Low tidal volume pressure support versus controlled ventilation in early experimental sepsis in pigs

Respiratory Research

Matthias David¹  Serge C Thal¹  Marc Bodenstein¹  Arno Schad²  Bastian Duenges¹  Tanghua Liu¹  Rainer Thomas¹  Erik K Hartmann¹  Alexander Ziebart¹ 

[1] Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, Mainz, 55131, Germany;Institute of Pathology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, Mainz, 55131, Germany

关键词: Pig model;    Volume controlled ventilation;    Pressure support ventilation;    Sepsis-induced lung injury;    ARDS;   

Others  :  1137272
DOI  :  10.1186/s12931-014-0101-6

 received in 2014-05-27, accepted in 2014-08-18,  发布年份 2014

【 摘 要 】

Background

In moderate acute respiratory distress syndrome (ARDS) several studies support the usage of assisted spontaneous breathing modes. Only limited data, however, focus on the application in systemic sepsis and developing lung injury. The present study examines the effects of immediate initiation of pressure support ventilation (PSV) in a model of sepsis-induced ARDS.

Methods

18 anesthetized pigs received a two-staged continuous lipopolysaccharide infusion to induce lung injury. The animals were randomly assigned to PSV or volume controlled (VCV) lung protective ventilation (tidal volume each 6 ml kg^-1, n = 2x9) over six hours. Gas exchange parameters, hemodynamics, systemic inflammation, and ventilation distribution by multiple inert gas elimination and electrical impedance tomography were assessed. The post mortem analysis included histopathological scoring, wet to dry ratio, and alveolar protein content.

Results

Within six hours both groups developed a mild to moderate ARDS with comparable systemic inflammatory response and without signs of improving gas exchange parameters during PSV. The PSV group showed signs of more homogenous ventilation distribution by electrical impedance tomography, but only slightly less hyperinflated lung compartments by multiple inert gas elimination. Post mortem and histopathological assessment yielded no significant intergroup differences.

Conclusions

In a porcine model of sepsis-induced mild ARDS immediate PSV was not superior to VCV. This contrasts with several experimental studies from non-septic mild to moderate ARDS. The present study therefore assumes that not only severity, but also etiology of lung injury considerably influences the response to early initiation of PSV.

【 授权许可】

   
2014 Ziebart et al.; licensee BioMed Central Ltd.

【 图 表 】

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