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Effects of airway pressure release ventilation on multi-organ injuries in severe acute respiratory distress syndrome pig models

BACKGROUND: Extra-pulmonary multi-organ failure in patients with severe acute respiratory distress syndrome (ARDS) is a major cause of high mortality. Our purpose is to assess whether airway pressure release ventilation (APRV) causes more multi-organ damage than low tidal volume ventilation (LTV). M...

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Autores principales: Ma, Aijia, Wang, Bo, Cheng, Jiangli, Dong, Meiling, Li, Yang, Wei, Canzheng, Zhou, Yongfang, Xue, Yang, Gao, Hui, Zhao, Lican, Li, Siyu, Qin, Yiwei, Zhang, Mengni, Wu, Qin, Yang, Jing, Kang, Yan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9730639/
https://www.ncbi.nlm.nih.gov/pubmed/36476475
http://dx.doi.org/10.1186/s12890-022-02238-x
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author Ma, Aijia
Wang, Bo
Cheng, Jiangli
Dong, Meiling
Li, Yang
Wei, Canzheng
Zhou, Yongfang
Xue, Yang
Gao, Hui
Zhao, Lican
Li, Siyu
Qin, Yiwei
Zhang, Mengni
Wu, Qin
Yang, Jing
Kang, Yan
author_facet Ma, Aijia
Wang, Bo
Cheng, Jiangli
Dong, Meiling
Li, Yang
Wei, Canzheng
Zhou, Yongfang
Xue, Yang
Gao, Hui
Zhao, Lican
Li, Siyu
Qin, Yiwei
Zhang, Mengni
Wu, Qin
Yang, Jing
Kang, Yan
author_sort Ma, Aijia
collection PubMed
description BACKGROUND: Extra-pulmonary multi-organ failure in patients with severe acute respiratory distress syndrome (ARDS) is a major cause of high mortality. Our purpose is to assess whether airway pressure release ventilation (APRV) causes more multi-organ damage than low tidal volume ventilation (LTV). METHODS: Twenty one pigs were randomized into control group (n = 3), ARDS group (n = 3), LTV group (n = 8) and APRV group (n = 7). Severe ARDS model was induced by repeated bronchial saline lavages. Pigs were ventilated and monitored continuously for 48 h. Respiratory data, hemodynamic data, serum inflammatory cytokines were collected throughout the study. Histological injury and apoptosis were assessed by two pathologists. RESULTS: After severe ARDS modeling, pigs in ARDS, LTV and APRV groups experienced significant hypoxemia and reduced lung static compliance (C(stat)). Oxygenation recovered progressively after 16 h mechanical ventilation (MV) in LTV and APRV group. The results of the repeated measures ANOVA showed no statistical difference in the PaO(2)/FiO(2) ratio between the APRV and LTV groups (p = 0.54). The C(stat) showed a considerable improvement in APRV group with statistical significance (p < 0.01), which was significantly higher than in the LTV group since 16 h (p = 0.04). Histological injury scores showed a significantly lower injury score in the middle and lower lobes of the right lung in the APRV group compared to LTV (p(middle) = 0.04, p(lower) = 0.01), and no significant increase in injury scores for extra-pulmonary organs, including kidney (p = 0.10), small intestine (p = 1.0), liver (p = 0.14, p = 0.13) and heart (p = 0.20). There were no significant differences in serum inflammatory cytokines between the two groups. CONCLUSION: In conclusion, in the experimental pig models of severe ARDS induced by repetitive saline lavage, APRV improved lung compliance with reduced lung injury of middle and lower lobes, and did not demonstrate more extra-pulmonary organ injuries as compared with LTV. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-022-02238-x.
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spelling pubmed-97306392022-12-09 Effects of airway pressure release ventilation on multi-organ injuries in severe acute respiratory distress syndrome pig models Ma, Aijia Wang, Bo Cheng, Jiangli Dong, Meiling Li, Yang Wei, Canzheng Zhou, Yongfang Xue, Yang Gao, Hui Zhao, Lican Li, Siyu Qin, Yiwei Zhang, Mengni Wu, Qin Yang, Jing Kang, Yan BMC Pulm Med Research BACKGROUND: Extra-pulmonary multi-organ failure in patients with severe acute respiratory distress syndrome (ARDS) is a major cause of high mortality. Our purpose is to assess whether airway pressure release ventilation (APRV) causes more multi-organ damage than low tidal volume ventilation (LTV). METHODS: Twenty one pigs were randomized into control group (n = 3), ARDS group (n = 3), LTV group (n = 8) and APRV group (n = 7). Severe ARDS model was induced by repeated bronchial saline lavages. Pigs were ventilated and monitored continuously for 48 h. Respiratory data, hemodynamic data, serum inflammatory cytokines were collected throughout the study. Histological injury and apoptosis were assessed by two pathologists. RESULTS: After severe ARDS modeling, pigs in ARDS, LTV and APRV groups experienced significant hypoxemia and reduced lung static compliance (C(stat)). Oxygenation recovered progressively after 16 h mechanical ventilation (MV) in LTV and APRV group. The results of the repeated measures ANOVA showed no statistical difference in the PaO(2)/FiO(2) ratio between the APRV and LTV groups (p = 0.54). The C(stat) showed a considerable improvement in APRV group with statistical significance (p < 0.01), which was significantly higher than in the LTV group since 16 h (p = 0.04). Histological injury scores showed a significantly lower injury score in the middle and lower lobes of the right lung in the APRV group compared to LTV (p(middle) = 0.04, p(lower) = 0.01), and no significant increase in injury scores for extra-pulmonary organs, including kidney (p = 0.10), small intestine (p = 1.0), liver (p = 0.14, p = 0.13) and heart (p = 0.20). There were no significant differences in serum inflammatory cytokines between the two groups. CONCLUSION: In conclusion, in the experimental pig models of severe ARDS induced by repetitive saline lavage, APRV improved lung compliance with reduced lung injury of middle and lower lobes, and did not demonstrate more extra-pulmonary organ injuries as compared with LTV. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-022-02238-x. BioMed Central 2022-12-07 /pmc/articles/PMC9730639/ /pubmed/36476475 http://dx.doi.org/10.1186/s12890-022-02238-x 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
Ma, Aijia
Wang, Bo
Cheng, Jiangli
Dong, Meiling
Li, Yang
Wei, Canzheng
Zhou, Yongfang
Xue, Yang
Gao, Hui
Zhao, Lican
Li, Siyu
Qin, Yiwei
Zhang, Mengni
Wu, Qin
Yang, Jing
Kang, Yan
Effects of airway pressure release ventilation on multi-organ injuries in severe acute respiratory distress syndrome pig models
title Effects of airway pressure release ventilation on multi-organ injuries in severe acute respiratory distress syndrome pig models
title_full Effects of airway pressure release ventilation on multi-organ injuries in severe acute respiratory distress syndrome pig models
title_fullStr Effects of airway pressure release ventilation on multi-organ injuries in severe acute respiratory distress syndrome pig models
title_full_unstemmed Effects of airway pressure release ventilation on multi-organ injuries in severe acute respiratory distress syndrome pig models
title_short Effects of airway pressure release ventilation on multi-organ injuries in severe acute respiratory distress syndrome pig models
title_sort effects of airway pressure release ventilation on multi-organ injuries in severe acute respiratory distress syndrome pig models
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9730639/
https://www.ncbi.nlm.nih.gov/pubmed/36476475
http://dx.doi.org/10.1186/s12890-022-02238-x
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