Dreyfus D (2011) Ventialtor-induced lung injury: historical perspectives and clinical implications. Ann Intensive Care; 1: 28.
Dreyfuss D, Saumon G (2001) Pressure-volume curves. Searching for the grail or laying patients with adult respiratory distress syndrome on Procrustes’ bed? Am J Respir Crit Care Med; 163:2-3.
Dreyfuss D, Soler P, Basset G, Saumon G (1988) High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am J Respir Crit Care Med; 137:1159-64.
Esteban A, Frutos-Vivar F, Muriel A, Ferguson ND, Peñyelas O, Abraira V, Raymondos K, Rios F, Nin N, Apeztequía C, Violi DA, Thille AW, Brochard L, González M, Villagomez AJ, Hurtado J, Davies AR, Du B, Maggiore SM, Pelosi P, Soto L, Tomicic C, D’Empaire G, Matamis D, Abroug F, Moreno RP, Soares MA, Arabi Y, Sandi F, Jibaja M, Amin P, Koh Y, Kuiper MA, Bülow HH, Zeggwagh AA, Anzueto A (2013) Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med; 188:220-230.
Gattinoni L, Carlesso E, Langer T (2012) Towards ultraprotective mechanical ventilation. Curr Opin Anaesthesiol; 25: 141–147.
Gattinoni L, D’Andrea L, Pelosi P, Vitale G, Pesenti A, Fumagalli R (1993) Regional effects and mechanism of positive end expiratory pressure in early adult respiratory distress syndrome. JAMA; 269:2122-7.
Gattinoni L (2011) Counterpoint: Is low tidal volume mechanical ventilation preferred for all patients on ventilation? Chest; 140: 11–13.
Hiil JD, Main FB, Osborn JJ, Gezback F (1965) Correct use of respirator on cardiac patient after operation. Arch Surg; 91:775.
Imberger G, McIlroy D, Pace NL, Wetterslev J, Brok J, Møller AM (2010) Positive end-expiratory pressure (PEEP) during anaesthesia for the prevention of mortality and postoperative pulmonary complications. Cochrane Database Syst Rev;(9): CD007922.
Laffey JG, Kavanagh BP (2000) Biological effects of hypercapnia. Intensive Care Med; 26:133-8.
Marhong J, Fan E (2014) Carbon dioxide in the critically ill: too much or too little of a good thing? Respir Care; 59(10):1597-605.
Marini JJ (2001) Ventilator-induced airway dysfunction? Am J Respir Crit Care Med; 163: 806–807.
Masterson C, Otulakowski G, Kavanagh BP (2015) Hypercapnia: clinical relevance and mechanisms of action. Curr Opin Crit Care; 21(1):7-12.
Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ, Davies AR, Hand LE, Zhou Q, Thabane L, Austin P, Lapinsky S, Baxter A, Russell J, Skrobik Y, Ronco JJ, Stewart TE (2008) Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA; 299: 637–645.
Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL, Lefrant JY, Prat G, Richecoeur J, Nieszkowska A, Gervais C, BaudotJ, Bouadma L, Brochard L (2008) Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA; 299: 646–655.
Muscedere JG, Mullen JB, Gan K, Slutsky AS (1994) Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med; 149:1327-34.
Ni Chonghaile M, Higgins B, Laffey JG (2005) Permissive hypercapnia: role in protective lung ventilatory strategies. Curr Opin Crit Care;11(1):56-62.
Rimensberger PC, Cox PN, Frndova H, Bryan AC (1999) The open lung during small tidal volume ventilation: concepts of recruitment and “optimal” positive end-expiratory pressure. Crit Care Med; 27:1946-52.
Sánchez Casado M, Quintana Díaz M, Palacios D, Hortigüela V, Marco Schulke C, García J, Canabal A, Pérez Pedrero MJ, Velasco Ramos A, Arrese MA (2012) Relationship between the alveolar-arterial oxygen gradient and PaO2/FiO2-introducingPEEP into the model. Med Intensiva; 36(5):329-34.
Sandhar BK, Niblett DJ, Argiras EP, Dunnill MS, Sykes MK (1988) Effects of positive end-expiratory pressure on hyaline membrane formation in a rabbit model of the neonatal respiratory distress syndrome.Intensive Care Med; 14:538-46.
Santa Cruz R, Rojas JI, Nervi R, Heredia R, Ciapponi A (2013) High versus low positive end expiratory pressure (PEEP) levels for mechanically ventilated adult patients with acute lung injury and acute respiratory distress syndrome. The Cochrane database of systematic reviews; 6.
Şentürk M, Slinger P, Cohen E (2015) Intraoperative mechanical ventilation strategies for one lung ventilation. Best Pract Res Clin Anaesthesiol; 29(3):357-69.
Severgnini P, Selmo G, Lanza C, Chiesa A, Frigerio A, Bacuzzi A, Dionigi G, Novario R, Gregoretti C, de Abreu MG, Schultz MJ, Jaber S, Futier E, Chiaranda M, Pelosi P (2013) Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function. Anesthesiology; 118:1307-1321.
Silva PL, Negrini D, Macêdo Rocco PR (2015) Mechanisms of ventilator-induced lung injury in healthy lungs. Best Pract Res Clin Anaesthesiol; 29(3):301-13.
Toth I, Leiner T, Mikor A, Szakmany T, Bogar L, Molnar Z (2007) Hemodynamic and respiratory changes during lung recruitment and descending optimal positive end-expiratory pressure titration in patients with acute respiratory distress syndrome. Crit Care Med; 35(3):787-93.
Treschan TA, Kaisers W, Schaefer MS, Bastin B, Schmalz U, Wania V, Eisenberger CF, Saleh A, Weiss M, Schmitz A, Kienbaum P, Sessler DI, Pannen B, Beiderlinden M (2012) Ventilation with low tidal volumes during upper abdominal surgery does not improve postoperative lung function. Br J Anaesth; 109:263-271.
Tugrul S, Cakar N, Akinci O, Ozcan PE, Disci R, Esen F, Telci L, Akpir K (2005) Time required for equilibration of arterial oxygen pressure after setting optimal positive end-expiratory pressure in acute respiratory distress syndrome. Crit Care Med; 33(5):995-1000.
Villar J, Herrera-Abreu MT, Valladares F, Muros M, Pérez-Méndez L, Flores C, Kacmarek RM (2009) Experimental ventilator-induced lung injury: exacerbation by positive end-expiratory pressure. Anesthesiology; 110(6):1341-7.
Webb HH, Tierney DF (1974) Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures. Protection by positive end-expiratory pressure. Am Rev Respir Dis; 110:556-65.
Whitehead T, Slutsky AS (2002) The pulmonary physician in critical care *7: ventilator induced lung injury. Thorax; 57: 635–642.
Yuda Sutherasan, Maria Vargas, Paolo Pelosi (2014) Protective mechanical ventilation in the non injured lung: review and meta-analysis. Critical Care; 18:211.