Am. J. Respir. Crit. Care Med., Volume 164, Number 5, September 2001, 802-806

Protective Effects of Hypercapnic Acidosis on Ventilator-induced Lung Injury

ALAIN F. BROCCARD, JOHN R. HOTCHKISS, CHRISTINE VANNAY, MICHELE MARKERT, ALAIN SAUTY, FRANÇOIS FEIHL, and MARIE-DENISE SCHALLER

Division of Intensive Care, Department of Internal Medicine and Central Laboratory for Clinical Chemistry, University Hospital (CHUV), Lausanne, Switzerland

To investigate whether respiratory acidosis modulates ventilator-induced lung injury (VILI), we perfused (constant flow) 21 isolated sets of normal rabbit lungs, ventilated them for 20 min (pressure controlled ventilation [PCV] = 15 cm H₂O) (Baseline) with an inspired CO₂ fraction adjusted for the partial pressure of CO₂ in the perfusate (PCO₂  40 mm Hg), and then randomized them into three groups. Group A (control: n = 7) was ventilated with PCV = 15 cm H₂O for three consecutive 20-min periods (T1, T2, T3). In Group B (high PCV/normocapnia; n = 7), PCV was given at 20 (T1), 25 (T2), and 30 (T3) cm H₂O. The targeted PCO₂ was 40 mm Hg in Groups A and B. Group C (high PCV/hypercapnia; n = 7) was ventilated in the same way as Group B, but the targeted PCO₂ was  70 to 100 mm Hg. The changes (from Baseline to T3) in weight gain (WG: g) and in the ultrafiltration coefficient (K_f = gr/min/ cm H₂O/100g) and the protein and hemoglobin concentrations in bronchoalveolar lavage fluid (BALF) were used to assess injury. Group B experienced a significantly greater WG (14.85 ± 5.49 [mean ± SEM] g) and K_f (1.40 ± 0.49 g/min/cm H₂O/100 g) than did either Group A (WG = 0.70 ± 0.43; K_f = 0.01 ± 0.03) or Group C (WG = 5.27 ± 2.03 g; K_f = 0.25 ± 0.12 g/min/cm H₂O/ 100 g). BALF protein and hemoglobin concentrations (g/L) were higher in Group B (11.98 ± 3.78 g/L and 1.82 ± 0.40 g/L, respectively) than in Group A (2.92 ± 0.75 g/L and 0.38 ± 0.15 g/L) or Group C (5.71 ± 1.88 g/L and 1.19 ± 0.32 g/L). We conclude that respiratory acidosis decreases the severity of VILI in this model.

Keywords: respiratory acidosis; hypercapnia; mechanical ventilation; acute lung injury; rabbits

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