Mechanical Ventilation Affects Lung Function and Cytokine Production in an Experimental Model of Endotoxemia

Author:

Brégeon Fabienne1,Delpierre Stéphane2,Chetaille Bruno3,Kajikawa Osamu4,Martin Thomas R5,Autillo-Touati Amapola6,Jammes Yves7,Pugin Jérôme8

Affiliation:

1. Assistant Professor, Staff Pulmonary Physiologist, Staff Anesthesiologist, Laboratoire de Physiopathologie Respiratoire (EA 2201) Institut Jean Roche, Faculté de Médecine, Université de la Méditerranée, and Centre Hospitalier Universitaire (CHU) Nord, Marseille, France.

2. Assistant Professor, Staff Pulmonary Physiologist, Laboratoire de Physiopathologie Respiratoire (EA 2201) Institut Jean Roche, Faculté de Médecine, Université de la Méditerranée, and Service des Explorations Fonctionnelles Respiratoires, CHU Hôpital Ste Marguerite, Marseille, France.

3. Resident, staff Histopathologist, Faculté de Médecine, Université de la Méditerranée, and Laboratoire d’Histopathologie, CHU Hôpital Timone, Marseille, France.

4. Research Scientist, Pulmonary Research Laboratories.

5. Professor of Medicine and Chief of Medicine, VA Puget Sound Medical Center, Seattle, Washington.

6. Associate Professor, Laboratoire de Biologie Cellulaire, Institut Jean Roche, Faculté de Médecine, Université de la Méditerranée, Marseille, France.

7. Professor of Physiology, Chief of the Laboratoire de Physiopathologie Respiratoire (EA 2201), and Chief of the Service d’Explorations Fonctionnelles Respiratoires, CHU Nord, Marseille, France, and Institut Jean Roche, Faculté de Médecine, Université de la Méditerranée, Marseille, France.

8. Senior Lecturer, Attending Physician, Head of the Laboratory of Medical Intensive Care Unit, Medical Intensive Care Unit, University Hospital of Geneva, Switzerland, and Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Switzerland.

Abstract

Background Mechanical ventilation using tidal volumes around 10 ml/kg and zero positive end-expiratory pressure is still commonly used in anesthesia. This strategy has been shown to aggravate lung injury and inflammation in preinjured lungs but not in healthy lungs. In this study, the authors investigated whether this strategy would result in lung injury during transient endotoxemia in the lungs of healthy animals. Methods Volume-controlled ventilation with a tidal volume of 10 ml/kg and zero positive end-expiratory pressure was applied in two groups of anesthetized-paralyzed rabbits receiving either intravenous injection of 5 mug/kg Escherichia coli lipopolysaccharide (n = 10) or saline (n = 10) 2 h after the start of mechanical ventilation. The third group consisted of 10 spontaneously breathing anesthetized animals receiving lipopolysaccharide. Anesthesia was then continued for 4 h in the three groups while the ventilatory modes were maintained unchanged. Lung injury was studied using blood gases, respiratory physiologic variables, analysis of the bronchoalveolar lavage cell counts, and cytokine concentrations and lung pathologic examination. Results Significant histologic lung alterations, hypoxemia, and altered lung mechanics were observed in rabbits treated with mechanical ventilation and intravenous lipopolysaccharide but not in the mechanically ventilated animals injected with saline or in spontaneously breathing animals treated with lipopolysaccharide. Endotoxemic ventilated animals also had significantly more lung inflammation as assessed by the alveolar concentration of neutrophils, and the concentrations of the chemokines interleukin 8 and growth-related oncogen alpha. Conclusions These results showed that positive-pressure mechanical ventilation using a tidal volume of 10 ml/kg and zero positive end-expiratory pressure was harmful in the setting of endotoxemia, suggesting that the use of this ventilator strategy in the operating room may predispose to lung injury when endotoxemia occurs.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

Reference52 articles.

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