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Repeated endo-tracheal tube disconnection generates pulmonary edema in a model of volume overload: an experimental study
BACKGROUND: An abrupt lung deflation in rodents results in lung injury through vascular mechanisms. Ventilator disconnections during endo-tracheal suctioning in humans often cause cardio-respiratory instability. Whether repeated disconnections or lung deflations cause lung injury or oedema is not kn...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8857825/ https://www.ncbi.nlm.nih.gov/pubmed/35180891 http://dx.doi.org/10.1186/s13054-022-03924-2 |
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author | Katira, Bhushan H. Engelberts, Doreen Bouch, Sheena Fliss, Jordan Bastia, Luca Osada, Kohei Connelly, Kim A. Amato, Marcelo B. P. Ferguson, Niall D. Kuebler, Wolfgang M. Kavanagh, Brian P. Brochard, Laurent J. Post, Martin |
author_facet | Katira, Bhushan H. Engelberts, Doreen Bouch, Sheena Fliss, Jordan Bastia, Luca Osada, Kohei Connelly, Kim A. Amato, Marcelo B. P. Ferguson, Niall D. Kuebler, Wolfgang M. Kavanagh, Brian P. Brochard, Laurent J. Post, Martin |
author_sort | Katira, Bhushan H. |
collection | PubMed |
description | BACKGROUND: An abrupt lung deflation in rodents results in lung injury through vascular mechanisms. Ventilator disconnections during endo-tracheal suctioning in humans often cause cardio-respiratory instability. Whether repeated disconnections or lung deflations cause lung injury or oedema is not known and was tested here in a porcine large animal model. METHODS: Yorkshire pigs (~ 12 weeks) were studied in three series. First, we compared PEEP abruptly deflated from 26 cmH(2)O or from PEEP 5 cmH(2)O to zero. Second, pigs were randomly crossed over to receive rapid versus gradual PEEP removal from 20 cmH(2)O. Third, pigs with relative volume overload, were ventilated with PEEP 15 cmH(2)O and randomized to repeated ETT disconnections (15 s every 15 min) or no disconnection for 3 h. Hemodynamics, pulmonary variables were monitored, and lung histology and bronchoalveolar lavage studied. RESULTS: As compared to PEEP 5 cmH(2)O, abrupt deflation from PEEP 26 cmH(2)O increased PVR, lowered oxygenation, and increased lung wet-to-dry ratio. From PEEP 20 cmH(2)O, gradual versus abrupt deflation mitigated the changes in oxygenation and vascular resistance. From PEEP 15, repeated disconnections in presence of fluid loading led to reduced compliance, lower oxygenation, higher pulmonary artery pressure, higher lung wet-to-dry ratio, higher lung injury score and increased oedema on morphometry, compared to no disconnects. CONCLUSION: Single abrupt deflation from high PEEP, and repeated short deflations from moderate PEEP cause pulmonary oedema, impaired oxygenation, and increased PVR, in this large animal model, thus replicating our previous finding from rodents. Rapid deflation may thus be a clinically relevant cause of impaired lung function, which may be attenuated by gradual pressure release. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-03924-2. |
format | Online Article Text |
id | pubmed-8857825 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-88578252022-02-23 Repeated endo-tracheal tube disconnection generates pulmonary edema in a model of volume overload: an experimental study Katira, Bhushan H. Engelberts, Doreen Bouch, Sheena Fliss, Jordan Bastia, Luca Osada, Kohei Connelly, Kim A. Amato, Marcelo B. P. Ferguson, Niall D. Kuebler, Wolfgang M. Kavanagh, Brian P. Brochard, Laurent J. Post, Martin Crit Care Research BACKGROUND: An abrupt lung deflation in rodents results in lung injury through vascular mechanisms. Ventilator disconnections during endo-tracheal suctioning in humans often cause cardio-respiratory instability. Whether repeated disconnections or lung deflations cause lung injury or oedema is not known and was tested here in a porcine large animal model. METHODS: Yorkshire pigs (~ 12 weeks) were studied in three series. First, we compared PEEP abruptly deflated from 26 cmH(2)O or from PEEP 5 cmH(2)O to zero. Second, pigs were randomly crossed over to receive rapid versus gradual PEEP removal from 20 cmH(2)O. Third, pigs with relative volume overload, were ventilated with PEEP 15 cmH(2)O and randomized to repeated ETT disconnections (15 s every 15 min) or no disconnection for 3 h. Hemodynamics, pulmonary variables were monitored, and lung histology and bronchoalveolar lavage studied. RESULTS: As compared to PEEP 5 cmH(2)O, abrupt deflation from PEEP 26 cmH(2)O increased PVR, lowered oxygenation, and increased lung wet-to-dry ratio. From PEEP 20 cmH(2)O, gradual versus abrupt deflation mitigated the changes in oxygenation and vascular resistance. From PEEP 15, repeated disconnections in presence of fluid loading led to reduced compliance, lower oxygenation, higher pulmonary artery pressure, higher lung wet-to-dry ratio, higher lung injury score and increased oedema on morphometry, compared to no disconnects. CONCLUSION: Single abrupt deflation from high PEEP, and repeated short deflations from moderate PEEP cause pulmonary oedema, impaired oxygenation, and increased PVR, in this large animal model, thus replicating our previous finding from rodents. Rapid deflation may thus be a clinically relevant cause of impaired lung function, which may be attenuated by gradual pressure release. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-03924-2. BioMed Central 2022-02-18 /pmc/articles/PMC8857825/ /pubmed/35180891 http://dx.doi.org/10.1186/s13054-022-03924-2 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Katira, Bhushan H. Engelberts, Doreen Bouch, Sheena Fliss, Jordan Bastia, Luca Osada, Kohei Connelly, Kim A. Amato, Marcelo B. P. Ferguson, Niall D. Kuebler, Wolfgang M. Kavanagh, Brian P. Brochard, Laurent J. Post, Martin Repeated endo-tracheal tube disconnection generates pulmonary edema in a model of volume overload: an experimental study |
title | Repeated endo-tracheal tube disconnection generates pulmonary edema in a model of volume overload: an experimental study |
title_full | Repeated endo-tracheal tube disconnection generates pulmonary edema in a model of volume overload: an experimental study |
title_fullStr | Repeated endo-tracheal tube disconnection generates pulmonary edema in a model of volume overload: an experimental study |
title_full_unstemmed | Repeated endo-tracheal tube disconnection generates pulmonary edema in a model of volume overload: an experimental study |
title_short | Repeated endo-tracheal tube disconnection generates pulmonary edema in a model of volume overload: an experimental study |
title_sort | repeated endo-tracheal tube disconnection generates pulmonary edema in a model of volume overload: an experimental study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8857825/ https://www.ncbi.nlm.nih.gov/pubmed/35180891 http://dx.doi.org/10.1186/s13054-022-03924-2 |
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