Effects of continuous tracheal gas insufflation during pressure limited ventilation on pulmonary surfactant in rabbits with acute lung injury
- Author:
- No author available
- Journal Title:
- CHINESE MEDICAL JOURNAL
- Issue:
- 17
- DOI:
- No doi available
- Key Word:
- tracheal gas insufflation;acute lung injury;pulmonary surfactant;ventilator induced lung injury;mechanical ventilation
Abstract： Background Pulmonary surfactant dysfunction may contribute to the development of ventilator induced lung injury (VILI). Tracheal gas insufflation (TGI) is a technique in which fresh gas is introduced into the trachea and augment ventilation by reducing the dead space of ventilatory system, reducing ventilatory pressures and tidal volume (VT) while maintaining constant partial arterial CO2 pressure (PaCO2). We hypothesised that TGI limited peak inspiratory pressure (PIP) and VT and would minimize conventional mechanical ventilation (CMV) induced pulmonary surfactant dysfunction and thereby attenuate VILI in rabbits with acute lung injury (ALI).Methods ALI was induced by intratracheal administration of lipopolysaccharide in anaesthetized, ventilated healthy adult rabbits randomly assigned to continuous TGI at 0.5 L/min (TGI group) or CMV group (n=8 for each group), and subsequently ventilated with limited PIP and VT to maintain PaCO2 within 35 to 45 mmHg for 4 hours. Physiological dead space to VT ratio (VD/VT), dynamic respiratory compliance (Cdyn) and partial arterial O2 pressure (PaO2) were monitored. After ventilation, lungs were analysed for total phospholipids (TPL), total proteins (TP), pulmonary surfactant small to large aggregates ratio (SA/LA) in bronchoalveolar lavage fluid (BALF) and for determination of alveolar volume density (Vv), myeloperoxidase and interleukin (IL)-8.Results TGI resulted in significant (P＜0.05 or P＜0.01) decrease in PIP [(22.4±1.8) cmH2O vs (29.5±1.1) cmH2O], VT [(6.9±1.3) ml/kg vs (9.8±1.11) ml/kg], VD/VT [(32±5)% vs (46±2)%], TP [(109±22) mg/kg vs (187±25) mg/kg], SA/LA (2.5±0.4 vs 5.4±0.7), myeloperoxidase [(6.2±0.5) U/g tissue vs (12.3±0.8) U/g tissue] and IL-8 [(987±106) ng/g tissue vs (24±3) mN/m] of BALF, and significant (P＜0.05) increase in Cdyn [(0.47±0.02) ml ·cmH2O-1 ·kg-1 vs (0.31±0.02) ml ·cmH2O-1 ·kg-1], PaO2 [(175±24) mmHg vs (135±26) mmHg],TPL/TP (52±8 vs 33±11) and Vv (0.65±0.05 vs 0.44±0.07) as compared with CMV.Conclusions In this animal model of ALI, TGI decreased ventilatory requirements (PIP, VT and VD/VT),resulted in more favourable alveolar pulmonary surfactant composition and function and less severity of lung injury than CMV. TGI in combination with pressure limited ventilation may be a lung protective strategy for ALI.
- [1]ZHANG Xin-ri,DU Yong-Cheng,JIANG Hong-ying,etc.Experimental study of acute lung injury induced by different tidal volume ventilation in rats[J].2005,(9).
- [2]詹庆元,王辰,商鸣宇,等.自主呼吸条件下双相气道正压通气与持续性气管内吹气联合运用的实验研究[J].2001,(6).
- [3]J L, Malloy,R A, Veldhuizen,J F, Lewis.Effects of ventilation on the surfactant system in sepsis-induced lung injury.[J].2000,88.
- [4]G, Dassieu,L, Brochard,M, Benani,etc.Continuous tracheal gas insufflation in preterm infants with hyaline membrane disease. A prospective randomized trial.[J].2000,162.
- [5]GUANG FA ZHU,KE LIN,YING YUN CAI,etc.Combined Surfactant Therapy and Inhaled Nitric Oxide in Rabbits with Oleic Acid-induced Acute Respiratory Distress Syndrome[J].1998,158(2).
- [6]N J, Gross.Extracellular metabolism of pulmonary surfactant: the role of a new serine protease.[J].1995,57.
- [7]D, Dreyfuss,G, Saumon.Ventilator-induced lung injury: lessons from experimental studies.[J].1998,157.
- [8]Shaffer TH,Greenspan JS,Oliver RE.Tracheal gas insufflation as a lung-protective strategy: Physiologic, histologic, and biochemical markers.[J].2005,6(1).
- [9]Ito Y,Veldhuizen R A,Yao L J,etc.Ventilation strategies affect surfactant aggregate conversion in acute lung injury.[J].1997.
- [10]Pinhu L,Whitehead T,Evans T,etc.Ventilator-associated lung injury.[J].2003,361(9354).
- [11]S, Hota,P S, Crooke,A B, Adams,etc.Optimal phasic tracheal gas insufflation timing: an experimental and mathematical analysis.[J].2006,34.
- [12]Dyer IR,Esmail M,Findlay G,etc.Effect of catheter design on tracheal pressures during tracheal gas insufflation.[J].2003,20(9).
- [13]Q, Zhan,C, Wang,M, Shang.[Effects of continuous tracheal gas insufflation during biphasic intermittent positive airway pressure ventilation on canine model of acute lung injury with spontaneous breathing].[J].2000,80(1).
- [14]G, Enhorning.Pulsating bubble technique for evaluating pulmonary surfactant.[J].1977,43.
- [15]Martinez-Perez, M.,Bernabe, F.,Pena, R.,etc.Effects of expiratory tracheal gas insufflation in patients with severe head trauma and acute lung injury[J].2004,30(11).
- [16]Solomon PJ,Moran JL,Bersten AD.Meta-analysis of controlled trials of ventilator therapy in acute lung injury and acute respiratory distress syndrome: an alternative perspective.[J].2005,31(2).
- [17]KIRMSE MAX,FUJINO YUJI,HROMI JONATHAN,etc.Pressure-release Tracheal Gas Insufflation Reduces Airway Pressures in Lung-injured Sheep Maintaining Eucapnia[J].1999.
- [18]J F, Lewis,M, Ikegami,A H, Jobe.Altered surfactant function and metabolism in rabbits with acute lung injury.[J].1990,69.
- [19]B, Zhang,Y, Liu.[Effects of tracheal gas insufflation on blood gases and respiratory mechanics in acute hypercapnia rabbits].[J].1999,22(9).