Impact of different frequencies of controlled breath and pressure-support levels during biphasic positive airway pressure ventilation on the lung and diaphragm in experimental mild acute respiratory distress syndrome

Autor: Pedro L. Silva, Lillian Moraes, Alessandra Thompson, Marcelo Gama de Abreu, Cintia L. Santos, Mariana A. Antunes, Paolo Pelosi, Cynthia S. Samary, Nazareth N. Rocha, Vera Luiza Capelozzi, Felipe Saddy, Marcos V. S. Fernandes, Soraia C. Abreu, Patricia R. M. Rocco
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
ARDS
Critical Care and Emergency Medicine
Pulmonology
Physiology
Respiratory System
Gene Expression
Basement Membrane
Epithelium
Medical Conditions
Animal Cells
Thoracic Diaphragm
Medicine and Health Sciences
Edema
Diffuse alveolar damage
Acute Respiratory Distress Syndrome
Lung
Respiratory Distress Syndrome
Multidisciplinary
Continuous Positive Airway Pressure
Respiration
respiratory system
Diaphragm (structural system)
Extracellular Matrix
Laboratory Equipment
medicine.anatomical_structure
Breathing
Cardiology
Medicine
Engineering and Technology
Anatomy
Cellular Structures and Organelles
Cellular Types
Transpulmonary pressure
Research Article
medicine.medical_specialty
Science
Ventilators
Acute Lung Injury
Diaphragm
Equipment
Lung injury
Biphasic Positive Airway Pressure
Respiratory Disorders
Signs and Symptoms
Respiratory Failure
Internal medicine
medicine
Genetics
Tidal Volume
Animals
Endothelium
Rats
Wistar
business.industry
Biology and Life Sciences
Endothelial Cells
Epithelial Cells
Cell Biology
medicine.disease
Rats
Biological Tissue
Clinical Medicine
business
Physiological Processes
Zdroj: PLoS ONE
PLoS ONE, Vol 16, Iss 8, p e0256021 (2021)
ISSN: 1932-6203
Popis: BackgroundWe hypothesized that a decrease in frequency of controlled breaths during biphasic positive airway pressure (BIVENT), associated with an increase in spontaneous breaths, whether pressure support (PSV)-assisted or not, would mitigate lung and diaphragm damage in mild experimental acute respiratory distress syndrome (ARDS).Materials and methodsWistar rats receivedEscherichia colilipopolysaccharide intratracheally. After 24 hours, animals were randomly assigned to: 1) BIVENT-100+PSV0%: airway pressure (Phigh) adjusted to VT= 6 mL/kg and frequency of controlled breaths (f) = 100 bpm; 2) BIVENT-50+PSV0%: Phighadjusted to VT= 6 mL/kg andf= 50 bpm; 3) BIVENT-50+PSV50%(PSV set to half the Phighreference value, i.e., PSV50%); or 4) BIVENT-50+PSV100%(PSV equal to Phighreference value, i.e., PSV100%). Positive end-expiratory pressure (Plow) was equal to 5 cmH2O. Nonventilated animals were used for lung and diaphragm histology and molecular biology analysis.ResultsBIVENT-50+PSV0%, compared to BIVENT-100+PSV0%, reduced the diffuse alveolar damage (DAD) score, the expression of amphiregulin (marker of alveolar stretch) and muscle atrophy F-box (marker of diaphragm atrophy). In BIVENT-50 groups, the increase in PSV (BIVENT-50+PSV50%versusBIVENT-50+PSV100%) yielded better lung mechanics and less alveolar collapse, interstitial edema, cumulative DAD score, as well as gene expressions associated with lung inflammation, epithelial and endothelial cell damage in lung tissue, and muscle ring finger protein 1 (marker of muscle proteolysis) in diaphragm. Transpulmonary peak pressure (Ppeak,L) and pressure–time product per minute (PTPmin) at Phighwere associated with lung damage, while increased spontaneous breathing at Plowdid not promote lung injury.ConclusionIn the ARDS model used herein, during BIVENT, the level of PSV and the phase of the respiratory cycle in which the inspiratory effort occurs affected lung and diaphragm damage. Partitioning of inspiratory effort and transpulmonary pressure in spontaneous breaths at Plowand Phighis required to minimize VILI.
Databáze: OpenAIRE
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