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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 congruent  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 congruent  70 to 100 mm Hg. The changes (from Baseline to T3) in weight gain (Delta WG: g) and in the ultrafiltration coefficient (Delta Kf = 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 Delta WG (14.85 ± 5.49 [mean ± SEM] g) and Delta Kf (1.40 ± 0.49 g/min/cm H2O/100 g) than did either Group A (Delta WG = 0.70 ± 0.43; Delta Kf = 0.01 ± 0.03) or Group C (Delta WG = 5.27 ± 2.03 g; Delta Kf = 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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