The Comparison of Spontaneous Breathing and Muscle Paralysis in Two Different Severities of Experimental Lung Injury*
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- 1 February 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 41 (2), 536-545
- https://doi.org/10.1097/ccm.0b013e3182711972
Abstract
The benefits of spontaneous breathing over muscle paralysis have been proven mainly in mild lung injury; no one has yet evaluated the effects of spontaneous breathing in severe lung injury. We investigated the effects of spontaneous breathing in two different severities of lung injury compared with muscle paralysis. Prospective, randomized, animal study. University animal research laboratory. Twenty-eight New Zealand white rabbits. Rabbits were randomly divided into the mild lung injury (surfactant depletion) group or severe lung injury (surfactant depletion followed by injurious mechanical ventilation) group and ventilated with 4-hr low tidal volume ventilation with spontaneous breathing or without spontaneous breathing (prevented by a neuromuscular blocking agent). Inspiratory pressure was adjusted to control tidal volume to 5-7 mL/kg, maintaining a plateau pressure less than 30 cm H2O. Dynamic CT was used to evaluate changes in lung aeration and the regional distribution of tidal volume. In mild lung injury, spontaneous breathing improved oxygenation and lung aeration by redistribution of tidal volume to dependent lung regions. However, in severe lung injury, spontaneous breathing caused a significant increase in atelectasis with cyclic collapse. Because of the severity of lung injury, this group had higher plateau pressure and more excessive spontaneous breathing effort, resulting in the highest transpulmonary pressure and the highest driving pressure. Although no improvements in lung aeration were observed, muscle paralysis with severe lung injury resulted in better oxygenation, more even tidal ventilation, and less histological lung injury. In animals with mild lung injury, spontaneous breathing was beneficial to lung recruitment; however, in animals with severe lung injury, spontaneous breathing could worsen lung injury, and muscle paralysis might be more protective for injured lungs by preventing injuriously high transpulmonary pressure and high driving pressure.Keywords
This publication has 24 references indexed in Scilit:
- Assisted ventilation modes reduce the expression of lung inflammatory and fibrogenic mediators in a model of mild acute lung injuryIntensive Care Medicine, 2010
- The Impact of Spontaneous Ventilation on Distribution of Lung Aeration in Patients with Acute Respiratory Distress Syndrome: Airway Pressure Release Ventilation Versus Pressure Support VentilationAnesthesia & Analgesia, 2009
- Airway pressure release ventilation and biphasic positive airway pressure: a systematic review of definitional criteriaIntensive Care Medicine, 2008
- Effects of partial ventilatory support modalities on respiratory function in severe hypoxemic lung injury*Critical Care Medicine, 2006
- Spontaneous breathing with airway pressure release ventilation favors ventilation in dependent lung regions and counters cyclic alveolar collapse in oleic-acid-induced lung injury: a randomized controlled computed tomography trialCritical Care, 2005
- Ventilation with biphasic positive airway pressure in experimental lung injuryIntensive Care Medicine, 2004
- Spontaneous Breathing Improves Lung Aeration in Oleic Acid–induced Lung InjuryAnesthesiology, 2003
- Effects of spontaneous breathing during airway pressure release ventilation on renal perfusion and function in patients with acute lung injuryIntensive Care Medicine, 2002
- Long-Term Effects of Spontaneous Breathing During Ventilatory Support in Patients with Acute Lung InjuryAmerican Journal of Respiratory and Critical Care Medicine, 2001
- Ventilation-perfusion distributions during mechanical ventilation with superimposed spontaneous breathing in canine lung injury.American Journal of Respiratory and Critical Care Medicine, 1994