Effects of Positive End-Expiratory Pressure Ventilation via Different Tidal Volume on Dogs with Oleic Acid-Induced Acute Lung Injury_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 LAI Tianshun ¹ , GUO Zhenhui ¹ , CAI Shaoxi ² , BAI Tao ¹ , SU Lei ¹ , SUN Jie. ¹

Emergency and Critical Care Medical Therapeutic Center, Guangzhou General Hospital of Guangzhou Military Command. Guangzhou, Guangdong, 510010, China;

Corresponding author：

LAI Tianshun, Email: timsonlai@yahoo.com.cn

Keywords：

Acute lung injury; Oleic acid; Ventilator-induced lung injury; Tidal volume; Positive end expiratory pressure

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Objective To investigate the effects of mechanical ventilation( MV) via different tidal volume ( VT) in combination with positive end expiratory pressure( PEEP) on dogs with acute lung injury( ALI) . Methods Dog model of oleic acid-induced ALI was established. And after that animals were randomized into different MV groups ( included low VT group, VT =6 mL/kg; and high VT group, VT =20 mL/kg) and ventilated for 6 h with a PEEP of 10 cmH2O. Arterial blood gas wasmeasured before, during and after ALI model was established ( at 1 h,2 h, 4 h and 6 h during MV) . The albumin concentration in BALF and pathological change of the lung tissue were evaluated in order to determine the lung injury while animals were sacrificed after 6 h MV. Results ALI model was successfully established ( 2. 50 ±0. 80) hours after oleic acid injection. Arterial pH decreased much severer in the low VT group than the high VT group( P lt;0. 01) . PaO2 and SaO2 in ventilation groups decreased after modeling but increased after MV, and PaO2 and SaO2 were significantly higher in the low VT group than the high VT group after 6 h MV( P lt;0. 05) . PaCO2 fluctuated less in the high VT group, while it increased significantly in the low VT group after MV( P lt; 0. 01) . Oxygenation index( PaO2 /FiO2 ) was lowered after modeling( P lt; 0. 01) , decreased to about 190 mm Hg after 1 h MV. And PaO2 /FiO2 in low VT group was significantly higher than the high VT group after 6 h MV( P lt; 0. 05) . BALF albumin concentration and the lung injury score in the low VT group were both significantly lower than the high VT group( both P lt; 0. 05) . Conclusions Ventilation with PEEP could improve the oxygenation of ALI dogs, and low VT ventilation improves the oxygenation better than high VT. Otherwise, low VT could induce hypercapnia and ameliorate lung injury caused by high VT MV.

Citation： LAI Tianshun,GUO Zhenhui,CAI Shaoxi,BAI Tao,SU Lei,SUN Jie.. Effects of Positive End-Expiratory Pressure Ventilation via Different Tidal Volume on Dogs with Oleic Acid-Induced Acute Lung Injury. Chinese Journal of Respiratory and Critical Care Medicine, 2009, 09(1): 43-47. doi: Copy

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4.	燕艳丽, 邱海波, 杨毅, 等. 急性呼吸窘迫综合征家兔肺部及肺外器官炎症反应的变化. 中国呼吸与危重监护杂志, 2004, 3:147 -151.
5.	Slutsky AS, Hudson LD. PEEP or no PEEP--lung recruitmentmay be the solution. N Engl JMed, 2006, 354: 1839-1841.
6.	Villar J, Kacmarek RM, Perez-Mendez L, et al. A high positive endexpiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized,controlled trial. Crit Care Med, 2006, 34: 1311-1318.
7.	解立新, 刘又宁. 急性肺损伤/急性呼吸窘迫综合征机械通气的共识和争议. 中国呼吸与危重监护杂志, 2004, 3: 194-196.
8.	Choi WI, Quinn DA, Park KM, et al. Systemic microvascular leak in an in vivo rat model of ventilator-induced lung injury. Am J Respir Crit Care Med, 2003, 167: 1627-1632.
9.	Kloot TE, Blanch L, Melynne-Youngblood A, et al. Recruitment Maneuvers in Three Experimental Models of Acute Lung Injury.Effect on Lung Volume and Gas Exchange. AmJ Respir Crit Care Med, 2000, 161: 1485-1494.
10.	Jeon K, Jeon IS, Suh GY, et al. Two methods of setting positive endexpiratory pressure in acute lung injury: an experimental computed tomography volumetric study. J Korean Med Sci, 2007, 22: 476-483.
11.	万小健, 江来, 朱科明, 等. 肺保护性通气对急性肺损伤患者的影响. 中国呼吸与危重监护杂志, 2006, 5: 267-270.
12.	Zhang X, Du Y, Jiang H, et al. Experimental study of acute lung injury induced by different tidal volume ventilation in rats. Chinese Med J, 2005, 118: 777-780.
13.	Makiko K, Katsumi T, Yasuko T, et al. Permissive range of hypercapnia for improved peripheral microcirculation and cardiac output in rabbits. Crit Care Med, 2007, 35: 2171-2175.
14.	Parker JC, Mary IT. Evaluation of lung injury in rats and mice. Am J Physiol Lung Cell Mol Physiol, 2004, 286: 231-246.
15.	Broccard AF, Hotchkiss JR, Vannay C. Protective effects of hypercapnic acidosis on ventilator-induced lung injury. Am J Respir Crit Care Med, 2001, 164: 802-806.
16.	例重症急性呼吸窘迫综合征临床资料回顾性分析. 中国呼吸与危重监护杂志, 2006, 5: 35-38.

