Biological impact of transpulmonary driving pressure in experimental acute respiratory distress syndrome

Cynthia S. Samary; Raquel S. Santos; Cíntia L. Santos; Nathane S. Felix; Maira Bentes; Thiago Barboza; Vera L. Capelozzi; Marcelo M. Morales; Cristiane S N B Garcia; Sergio A L Souza; John J. Marini; Marcelo Gama De Abreu; Pedro L. Silva; Paolo Pelosi; Patricia R M Rocco

doi:10.1097/ALN.0000000000000716

Biological impact of transpulmonary driving pressure in experimental acute respiratory distress syndrome

Cynthia S. Samary
, Raquel S. Santos
, Cíntia L. Santos
, Nathane S. Felix
, Maira Bentes
, Thiago Barboza
, Vera L. Capelozzi
, Marcelo M. Morales
, Cristiane S N B Garcia
, Sergio A L Souza
, John J. Marini
, Marcelo Gama De Abreu
, Pedro L. Silva
, Paolo Pelosi
, Patricia R M Rocco

Pulmonary, Allergy, Critical Care and Sleep Medicine

Research output: Contribution to journal › Article › peer-review

56 Scopus citations

Abstract

Background: Ventilator-induced lung injury has been attributed to the interaction of several factors: tidal volume (V_T), positive end-expiratory pressure (PEEP), transpulmonary driving pressure (difference between transpulmonary pressure at end-inspiration and end-expiration, ΔP,L), and respiratory system plateau pressure (Pplat,rs). Methods: Forty-eight Wistar rats received Escherichia coli lipopolysaccharide intratracheally. After 24 h, animals were randomized into combinations of V_T and PEEP, yielding three different ΔP,L levels: ΔP,L_LOW (V_T = 6 ml/kg, PEEP = 3 cm H₂O); ΔP,L_MEAN (V_T = 13 ml/kg, PEEP = 3 cm H₂O or V_T = 6 ml/kg, PEEP = 9.5 cm H₂O); and ΔP,L_HIGH (V_T = 22 ml/kg, PEEP = 3 cm H₂O or V_T = 6 ml/kg, PEEP = 11 cm H₂O). In other groups, at low V_T, PEEP was adjusted to obtain a Pplat,rs similar to that achieved with ΔP,L_MEAN and ΔP,L_HIGH at high V_T. Results: At ΔP,L_LOW, expressions of interleukin (IL)-6, receptor for advanced glycation end products (RAGE), and amphiregulin were reduced, despite morphometric evidence of alveolar collapse. At ΔP,L_HIGH (V_T = 6 ml/kg and PEEP = 11 cm H₂O), lungs were fully open and IL-6 and RAGE were reduced compared with ΔP,L_MEAN (27.4 ± 12.9 vs. 41.6 ± 14.1 and 0.6 ± 0.2 vs. 1.4 ± 0.3, respectively), despite increased hyperinflation and amphiregulin expression. At ΔP,L_MEAN (V_T = 6 ml/kg and PEEP = 9.5 cm H₂O), when PEEP was not high enough to keep lungs open, IL-6, RAGE, and amphiregulin expression increased compared with ΔP,L_LOW (41.6 ± 14.1 vs. 9.0 ± 9.8, 1.4 ± 0.3 vs. 0.6 ± 0.2, and 6.7 ± 0.8 vs. 2.2 ± 1.0, respectively). At Pplat,rs similar to that achieved with ΔP,L_MEAN and ΔP,L_HIGH, higher V_T and lower PEEP reduced IL-6 and RAGE expression. Conclusion: In the acute respiratory distress syndrome model used in this experiment, two strategies minimized ventilatorinduced lung injury: (1) low V_T and PEEP, yielding low ΔP,L and Pplat,rs; and (2) low V_T associated with a PEEP level sufficient to keep the lungs open.

Original language	English (US)
Pages (from-to)	423-433
Number of pages	11
Journal	Anesthesiology
Volume	123
Issue number	2
DOIs	https://doi.org/10.1097/ALN.0000000000000716
State	Published - Aug 1 2015

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Copyright © 2015, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.

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10.1097/ALN.0000000000000716

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Samary, C. S., Santos, R. S., Santos, C. L., Felix, N. S., Bentes, M., Barboza, T., Capelozzi, V. L., Morales, M. M., Garcia, C. S. N. B., Souza, S. A. L., Marini, J. J., De Abreu, M. G., Silva, P. L., Pelosi, P., & Rocco, P. R. M. (2015). Biological impact of transpulmonary driving pressure in experimental acute respiratory distress syndrome. Anesthesiology, 123(2), 423-433. https://doi.org/10.1097/ALN.0000000000000716

