Journal article
Regional gas exchange and cellular metabolic activity in ventilator-induced lung injury
Anesthesiology (Philadelphia), Vol.106(4), pp.723-735
04/01/2007
DOI: 10.1097/01.anes.0000264748.86145.ac
PMID: 17413910
Abstract
Alveolar overdistension and repetitive derecruitment-recruitment contribute to ventilator-induced lung injury (VILI). The authors investigated (1) whether inflammatory cell activation due to VILI was assessable by positron emission tomography and (2) whether cell activation due to dynamic overdistension alone was detectable when other manifestations of VILI were not yet evident.
Methods
The authors assessed cellular metabolic activity with [(18)F]fluorodeoxyglucose and regional gas exchange with [(13)N]nitrogen. In 12 sheep, the left ("test") lung was overdistended with end-inspiratory pressure of 50 cm H(2)O for 90 min, while end-expiratory derecruitment of this lung was either promoted with end-expiratory pressure of -10 cm H(2)O in 6 of these sheep (negative end-expiratory pressure [NEEP] group) or prevented with +10 cm H(2)O in the other 6 (positive end-expiratory pressure [PEEP] group) to isolate the effect of overdistension. The right ("control") lung was protected from VILI.
Results
Aeration decreased and shunt fraction increased in the test lung of the NEEP group. [(18)F]fluorodeoxyglucose uptake of this lung was higher than that of the control lung and of the test lung of the PEEP group, and correlated with neutrophil count. When normalized by tissue fraction to account for increased aeration of the test lung in the PEEP group, [(18)F]fluorodeoxyglucose uptake was elevated also in this group, despite the fact that gas exchange had not yet deteriorated after 90 min of overdistension alone.
Conclusion
The authors could detect regional neutrophil activation in VILI even when end-expiratory derecruitment was prevented and impairment of gas exchange was not evident. Concomitant end-expiratory derecruitment converted this activation into profound inflammation with decreased aeration and regional shunting.
Details
- Title: Subtitle
- Regional gas exchange and cellular metabolic activity in ventilator-induced lung injury
- Creators
- Guido Musch - Massachusetts General HospitalJose G. Venegas - Department of Anesthesia and Critical Care, United StatesGiacomo Bellani - University of Milano-BicoccaTilo Winkler - Department of Anesthesia and Critical Care, United StatesTobias Schroeder - Society of Critical Care MedicineBodil Petersen - Society of Critical Care MedicineR. Scott Harris - Massachusetts General HospitalMarcos F. Vidal Melo - Department of Anesthesia and Critical Care, United States
- Resource Type
- Journal article
- Publication Details
- Anesthesiology (Philadelphia), Vol.106(4), pp.723-735
- DOI
- 10.1097/01.anes.0000264748.86145.ac
- PMID
- 17413910
- NLM abbreviation
- Anesthesiology
- ISSN
- 0003-3022
- eISSN
- 1528-1175
- Number of pages
- 13
- Grant note
- R01HL068011 / National Heart, Lung, and Blood Institute (http://data.elsevier.com/vocabulary/SciValFunders/100000050) National Heart, Lung, and Blood Institute (http://data.elsevier.com/vocabulary/SciValFunders/100000050)
- Language
- English
- Date published
- 04/01/2007
- Academic Unit
- Anesthesia
- Record Identifier
- 9985141865702771
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