Am. J. Respir. Crit. Care Med., Volume 162, Number 6, December 2000, 2287-2294

Therapeutic Hypercapnia Reduces Pulmonary and Systemic Injury following In Vivo Lung Reperfusion

JOHN G. LAFFEY, MOTOSHI TANAKA, DOREEN ENGELBERTS, XIAOPING LUO, SHIZENG YUAN, A. KEITH TANSWELL, MARTIN POST, THOMAS LINDSAY, and BRIAN P. KAVANAGH

The Lung Biology Programme and the Departments of Critical Care Medicine and Paediatrics, The Research Institute, The Hospital for Sick Children; and The University of Toronto, Toronto, Ontario, Canada

Permissive hypercapnia, involving tolerance to elevated Pa_CO2, is associated with reduced acute lung injury (ALI), thought to result from reduced mechanical stretch, and improved outcome in ARDS. However, deliberately elevating inspired CO₂ concentration alone (therapeutic hypercapnia, TH) protects against ALI in ex vivo models. We investigated whether TH would protect against ALI in an in vivo model of lung ischemia-reperfusion (IR). Anesthetized open chest rabbits were ventilated (standard eucapnic settings), and were randomized to TH (FI_CO2 0.12) versus control (FI_CO2 0.00). Pa_CO2 and arterial pH values achieved in the TH versus CON groups were 101 ± 3 versus 44.4 ± 4 mm Hg and 7.10 ± 0.03 versus 7.37 ± 0.03, respectively. Following left lung ischemia and reperfusion, TH versus control was associated with preservation of lung mechanics, attenuation of protein leakage, reduction in pulmonary edema, and improved oxygenation. Indices of systemic protection included improved acid-base and lactate profile, in the absence of systemic hypoxemia. In the TH group, mean BALF TNF- levels were 3.5% of CON levels (p < 0.01), and mean 8-isoprostane levels were 30% of CON levels (p = 0.02). Western blot analysis demonstrated reduced lung tissue nitrotyrosine in TH, indicating attenuation of tissue nitration. Finally, preliminary data suggest that TH may attenuate apoptosis following lung IR. We conclude that in the current model TH is protective versus IR lung injury and mechanisms of protection include preservation of lung mechanics, attenuation of pulmonary inflammation, and reduction of free radical mediated injury. If these findings are confirmed in additional models, TH may become a candidate for clinical testing in critical care.

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