Samary, CS, Santos, RS, Santos, CL, Felix, NS, Bentes, M, Barboza, T, Capelozzi, VL, Morales, MM, Garcia, CSNB, Souza, SAL, Marini, JJ, De Abreu, MG, Silva, PL, Pelosi, P & Rocco, PRM 2015, 'Biological impact of transpulmonary driving pressure in experimental acute respiratory distress syndrome', Anesthesiology, vol. 123, no. 2, pp. 423-433. https://doi.org/10.1097/ALN.0000000000000716

@article{3cc16862e1c04267a8e52be0774b780e,

title = "Biological impact of transpulmonary driving pressure in experimental acute respiratory distress syndrome",

abstract = "Background: Ventilator-induced lung injury has been attributed to the interaction of several factors: tidal volume (VT), positive end-expiratory pressure (PEEP), transpulmonary driving pressure (difference between transpulmonary pressure at end-inspiration and end-expiration, ΔP,L), and respiratory system plateau pressure (Pplat,rs). Methods: Forty-eight Wistar rats received Escherichia coli lipopolysaccharide intratracheally. After 24 h, animals were randomized into combinations of VT and PEEP, yielding three different ΔP,L levels: ΔP,LLOW (VT = 6 ml/kg, PEEP = 3 cm H2O); ΔP,LMEAN (VT = 13 ml/kg, PEEP = 3 cm H2O or VT = 6 ml/kg, PEEP = 9.5 cm H2O); and ΔP,LHIGH (VT = 22 ml/kg, PEEP = 3 cm H2O or VT = 6 ml/kg, PEEP = 11 cm H2O). In other groups, at low VT, PEEP was adjusted to obtain a Pplat,rs similar to that achieved with ΔP,LMEAN and ΔP,LHIGH at high VT. Results: At ΔP,LLOW, expressions of interleukin (IL)-6, receptor for advanced glycation end products (RAGE), and amphiregulin were reduced, despite morphometric evidence of alveolar collapse. At ΔP,LHIGH (VT = 6 ml/kg and PEEP = 11 cm H2O), lungs were fully open and IL-6 and RAGE were reduced compared with ΔP,LMEAN (27.4 ± 12.9 vs. 41.6 ± 14.1 and 0.6 ± 0.2 vs. 1.4 ± 0.3, respectively), despite increased hyperinflation and amphiregulin expression. At ΔP,LMEAN (VT = 6 ml/kg and PEEP = 9.5 cm H2O), when PEEP was not high enough to keep lungs open, IL-6, RAGE, and amphiregulin expression increased compared with ΔP,LLOW (41.6 ± 14.1 vs. 9.0 ± 9.8, 1.4 ± 0.3 vs. 0.6 ± 0.2, and 6.7 ± 0.8 vs. 2.2 ± 1.0, respectively). At Pplat,rs similar to that achieved with ΔP,LMEAN and ΔP,LHIGH, higher VT and lower PEEP reduced IL-6 and RAGE expression. Conclusion: In the acute respiratory distress syndrome model used in this experiment, two strategies minimized ventilatorinduced lung injury: (1) low VT and PEEP, yielding low ΔP,L and Pplat,rs; and (2) low VT associated with a PEEP level sufficient to keep the lungs open.",

author = "Samary, \{Cynthia S.\} and Santos, \{Raquel S.\} and Santos, \{C{\'i}ntia L.\} and Felix, \{Nathane S.\} and Maira Bentes and Thiago Barboza and Capelozzi, \{Vera L.\} and Morales, \{Marcelo M.\} and Garcia, \{Cristiane S N B\} and Souza, \{Sergio A L\} and Marini, \{John J.\} and \{De Abreu\}, \{Marcelo Gama\} and Silva, \{Pedro L.\} and Paolo Pelosi and Rocco, \{Patricia R M\}",

note = "Publisher Copyright: Copyright {\textcopyright} 2015, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.",

year = "2015",

month = aug,

day = "1",

doi = "10.1097/ALN.0000000000000716",

language = "English (US)",

volume = "123",

pages = "423--433",

journal = "Anesthesiology",

issn = "0003-3022",

publisher = "Lippincott Williams and Wilkins",

number = "2",

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TY - JOUR

T1 - Biological impact of transpulmonary driving pressure in experimental acute respiratory distress syndrome

AU - Samary, Cynthia S.

AU - Santos, Raquel S.

AU - Santos, Cíntia L.

AU - Felix, Nathane S.

AU - Bentes, Maira

AU - Barboza, Thiago

AU - Capelozzi, Vera L.

AU - Morales, Marcelo M.

AU - Garcia, Cristiane S N B

AU - Souza, Sergio A L

AU - Marini, John J.

AU - De Abreu, Marcelo Gama

AU - Silva, Pedro L.

