Am. J. Respir. Crit. Care Med., Vol 149, No. 5, 05 1994, 1327-1334.
Tidal ventilation at low airway pressures can augment lung injury
JG Muscedere, JB Mullen, K Gan and AS Slutsky
Department of Medicine, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
Intermittent positive pressure ventilation with large tidal volumes and
high peak airway pressures can result in pulmonary barotrauma. In the
present study, we examined the hypothesis that ventilation at very low lung
volumes can also worsen lung injury by repeated opening and closing of
airway and alveolar duct units as ventilation occurs from below to above
the infection point (Pinf) as determined from the inspiratory
pressure-volume curve. We ventilated isolated, nonperfused, lavaged rat
lungs with physiologic tidal volumes (5 to 6 ml/kg) at different
end-expiratory pressures (above and below Pinf) and studied the effect on
compliance and lung injury. In the groups ventilated with positive
end-expiratory pressure (PEEP) below Pinf compliance fell dramatically
after ventilation. It did not change in either the control group or the
group ventilated with PEEP above Pinf. Lung injury assessed morphologically
was significantly greater in the groups ventilated with a PEEP below Pinf,
and in these groups the site of injury was dependent on the level of PEEP.
The group ventilated without PEEP had significantly greater respiratory and
membranous injury to bronchioles, while the group ventilated with PEEP of 4
cm H2O had significantly greater alveolar duct injury. In conclusion,
ventilation at lung volumes below those found at Pinf caused a significant
decrease in lung compliance and progression of lung injury. Therefore, in
addition to high airway pressures, end-expiratory lung volume is an
important determinant of the degree and site of lung injury during
positive-pressure ventilation.
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284(5):
L783 - L790.
[Abstract]
[Full Text]
[PDF]
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