Effects of neurally adjusted ventilatory assist on prevention of ventilator-induced diaphragmatic dysfunction in acute respiratory distress syndrome rabbits
- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF TUBERCULOSIS AND RESPIRATORY DISEASES
- Issue:
- 4
- DOI:
- 10.3760/cma.j.issn.1001-0939.2011.04.020
- Key Word:
- 呼吸,人工;呼吸窘迫综合征,成人;膈;Respiration,artificial;Respiratory distress syndrome,adult;Diaphragm
Abstract： Objective To evaluate the effect of neurally adjusted ventilatory assist (NAVA) on prevention of ventilator-induced diaphragmatic dysfunction (VIDD) in ARDS rabbits.Methods Twenty New Zealand white rabbits were randomly divided into 4 groups: ( 1 ) control group ( n = 5 ); ( 2 ) Volume control (VC) group ( n = 5 ); ( 3 ) Pressure support ( PSV ) group ( n = 5 ); (4) NAVA group ( n = 5 ).In VC, PSV and NAVA groups, the rabbits were killed and the diaphragm was removed after 4 hours of ventilation.Animals in the control group were not mechanically ventilated, and the diaphragm was also removed immediately after anesthetizing.In all rabbits, malondialdehyde ( MDA), superoxide disrmutase (SOD) and glutathione(GSH) of diaphragm were measured.Structure of diaphragm was observed by light microscope, electron microscope, constituent ratio and mean cross-sectional area (CSA) of diaphragm fiber.Results (1)MDA: Compared with the control [(0.15 ±0.06)nmol/mg], PSV group[(0.30 ±0.11)nmol/mg], there was no significant difference in MDA of diaphragm in NAVA group [( 0.28 ± 0.19 )nmol/mg] (F = 2.730, P ＞ 0.05).MDA in VC group [(0.40 ±0.16)nmol/mg] was significantly higher than the control group (P＜0.05).(2) SOD: Compared with control [( 111 ± 12) U/mg], PSV group [(93 ± 4) U/mg], there was no significant difference in SOD of diaphragm in NAVA group [( 94 ± 9 )U/mg] (F=4.422,P ＞0.05).SOD in VC group [(80 ±21 )U/mg] was significantly lower than the control group(P ＜0.05).(3)GSH: Compared with control [(5.3 ± 1.0)mg/g] and PSV group [(4.5 ±1.2)mg/g], there was no significant difference in GSH of diaphragm in NAVA group [(5.6 ± 1.0) mg/g](F =3.001 ,P ＞ 0.05 ).GSH in VC group [(3.3 ± 1.7)mg/g] is significantly lower than control and NAVA groups ( P ＜ 0.05 ).( 4 ) Light microscope: In VC group, many changes were observed in the muscle, such as myofibrosis, necrosis, and some of muscle fibers became atrophy, but these were no obvious changes of pathological structure in control, PSV or NAVA groups.(5)Electron microscope: In control, PSV and NAVA groups, the ultrastructure of diaphragm was normal Different from the above 3 groups, some abnormal ultrastructure was observed in VC group, including disrupted myofibrils, swollen mitochondria.(6)CSA of diaphragm fiber: Compared with control and PSV group, there was no significant difference in CSA of diaphragm fiber in NAVA group ( P ＞ 0.05 ); The CSA of type Ⅱ fibers in VC group was markedly lower than control group ( P ＜ 0.05 ) .Conclusions Compared with volume control ventilation, NAVA may mitigate diaphragmatic oxidative stress, atrophy and injury, and prevent VIDD better than VC.
- [1]Georgopoulos D,Prinianakis G,Kondili E.Effects of the flow waveform method of triggering and cycling on patient-ventilator interaction during pressure support.[J].2003,29(11).
- [2]K D, Hunter,J A, Faulkner.Pliometric contraction-induced injury of mouse skeletal muscle: effect of initial length.[J].1997,82(1).