AU - Pelosi, Paolo

AU - Rocco, Patricia R M

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Background: Ventilator-induced lung injury has been attributed to the interaction of several factors: tidal volume (VT), positive end-expiratory pressure (PEEP), transpulmonary driving pressure (difference between transpulmonary pressure at end-inspiration and end-expiration, ΔP,L), and respiratory system plateau pressure (Pplat,rs). Methods: Forty-eight Wistar rats received Escherichia coli lipopolysaccharide intratracheally. After 24 h, animals were randomized into combinations of VT and PEEP, yielding three different ΔP,L levels: ΔP,LLOW (VT = 6 ml/kg, PEEP = 3 cm H2O); ΔP,LMEAN (VT = 13 ml/kg, PEEP = 3 cm H2O or VT = 6 ml/kg, PEEP = 9.5 cm H2O); and ΔP,LHIGH (VT = 22 ml/kg, PEEP = 3 cm H2O or VT = 6 ml/kg, PEEP = 11 cm H2O). In other groups, at low VT, PEEP was adjusted to obtain a Pplat,rs similar to that achieved with ΔP,LMEAN and ΔP,LHIGH at high VT. Results: At ΔP,LLOW, expressions of interleukin (IL)-6, receptor for advanced glycation end products (RAGE), and amphiregulin were reduced, despite morphometric evidence of alveolar collapse. At ΔP,LHIGH (VT = 6 ml/kg and PEEP = 11 cm H2O), lungs were fully open and IL-6 and RAGE were reduced compared with ΔP,LMEAN (27.4 ± 12.9 vs. 41.6 ± 14.1 and 0.6 ± 0.2 vs. 1.4 ± 0.3, respectively), despite increased hyperinflation and amphiregulin expression. At ΔP,LMEAN (VT = 6 ml/kg and PEEP = 9.5 cm H2O), when PEEP was not high enough to keep lungs open, IL-6, RAGE, and amphiregulin expression increased compared with ΔP,LLOW (41.6 ± 14.1 vs. 9.0 ± 9.8, 1.4 ± 0.3 vs. 0.6 ± 0.2, and 6.7 ± 0.8 vs. 2.2 ± 1.0, respectively). At Pplat,rs similar to that achieved with ΔP,LMEAN and ΔP,LHIGH, higher VT and lower PEEP reduced IL-6 and RAGE expression. Conclusion: In the acute respiratory distress syndrome model used in this experiment, two strategies minimized ventilatorinduced lung injury: (1) low VT and PEEP, yielding low ΔP,L and Pplat,rs; and (2) low VT associated with a PEEP level sufficient to keep the lungs open.

AB - Background: Ventilator-induced lung injury has been attributed to the interaction of several factors: tidal volume (VT), positive end-expiratory pressure (PEEP), transpulmonary driving pressure (difference between transpulmonary pressure at end-inspiration and end-expiration, ΔP,L), and respiratory system plateau pressure (Pplat,rs). Methods: Forty-eight Wistar rats received Escherichia coli lipopolysaccharide intratracheally. After 24 h, animals were randomized into combinations of VT and PEEP, yielding three different ΔP,L levels: ΔP,LLOW (VT = 6 ml/kg, PEEP = 3 cm H2O); ΔP,LMEAN (VT = 13 ml/kg, PEEP = 3 cm H2O or VT = 6 ml/kg, PEEP = 9.5 cm H2O); and ΔP,LHIGH (VT = 22 ml/kg, PEEP = 3 cm H2O or VT = 6 ml/kg, PEEP = 11 cm H2O). In other groups, at low VT, PEEP was adjusted to obtain a Pplat,rs similar to that achieved with ΔP,LMEAN and ΔP,LHIGH at high VT. Results: At ΔP,LLOW, expressions of interleukin (IL)-6, receptor for advanced glycation end products (RAGE), and amphiregulin were reduced, despite morphometric evidence of alveolar collapse. At ΔP,LHIGH (VT = 6 ml/kg and PEEP = 11 cm H2O), lungs were fully open and IL-6 and RAGE were reduced compared with ΔP,LMEAN (27.4 ± 12.9 vs. 41.6 ± 14.1 and 0.6 ± 0.2 vs. 1.4 ± 0.3, respectively), despite increased hyperinflation and amphiregulin expression. At ΔP,LMEAN (VT = 6 ml/kg and PEEP = 9.5 cm H2O), when PEEP was not high enough to keep lungs open, IL-6, RAGE, and amphiregulin expression increased compared with ΔP,LLOW (41.6 ± 14.1 vs. 9.0 ± 9.8, 1.4 ± 0.3 vs. 0.6 ± 0.2, and 6.7 ± 0.8 vs. 2.2 ± 1.0, respectively). At Pplat,rs similar to that achieved with ΔP,LMEAN and ΔP,LHIGH, higher VT and lower PEEP reduced IL-6 and RAGE expression. Conclusion: In the acute respiratory distress syndrome model used in this experiment, two strategies minimized ventilatorinduced lung injury: (1) low VT and PEEP, yielding low ΔP,L and Pplat,rs; and (2) low VT associated with a PEEP level sufficient to keep the lungs open.

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JO - Anesthesiology

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Biological impact of transpulmonary driving pressure in experimental acute respiratory distress syndrome

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