Dynamic Mechanical Interactions Between Neighboring Airspaces Determine Cyclic Opening and Closure in Injured Lung

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art_BROCHE_Dynamic_Mechanical_Interactions_Between_Neighboring_Airspaces_Determine_Cyclic_2017.PDF (1.1 MB)
Citações na Scopus
31
Tipo de produção
article
Data de publicação
2017
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
LIPPINCOTT WILLIAMS & WILKINS
Autores
BROCHE, Ludovic
PERCHIAZZI, Gaetano
PORRA, Liisa
TANNOIA, Angela
PELLEGRINI, Mariangela
DEROSA, Savino
SINDACO, Alessandra
DEGRUGILLIERS, Loic
LARSSON, Anders
Citação
CRITICAL CARE MEDICINE, v.45, n.4, p.687-694, 2017
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Objectives: Positive pressure ventilation exposes the lung to mechanical stresses that can exacerbate injury. The exact mechanism of this pathologic process remains elusive. The goal of this study was to describe recruitment/derecruitment at acinar length scales over short-time frames and test the hypothesis that mechanical interdependence between neighboring lung units determines the spatial and temporal distributions of recruitment/derecruitment, using a computational model. Design: Experimental animal study. Setting: International synchrotron radiation laboratory. Subjects: Four anesthetized rabbits, ventilated in pressure controlled mode. Interventions: The lung was consecutively imaged at - 1.5-minute intervals using phase-contrast synchrotron imaging, at positive end expiratory pressures of 12, 9, 6, 3, and 0 cm H2O before and after lavage and mechanical ventilation induced injury. The extent and spatial distribution of recruitment/derecruitment was analyzed by subtracting subsequent images. In a realistic lung structure, we implemented a mechanistic model in which each unit has individual pressures and speeds of opening and closing. Derecruited and recruited lung fractions (F-derecruaed, F-recruited) were computed based on the comparison of the aerated volumes at successive time points. Measurements and Main Results: Alternative recruitment/derecruitment occurred in neighboring alveoli over short-time scales in all tested positive end-expiratory pressure levels and despite stable pressure controlled mode. The computational model reproduced this behavior only when parenchymal interdependence between neighboring acini was accounted for. Simulations closely mimicked the experimental magnitude of F-derecruited and F-recruited when mechanical interdependence was included, while its exclusion gave F-recruited values of zero at positive end -expiratory pressure greater than or equal to 3 cm H2O. Conclusions: These findings give further insight into the microscopic behavior of the injured lung and provide a means of testing protective-ventilation strategies to prevent recruitment/derecruitment and subsequent lung damage. (Crit Care Med 2017; 45:687-694)
Palavras-chave
acute respiratory distress syndrome, assisted ventilation, imaging/computed tomography, pulmonary oedema, synchrotron
URI
https://observatorio.fm.usp.br/handle/OPI/20358
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Coleções
Artigos e Materiais de Revistas Científicas - LIM/09