Effects of Positive End-expiratory Pressure Titration and Recruitment Maneuver on Lung Inflammation and Hyperinflation in Experimental Acid Aspiration-induced Lung Injury

Author(s):Show less -

Ambrosio, Aline M. ^[1] ; Luo, Rubin ^{[2, 3]} ; Fantoni, Denise T. ^[1] ; Gutierres, Claudia ^[4] ; Lu, Qin ^[2] ; Gu, Wen-Jie ^{[2, 3]} ; Otsuki, Denise A. ^[1] ; Malbouisson, Luiz M. S. ^[5] ; Auler, Jr., Jose O. C. ^[6] ; Rouby, Jean-Jacques ^[2] ; Grp, Expt ARDS Study

Affiliation

^[1] Univ Sao Paulo, Fac Med, Dept Surg, Lab Med Invest Anesthesiol LIM 08, Sao Paulo - Brazil

^[2] UPMC Univ Paris, AP HP, La Pitie Salpetriere Hosp, Multidisciplinary Inten, Dept Anesthesiol & Crit Care Med, Lab Clin & Expt, Paris - France

^[3] Zhejiang Univ, Sch Med, Affiliated Hosp 2, Dept Emergency Med, Hangzhou 310003, Zhejiang - Peoples R China

^[4] Univ Fed Rio Grande do Sul, Hosp Clin Porto Alegre, Fac Med, Dept Anesthesiol, BR-90046900 Porto Alegre, RS - Brazil

^[5] Univ Sao Paulo, Fac Med, Hosp Clin, Dept Anesthesia & Surg Intens Care, Sao Paulo - Brazil

^[6] Univ Sao Paulo, Fac Med, Lab Med Invest Anesthesiol LIM 08, Dept Anesthesia & Surg Intens Care, Sao Paulo - Brazil

• Document type: Journal article
• Source: ANESTHESIOLOGY; v. 117, n. 6, p. 1322-1334, DEC 2012.
• Web of Science Citations: 15

Abstract

Background: In acute lung injury positive end-expiratory pressure (PEEP) and recruitment maneuver are proposed to optimize arterial oxygenation. The aim of the study was to evaluate the impact of such a strategy on lung histological inflammation and hyperinflation in pigs with acid aspiration-induced lung injury. Methods: Forty-seven pigs were randomly allocated in seven groups: (1) controls spontaneously breathing; (2) without lung injury, PEEP 5 cm H2O; (3) without lung injury, PEEP titration; (4) without lung injury, PEEP titration + recruitment maneuver; (5) with lung injury, PEEP 5 cm H2O; (6) with lung injury, PEEP titration; and (7) with lung injury, PEEP titration + recruitment maneuver. Acute lung injury was induced by intratracheal instillation of hydrochloric acid. PEEP titration was performed by incremental and decremental PEEP from 5 to 20 cm H2O for optimizing arterial oxygenation. Three recruitment maneuvers (pressure of 40 cm H2O maintained for 20 s) were applied to the assigned groups at each PEEP level. Proportion of lung inflammation, hemorrhage, edema, and alveolar wall disruption were recorded on each histological field. Mean alveolar area was measured in the aerated lung regions. Results: Acid aspiration increased mean alveolar area and produced alveolar wall disruption, lung edema, alveolar hemorrhage, and lung inflammation. PEEP titration significantly improved arterial oxygenation but simultaneously increased lung inflammation in juxta-diaphragmatic lung regions. Recruitment maneuver during PEEP titration did not induce additional increase in lung inflammation and alveolar hyperinflation. Conclusion: In a porcine model of acid aspiration-induced lung injury, PEEP titration aimed at optimizing arterial oxygenation, substantially increased lung inflammation. Recruitment maneuvers further improved arterial oxygenation without additional effects on inflammation and hyperinflation. (AU)