Author:
Fardin Luca,Broche Ludovic,Lovric Goran,Mittone Alberto,Stephanov Olivier,Larsson Anders,Bravin Alberto,Bayat Sam
Abstract
AbstractMechanical ventilation can damage the lungs, a condition called Ventilator-Induced Lung Injury (VILI). However, the mechanisms leading to VILI at the microscopic scale remain poorly understood. Here we investigated the within-tidal dynamics of cyclic recruitment/derecruitment (R/D) using synchrotron radiation phase-contrast imaging (PCI), and the relation between R/D and cell infiltration, in a model of Acute Respiratory Distress Syndrome in 6 anaesthetized and mechanically ventilated New-Zealand White rabbits. Dynamic PCI was performed at 22.6 µm voxel size, under protective mechanical ventilation [tidal volume: 6 ml/kg; positive end-expiratory pressure (PEEP): 5 cmH2O]. Videos and quantitative maps of within-tidal R/D showed that injury propagated outwards from non-aerated regions towards adjacent regions where cyclic R/D was present. R/D of peripheral airspaces was both pressure and time-dependent, occurring throughout the respiratory cycle with significant scatter of opening/closing pressures. There was a significant association between R/D and regional lung cellular infiltration (p = 0.04) suggesting that tidal R/D of the lung parenchyma may contribute to regional lung inflammation or capillary-alveolar barrier dysfunction and to the progression of lung injury. PEEP may not fully mitigate this phenomenon even at high levels. Ventilation strategies utilizing the time-dependence of R/D may be helpful in reducing R/D and associated injury.
Funder
Swedish Heart and Lung Foundation
Swedish Research Council
Agence Nationale de la Recherche
Publisher
Springer Science and Business Media LLC
Reference63 articles.
1. Ashbaugh, D., Boyd Bigelow, D., Petty, T. & Levine, B. Acute respiratory distress in adults. Lancet 290, 319–323 (1967).
2. The ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin definition. JAMA 307, 2526–2533 (2012).
3. Bellani, G., Laffey, J. G., Pham, T. & Fan, E. The LUNG SAFE study: a presentation of the prevalence of ARDS according to the Berlin Definition! Crit. Care 20, 268 (2016).
4. Bates, J. H. T. & Smith, B. J. Ventilator-induced lung injury and lung mechanics. Ann. Transl. Med. Publ. Ahead Print 6, 378 (2018).
5. Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N. Engl. J. Med. 342, 1301–1308 (2000).
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