Impact of different positive end-expiratory pressures on lung mechanics in the setting of moderately elevated intra-abdominal pressure and acute lung injury in a porcine model

• Verfasst von: Fiedler-Kalenka, Mascha [VerfasserIn]
• Verfasst von: Simeliunas, Emilis [VerfasserIn]
• Verfasst von: Deutsch, B. Luise [VerfasserIn]
• Verfasst von: Diktanaite, Dovile [VerfasserIn]
• Verfasst von: Harms, Alexander [VerfasserIn]
• Verfasst von: Brune, Maik [VerfasserIn]
• Verfasst von: Dietrich, Maximilian [VerfasserIn]
• Verfasst von: Uhle, Florian [VerfasserIn]
• Verfasst von: Weigand, Markus A. [VerfasserIn]
• Verfasst von: Kalenka, Armin [VerfasserIn]
• Titel: Impact of different positive end-expiratory pressures on lung mechanics in the setting of moderately elevated intra-abdominal pressure and acute lung injury in a porcine model
• Verf.angabe: Mascha O. Fiedler, Emilis Simeliunas, B. Luise Deutsch, Dovile Diktanaite, Alexander Harms, Maik Brune, Maximilian Dietrich, Florian Uhle, Markus A. Weigand and Armin Kalenka
• E-Jahr: 2021
• Jahr: 15 January 2021
• Umfang: 13 S.
• Fussnoten: Gesehen am 25.02.2021
• Titel Quelle: Enthalten in: Journal of Clinical Medicine
• Ort Quelle: Basel : MDPI, 2012
• Jahr Quelle: 2021
• Band/Heft Quelle: 10(2021,2) Artikel-Nummer 306, 13 Seiten
• ISSN Quelle: 2077-0383
• DOI: doi:10.3390/jcm10020306
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: ALI
• Sach-SW: ARDS
• Sach-SW: end-expiratory lung volume
• Sach-SW: intraabdominal pressure
• Sach-SW: PEEP
• Sach-SW: transpulmonary pressure
• K10plus-PPN: 1749368455

Abstract

The effects of a moderately elevated intra-abdominal pressure (IAP) on lung mechanics in acute respiratory distress syndrome (ARDS) have still not been fully analyzed. Moreover, the optimal positive end-expiratory pressure (PEEP) in elevated IAP and ARDS is unclear. In this paper, 18 pigs under general anesthesia received a double hit lung injury. After saline lung lavage and 2 h of injurious mechanical ventilation to induce an acute lung injury (ALI), an intra-abdominal balloon was filled until an IAP of 10 mmHg was generated. Animals were randomly assigned to one of three groups (group A = PEEP 5, B = PEEP 10 and C = PEEP 15 cmH2O) and ventilated for 6 h. We measured end-expiratory lung volume (EELV) per kg bodyweight, driving pressure (ΔP), transpulmonary pressure (ΔPL), static lung compliance (Cstat), oxygenation (P/F ratio) and cardiac index (CI). In group A, we found increases in ΔP (22 ± 1 vs. 28 ± 2 cmH2O; p = 0.006) and ΔPL (16 ± 1 vs. 22 ± 2 cmH2O; p = 0.007), with no change in EELV/kg (15 ± 1 vs. 14 ± 1 mL/kg) when comparing hours 0 and 6. In group B, there was no change in ΔP (26 ± 2 vs. 25 ± 2 cmH2O), ΔPL (19 ± 2 vs. 18 ± 2 cmH2O), Cstat (21 ± 3 vs. 21 ± 2 cmH2O/mL) or EELV/kg (12 ± 2 vs. 13 ± 3 mL/kg). ΔP and ΔPL were significantly lower after 6 h when comparing between group C and A (21 ± 1 vs. 28 ± 2 cmH2O; p = 0.020) and (14 ± 1 vs. 22 ± 2 cmH2O; p = 0.013)). The EELV/kg increased over time in group C (13 ± 1 vs. 19 ± 2 mL/kg; p = 0.034). The P/F ratio increased in all groups over time. CI decreased in groups B and C. The global lung injury score did not significantly differ between groups (A: 0.25 ± 0.05, B: 0.21 ± 0.02, C: 0.22 ± 0.03). In this model of ALI, elevated IAP, ΔP and ΔPL increased further over time in the group with a PEEP of 5 cmH2O applied over 6 h. This was not the case in the groups with a PEEP of 10 and 15 cmH2O. Although ΔP and ΔPL were significantly lower after 6 hours in group C compared to group A, we could not show significant differences in histological lung injury score.