Positive End-Expiratory Pressure and Variable Ventilation in Lung-Healthy Rats under General Anesthesia
Carregando...
Citações na Scopus
13
Tipo de produção
article
Data de publicação
2014
Editora
PUBLIC LIBRARY SCIENCE
Indexadores
Título da Revista
ISSN da Revista
Título do Volume
Autores
CAMILO, Luciana M.
AVILA, Mariana B.
CRUZ, Luis Felipe S.
RIBEIRO, Gabriel C. M.
SPIETH, Peter M.
RESKE, Andreas A.
GIANNELLA-NETO, Antonio
ZIN, Walter A.
CARVALHO, Alysson R.
Autor de Grupo de pesquisa
Editores
Coordenadores
Organizadores
Citação
PLOS ONE, v.9, n.11, article ID e110817, 10p, 2014
Resumo
Objectives: Variable ventilation (VV) seems to improve respiratory function in acute lung injury and may be combined with positive end-expiratory pressure (PEEP) in order to protect the lungs even in healthy subjects. We hypothesized that VV in combination with moderate levels of PEEP reduce the deterioration of pulmonary function related to general anesthesia. Hence, we aimed at evaluating the alveolar stability and lung protection of the combination of VV at different PEEP levels. Design: Randomized experimental study. Setting: Animal research facility. Subjects: Forty-nine male Wistar rats (200-270 g). Interventions: Animals were ventilated during 2 hours with protective low tidal volume (VT) in volume control ventilation (VCV) or VV and PEEP adjusted at the level of minimum respiratory system elastance (Ers), obtained during a decremental PEEP trial subsequent to a recruitment maneuver, and 2 cmH(2)O above or below of this level. Measurements and Main Results: Ers, gas exchange and hemodynamic variables were measured. Cytokines were determined in lung homogenate and plasma samples and left lung was used for histologic analysis and diffuse alveolar damage scoring. A progressive time-dependent increase in Ers was observed independent on ventilatory mode or PEEP level. Despite of that, the rate of increase of Ers and lung tissue IL-1 beta concentration were significantly lower in VV than in VCV at the level of the PEEP of minimum Ers. A significant increase in lung tissue cytokines (IL-6, IL-1 beta, CINC-1 and TNFalpha) as well as a ventral to dorsal and cranial to caudal reduction in aeration was observed in all ventilated rats with no significant differences among groups. Conclusions: VV combined with PEEP adjusted at the level of the PEEP of minimal Ers seemed to better prevent anesthesia-induced atelectasis and might improve lung protection throughout general anesthesia.
Palavras-chave
Referências
- Bellardine CL, 2006, CRIT CARE MED, V34, P439, DOI 10.1097/01.CCM.0000196208.01682.87
- Bilek AM, 2003, J APPL PHYSIOL, V94, P770, DOI 10.1152/japplphysiol.00764.2002
- Boker A, 2002, AM J RESP CRIT CARE, V165, P456, DOI 10.1164/rccm.2108006
- Boker A, 2004, ANESTHESIOLOGY, V100, P608, DOI 10.1097/00000542-200403000-00022
- Carvalho AR, 2013, ANESTH ANALG, V116, P677, DOI 10.1213/ANE.0b013e318254230b
- Carvalho ARS, 2006, CRIT CARE, V10, DOI 10.1186/cc5030
