Airway pressure release ventilation reduces conducting airway micro-strain in lung injury

Michaela Kollisch-Singule, Bryanna Emr, Bradford Smith, Cynthia Ruiz, Shreyas Roy, Qinghe Meng, Sumeet Jain, Joshua Satalin, Kathy Snyder, Auyon Ghosh, William H. Marx, Penny Andrews, Nader Habashi, Gary F. Nieman, Louis A. Gatto

Research output: Contribution to journalArticlepeer-review

46 Scopus citations

Abstract

Background Improper mechanical ventilation can exacerbate acute lung damage, causing a secondary ventilator-induced lung injury (VILI). We hypothesized that VILI can be reduced by modifying specific components of the ventilation waveform (mechanical breath), and we studied the impact of airway pressure release ventilation (APRV) and controlled mandatory ventilation (CMV) on the lung micro-anatomy (alveoli and conducting airways). The distribution of gas during inspiration and expiration and the strain generated during mechanical ventilation in the micro-anatomy (micro-strain) were calculated.

Study Design Rats were anesthetized, surgically prepared, and randomized into 1 uninjured control group (n = 2) and 4 groups with lung injury: APRV 75% (n = 2), time at expiration (T Low ) set to terminate appropriately at 75% of peak expiratory flow rate (PEFR); APRV 10% (n = 2), T Low set to terminate inappropriately at 10% of PEFR; CMV with PEEP 5 cm H 2 O (PEEP 5; n = 2); or PEEP 16 cm H 2 O (PEEP 16; n = 2). Lung injury was induced in the experimental groups by Tween lavage and ventilated with their respective settings. Lungs were fixed at peak inspiration and end expiration for standard histology. Conducting airway and alveolar air space areas were quantified and conducting airway micro-strain was calculated.

Results All lung injury groups redistributed inspired gas away from alveoli into the conducting airways. The APRV 75% minimized gas redistribution and micro-strain in the conducting airways and provided the alveolar air space occupancy most similar to control at both inspiration and expiration.

Conclusions In an injured lung, APRV 75% maintained micro-anatomic gas distribution similar to that of the normal lung. The lung protection demonstrated in previous studies using APRV 75% may be due to a more homogeneous distribution of gas at the micro-anatomic level as well as a reduction in conducting airway micro-strain.

Original languageEnglish (US)
Pages (from-to)968-976
Number of pages9
JournalJournal of the American College of Surgeons
Volume219
Issue number5
DOIs
StatePublished - Nov 1 2014

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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