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https://observatorio.fm.usp.br/handle/OPI/39373
Title: | Time-Controlled Adaptive Ventilation Versus Volume-Controlled Ventilation in Experimental Pneumonia |
Authors: | MAGALHAES, Raquel F. de; CRUZ, Daniela G.; ANTUNES, Mariana A.; FERNANDES, Marcos V. de S.; OLIVEIRA, Milena V.; BRAGA, Cassia L.; SATALIN, Joshua; ANDREWS, Penny; HABASHI, Nader; NIEMAN, Gary; DE-ALBUQUERQUE, Cassiano F. Goncalves; SILVA, Adriana R.; RIBEIRO, Roseli V.; CAPELOZZI, Vera L.; CRUZ, Fernanda F.; SAMARY, Cynthia dos S.; ROCCO, Patricia R. M.; SILVA, Pedro L. |
Citation: | CRITICAL CARE MEDICINE, v.49, n.1, p.140-150, 2021 |
Abstract: | OBJECTIVES: We hypothesized that a time-controlled adaptive ventilation strategy would open and stabilize alveoli by controlling inspiratory and expiratory duration. Time-controlled adaptive ventilation was compared with volume-controlled ventilation at the same levels of mean airway pressure and positive end-release pressure (time-controlled adaptive ventilation)/positive end-expiratory pressure (volume-controlled ventilation) in a Pseudomonas aeruginosa-induced pneumonia model. DESIGN: Animal study. SETTING: Laboratory investigation. SUBJECTS: Twenty-one Wistar rats. INTERVENTIONS: Twenty-four hours after pneumonia induction, Wistar rats (n = 7) were ventilated with time-controlled adaptive ventilation (tidal volume = 8 mL/kg, airway pressure release ventilation for a T-high = 0.75-0.85 s, release pressure (P-low) set at 0 cm H2O, and generating a positive end-release pressure = 1.6 cm H2O applied for T-low = 0.11-0.14 s). The expiratory flow was terminated at 75% of the expiratory flow peak. An additional 14 animals were ventilated using volume-controlled ventilation, maintaining similar time-controlled adaptive ventilation levels of positive end-release pressure (positive end-expiratory pressure=1.6 cm H2O) and mean airway pressure = 10 cm H2O. Additional nonventilated animals (n = 7) were used for analysis of molecular biology markers. MEASUREMENTS AND MAIN RESULTS: After 1 hour of mechanical ventilation, the heterogeneity score, the expression of pro-inflammatory biomarkers interleukin-6 and cytokine-induced neutrophil chemoattractant-1 in lung tissue were significantly lower in the time-controlled adaptive ventilation than volume-controlled ventilation with similar mean airway pressure groups (p = 0.008, p = 0.011, and p = 0.011, respectively). Epithelial cell integrity, measured by E-cadherin tissue expression, was higher in time-controlled adaptive ventilation than volume-controlled ventilation with similar mean airway pressure (p = 0.004). Time-controlled adaptive ventilation animals had bacteremia counts lower than volume-controlled ventilation with similar mean airway pressure animals, while time-controlled adaptive ventilation and volume-controlled ventilation with similar positive end-release pressure animals had similar colony-forming unit counts. In addition, lung edema and cytokine-induced neutrophil chemoattractant-1 gene expression were more reduced in time-controlled adaptive ventilation than volume-controlled ventilation with similar positive end-release pressure groups. CONCLUSIONS: In the model of pneumonia used herein, at the same tidal volume and mean airway pressure, time-controlled adaptive ventilation, compared with volume-controlled ventilation, was associated with less lung damage and bacteremia and reduced gene expression of mediators associated with inflammation. |
Appears in Collections: | Artigos e Materiais de Revistas Científicas - FM/MPT Artigos e Materiais de Revistas Científicas - LIM/03 Artigos e Materiais de Revistas Científicas - ODS/03 |
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