Journal article
Mechanical ventilation guided by driving pressure optimizes local pulmonary biomechanics in an ovine model
Science translational medicine, Vol.16(760), eado1097
08/14/2024
DOI: 10.1126/scitranslmed.ado1097
PMID: 39141699
Abstract
Mechanical ventilation exposes the lung to injurious stresses and strains that can negatively affect clinical outcomes in acute respiratory distress syndrome or cause pulmonary complications after general anesthesia. Excess global lung strain, estimated as increased respiratory system driving pressure, is associated with mortality related to mechanical ventilation. The role of small-dimension biomechanical factors underlying this association and their spatial heterogeneity within the lung are currently unknown. Using four-dimensional computed tomography with a voxel resolution of 2.4 cubic millimeters and a multiresolution convolutional neural network for whole-lung image segmentation, we dynamically measured voxel-wise lung inflation and tidal parenchymal strains. Healthy or injured ovine lungs were evaluated as the mechanical ventilation positive end-expiratory pressure (PEEP) was titrated from 20 to 2 centimeters of water. The PEEP of minimal driving pressure (PEEPDP) optimized local lung biomechanics. We observed a greater rate of change in nonaerated lung mass with respect to PEEP below PEEPDP compared with PEEP values above this threshold. PEEPDP similarly characterized a breaking point in the relationships between PEEP and SD of local tidal parenchymal strain, the 95th percentile of local strains, and the magnitude of tidal overdistension. These findings advance the understanding of lung collapse, tidal overdistension, and strain heterogeneity as local triggers of ventilator-induced lung injury in large-animal lungs similar to those of humans and could inform the clinical management of mechanical ventilation to improve local lung biomechanics.Mechanical ventilation exposes the lung to injurious stresses and strains that can negatively affect clinical outcomes in acute respiratory distress syndrome or cause pulmonary complications after general anesthesia. Excess global lung strain, estimated as increased respiratory system driving pressure, is associated with mortality related to mechanical ventilation. The role of small-dimension biomechanical factors underlying this association and their spatial heterogeneity within the lung are currently unknown. Using four-dimensional computed tomography with a voxel resolution of 2.4 cubic millimeters and a multiresolution convolutional neural network for whole-lung image segmentation, we dynamically measured voxel-wise lung inflation and tidal parenchymal strains. Healthy or injured ovine lungs were evaluated as the mechanical ventilation positive end-expiratory pressure (PEEP) was titrated from 20 to 2 centimeters of water. The PEEP of minimal driving pressure (PEEPDP) optimized local lung biomechanics. We observed a greater rate of change in nonaerated lung mass with respect to PEEP below PEEPDP compared with PEEP values above this threshold. PEEPDP similarly characterized a breaking point in the relationships between PEEP and SD of local tidal parenchymal strain, the 95th percentile of local strains, and the magnitude of tidal overdistension. These findings advance the understanding of lung collapse, tidal overdistension, and strain heterogeneity as local triggers of ventilator-induced lung injury in large-animal lungs similar to those of humans and could inform the clinical management of mechanical ventilation to improve local lung biomechanics.
Details
- Title: Subtitle
- Mechanical ventilation guided by driving pressure optimizes local pulmonary biomechanics in an ovine model
- Creators
- David Lagier - Aix-Marseille UniversitéCongli Zeng - Columbia UniversityDavid W Kaczka - University of IowaMin ZhuKira Grogg - Yale Cancer CenterSarah E Gerard - University of IowaJoseph M Reinhardt - University of IowaGabriel C Motta Ribeiro - Universidade Federal do Rio de JaneiroAzman Rashid - Massachusetts General HospitalTilo Winkler - Massachusetts General HospitalMarcos F Vidal Melo - Columbia University
- Resource Type
- Journal article
- Publication Details
- Science translational medicine, Vol.16(760), eado1097
- Publisher
- AMER ASSOC ADVANCEMENT SCIENCE
- DOI
- 10.1126/scitranslmed.ado1097
- PMID
- 39141699
- ISSN
- 1946-6242
- eISSN
- 1946-6242
- Grant note
- NIH, National Heart, Lung, and Blood Institute grant: R01HL121228 Office of the Assistant Secretary of Defense for Health Affairs, through the Peer reviewed Medical Research Program: W81XWH- 21- 1- 0507
This work was supported by NIH, National Heart, Lung, and Blood Institute grant (R01HL121228 to M.F.V.M.). D.L. was supported by the Societe Francaise d'Anesthesie Reanimation, France, the European Association of Cardiothoracic Anaesthesiology, Italy, and the Fondation Monahan, Fulbright Commission, France; and D.W.K. was funded by the Office of the Assistant Secretary of Defense for Health Affairs, through the Peer reviewed Medical Research Program (W81XWH- 21- 1- 0507).
- Language
- English
- Date published
- 08/14/2024
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Anesthesia
- Record Identifier
- 9984696787402771
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