- [3]Deering MA,Lee Y,Falk DJ,etc.Caspase-3 regulation of diaphragm myonuclear domain during mechanical ventilation-induced atrophy.[J].2007,175(2).
- [4]Lopez S,Py G,Bernard N,etc.Effects of prolonged mechanical ventilation on respiratory muscle ultrastructure and mitochondrial respiration in rabbits.[J].2003,29(1).
- [5]A, Brancatisano,T C, Amis,A, Tully,etc.Regional distribution of blood flow within the diaphragm.[J].1991,71.
- [6]Joseph M. McClung,Scott K. Powers,Andreas N. Kavazis.Oxidative stress and disuse muscle atrophy[J].2007,102(6).
- [7]Jean-Christophe, Allo,Jennifer C, Beck,Lukas, Brander,etc.Influence of neurally adjusted ventilatory assist and positive end-expiratory pressure on breathing pattern in rabbits with acute lung injury.[J].2006,34(12).
- [8]Kavazis AN,Talbert EE,Smuder AJ,etc.Mechanical ventilation induces diaphragmatic mitochondrial dysfunction and increased oxidant production.[J].2009,46(6).
- [9]A, Anzueto,J I, Peters,M J, Tobin,etc.Effects of prolonged controlled mechanical ventilation on diaphragmatic function in healthy adult baboons.[J].1997,25.
- [10]Lennon SL,Zergeroglu MA,Yimlamai T,etc.Mechanical ventilation-induced diaphragmatic atrophy is associated with oxidative injury and increased proteolytic activity.[J].2002,166(10).
- [11]Betters JL,Criswell DS,Deering M,etc.Trolox attenuates mechanical ventilation-induced diaphragmatic dysfunction and proteolysis.[J].2004,170(11).
- [12]Friberg S,Lindstrom L,Sinderby C,etc.Neural control of mechanical ventilation in respiratory failure.[J].1999,5(12).
- [13]Tidball JG,Spencer MJ.Expression of a calpastatin transgene slows muscle wasting and obviates changes in myosin isoform expression during murine muscle disuse.[J].2002,545(Pt.3).
- [14]Falk DJ,Nelson WB,Powers SK,etc.Xanthine oxidase contributes to mechanical ventilation-induced diaphragmatic oxidative stress and contractile dysfunction.[J].2009,106(2).
- [15]Kajikawa O,Keshavjee S,de Perrot M,etc.Injurious mechanical ventilation and end-organ epithelial cell apoptosis and organ dysfunction in an experimental model of acute respiratory distress syndrome.[J].2003,289(16).
- [16]Peter Q, Eichacker,Eric P, Gerstenberger,Steven M, Banks,etc.Meta-analysis of acute lung injury and acute respiratory distress syndrome trials testing low tidal volumes.[J].2002,166(11).
- [17]Gallagher P,Schulze K,Trappe S.Resistance training preserves skeletal muscle function during unloading in humans.[J].2002,34(2).
- [18]L J, Greenfield,R P, Singleton,D R, McCaffree,etc.Pulmonary effects of experimental graded aspiration of hydrochloric acid.[J].1969,170(1).
- [19]Powers SK,Decramer M,Testelmans D,etc.Infusions of rocuronium and cisatracurium exert different effects on rat diaphragm function.[J].2007,33(5).
- [20]Sieck GC,Mantilla CB.Effect of mechanical ventilation on the diaphragm.[J].2008,358(13).
- [21]Powers S,Testelmans D,Maes K,etc.Leupeptin inhibits ventilator-induced diaphragm dysfunction in rats.[J].2007,175(11).
- [22]Deering MA,Powers SK,Kavazis AN,etc.Mechanical ventilation promotes redox status alterations in the diaphragm.[J].2006,101(4).
- [23]Petrof BJ,Jaber S,Matecki S.Ventilator-induced diaphragmatic dysfunction.[J].2010,16(1).