1. 宋鹏, 李琦, 王长征, 等.
2. The ARDS Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000 , 342 :1301-1308.
3. Smith KM, Mrozek JD, Simonton SC, et al. Prolonged partial liquid ventilation using conventional and high-frequency ventilatory techniques:gas exchange and lung pathology in an animal model of respiratory distress syndrome. Crit Care Med, 1997, 25: 1888-1897.
4. 燕艳丽, 邱海波, 杨毅, 等. 急性呼吸窘迫综合征家兔肺部及肺外器官炎症反应的变化. 中国呼吸与危重监护杂志, 2004, 3:147 -151.
5. Slutsky AS, Hudson LD. PEEP or no PEEP--lung recruitmentmay be the solution. N Engl JMed, 2006, 354: 1839-1841.
6. Villar J, Kacmarek RM, Perez-Mendez L, et al. A high positive endexpiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized,controlled trial. Crit Care Med, 2006, 34: 1311-1318.
7. 解立新, 刘又宁. 急性肺损伤/急性呼吸窘迫综合征机械通气的共识和争议. 中国呼吸与危重监护杂志, 2004, 3: 194-196.
8. Choi WI, Quinn DA, Park KM, et al. Systemic microvascular leak in an in vivo rat model of ventilator-induced lung injury. Am J Respir Crit Care Med, 2003, 167: 1627-1632.
9. Kloot TE, Blanch L, Melynne-Youngblood A, et al. Recruitment Maneuvers in Three Experimental Models of Acute Lung Injury.Effect on Lung Volume and Gas Exchange. AmJ Respir Crit Care Med, 2000, 161: 1485-1494.
10. Jeon K, Jeon IS, Suh GY, et al. Two methods of setting positive endexpiratory pressure in acute lung injury: an experimental computed tomography volumetric study. J Korean Med Sci, 2007, 22: 476-483.
11. 万小健, 江来, 朱科明, 等. 肺保护性通气对急性肺损伤患者的影响. 中国呼吸与危重监护杂志, 2006, 5: 267-270.
12. Zhang X, Du Y, Jiang H, et al. Experimental study of acute lung injury induced by different tidal volume ventilation in rats. Chinese Med J, 2005, 118: 777-780.
13. Makiko K, Katsumi T, Yasuko T, et al. Permissive range of hypercapnia for improved peripheral microcirculation and cardiac output in rabbits. Crit Care Med, 2007, 35: 2171-2175.
14. Parker JC, Mary IT. Evaluation of lung injury in rats and mice. Am J Physiol Lung Cell Mol Physiol, 2004, 286: 231-246.
15. Broccard AF, Hotchkiss JR, Vannay C. Protective effects of hypercapnic acidosis on ventilator-induced lung injury. Am J Respir Crit Care Med, 2001, 164: 802-806.
16. 例重症急性呼吸窘迫综合征临床资料回顾性分析. 中国呼吸与危重监护杂志, 2006, 5: 35-38.

Chinese Journal of Respiratory and Critical Care Medicine

Effects of Positive End-Expiratory Pressure Ventilation via Different Tidal Volume on Dogs with Oleic Acid-Induced Acute Lung Injury

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