Biological Impact of Transpulmonary Driving Pressure in Experimental Acute Respiratory Distress Syndrome

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art_SAMARY_Biological_Impact_of_Transpulmonary_Driving_Pressure_in_Experimental_2015.PDF (1006.63 KB)
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52
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article
Data de publicação
2015
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LIPPINCOTT WILLIAMS & WILKINS
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Scopus
Web of Science
PubMed
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Autores
SAMARY, Cynthia S.
SANTOS, Raquel S.
SANTOS, Cintia L.
FELIX, Nathane S.
BENTES, Maira
BARBOZA, Thiago
MORALES, Marcelo M.
GARCIA, Cristiane S. N. B.
SOUZA, Sergio A. L.
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ANESTHESIOLOGY, v.123, n.2, p.423-433, 2015
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Resumo
Background: Ventilator-induced lung injury has been attributed to the interaction of several factors: tidal volume (V-T), positive end-expiratory pressure (PEEP), transpulmonary driving pressure (difference between transpulmonary pressure at end-inspiration and end-expiration, P,L), and respiratory system plateau pressure (Pplat,rs). Methods: Forty-eight Wistar rats received Escherichia coli lipopolysaccharide intratracheally. After 24h, animals were randomized into combinations of V-T and PEEP, yielding three different P,L levels: P,L-LOW (V-T = 6ml/kg, PEEP = 3cm H2O); P,L-MEAN (V-T = 13ml/kg, PEEP = 3cm H2O or V-T = 6ml/kg, PEEP = 9.5cm H2O); and P,L-HIGH (V-T = 22ml/kg, PEEP = 3cm H2O or V-T = 6ml/kg, PEEP = 11cm H2O). In other groups, at low V-T, PEEP was adjusted to obtain a Pplat,rs similar to that achieved with P,L-MEAN and P,L-HIGH at high V-T. Results: At P,L-LOW, expressions of interleukin (IL)-6, receptor for advanced glycation end products (RAGE), and amphiregulin were reduced, despite morphometric evidence of alveolar collapse. At P,L-HIGH (V-T = 6ml/kg and PEEP = 11cm H2O), lungs were fully open and IL-6 and RAGE were reduced compared with P,L-MEAN (27.412.9 vs. 41.6 +/- 14.1 and 0.6 +/- 0.2 vs. 1.4 +/- 0.3, respectively), despite increased hyperinflation and amphiregulin expression. At P,L-MEAN (V-T = 6ml/kg and PEEP = 9.5cm H2O), when PEEP was not high enough to keep lungs open, IL-6, RAGE, and amphiregulin expression increased compared with P,L-LOW (41.6 +/- 14.1 vs. 9.0 +/- 9.8, 1.4 +/- 0.3 vs. 0.6 +/- 0.2, and 6.7 +/- 0.8 vs. 2.2 +/- 1.0, respectively). At Pplat,rs similar to that achieved with P,L-MEAN and P,L-HIGH, higher V-T and lower PEEP reduced IL-6 and RAGE expression. Conclusion: In the acute respiratory distress syndrome model used in this experiment, two strategies minimized ventilator-induced lung injury: (1) low V-T and PEEP, yielding low P,L and Pplat,rs; and (2) low V-T associated with a PEEP level sufficient to keep the lungs open.
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https://observatorio.fm.usp.br/handle/OPI/12464
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MPT