- Do Anesthesia H, 2013, ANESTHESIOLOGY
- Duggan Michelle, 2007, Curr Opin Anaesthesiol, V20, P37, DOI 10.1097/ACO.0b013e328011d7e5
- Duggan M, 2005, ANESTHESIOLOGY, V102, P838, DOI 10.1097/00000542-200504000-00021
- Frank JA, 2008, THORAX, V63, P147, DOI 10.1136/thx.2007.079608
- Futier E, 2013, NEW ENGL J MED, V369, P428, DOI 10.1056/NEJMoa1301082
- Hedenstierna G, 2012, COMPR PHYSIOL, V2, P69, DOI 10.1002/cphy.c080111
- Hedenstierna G, 2000, Minerva Anestesiol, V66, P293
- Hedenstierna G, 2000, J CLIN MONITOR COMP, V16, P329, DOI 10.1023/A:1011491231934
- HUEMER G, 1994, CHEST, V106, P67, DOI 10.1378/chest.106.1.67
- Huh D, 2007, P NATL ACAD SCI USA, V104, P18886, DOI 10.1073/pnas.0610868104
- Imberger G, 2010, COCHRANE DB SYST REV, DOI 10.1002/14651858.CD007922.pub2
- Jaber S, 2012, ANAESTHESIA, V67, P999, DOI 10.1111/j.1365-2044.2012.07218.x
- JARDIN F, 1981, NEW ENGL J MED, V304, P387, DOI 10.1056/NEJM198102123040703
- Kowalski S, 2013, CAN J ANESTH, V60, P502, DOI 10.1007/s12630-013-9899-5
- Krebs J, 2011, RESP PHYSIOL NEUROBI, V178, P323, DOI 10.1016/j.resp.2011.07.006
- Kumar A, 1973, Crit Care Med, V1, P181, DOI 10.1097/00003246-197307000-00001
- LUTCH JS, 1972, ANN INTERN MED, V76, P193
- Ma BS, 2011, J APPL PHYSIOL, V110, P1319, DOI 10.1152/japplphysiol.01364.2010
- Mead J, 1959, J APPL PHYSL
- MEAD J, 1970, J APPL PHYSIOL, V28, P596
- Mutch WAC, 2000, BRIT J ANAESTH, V84, P197
- Mutch WAC, 2000, CRIT CARE MED, V28, P2457
- NEIDHART PP, 1988, INTENS CARE MED, V14, P471
- Neumann P, 1998, J APPL PHYSIOL, V85, P1533
- Ng CSH, 2009, CRIT CARE, V13, DOI 10.1186/cc7719
- Pecchiari M, 2013, ANESTHESIOLOGY
- ROBOTHAM JL, 1980, AM REV RESPIR DIS, V121, P677
- Rothen HU, 1999, BRIT J ANAESTH, V82, P551
- Rothen HU, 1998, BRIT J ANAESTH, V81, P681
- Rouby JJ, 2007, CRIT CARE, V11, DOI 10.1186/cc6183
- Rusca M, 2003, ANESTH ANALG, V97, P1835, DOI 10.1213/01.ANE.0000087042.02266F6
- SANTOS RLB, 1992, J APPL PHYSIOL, V72, P1985
- SEEGER W, 1993, EUR RESPIR J, V6, P971
- Severgnini P, 2013, ANESTHESIOLOGY, V118, P1307, DOI 10.1097/ALN.0b013e31829102de
- Shimabukuro DW, 2009, ANESTHESIOLOGY, V110, P214, DOI 10.1097/ALN.0b013e3181945b63
- Spieth PM, 2007, INTENS CARE MED, V33, P308, DOI 10.1007/s00134-006-0428-7
- Spieth PM, 2009, AM J RESP CRIT CARE, V179, P684, DOI 10.1164/rccm.200806-975OC
- Suki B, 1998, NATURE, V393, P127, DOI 10.1038/30130
- SUTER PM, 1975, NEW ENGL J MED, V292, P284, DOI 10.1056/NEJM197502062920604
- Thammanomai A, 2013, PLOS ONE, V8, DOI 10.1371/journal.pone.0053934
- TOBIN MJ, 1983, CHEST, V84, P286, DOI 10.1378/chest.84.3.286
- Vassilakopoulos T, 2008, CRIT CARE MED, V36, P1009, DOI 10.1097/CCM.0B013E3181650592
- Vlahakis NE, 2000, J APPL PHYSIOL, V89, P2490
- WALLIS TW, 1983, J APPL PHYSIOL, V54, P1039
- Wolff G, 1992, POLYMORPHOUS VENTILA, P235
- Wolthuis EK, 2009, CRIT CARE, V13, DOI 10.1186/cc7688
- Wu JB, 2013, J IMMUNOL, V190, P3590, DOI 10.4049/jimmunol.1200860