BACKGROUND:Pulmonary surfactant dysfunction may contribute to the development of ventilator induced lung injury (VILI). Tracheal gas insufflation (TGI) is a technique in which fresh gas is introduced into the trachea and augment ventilation by reducing the dead space of ventilatory system, reducing ventilatory pressures and tidal volume (V(T)) while maintaining constant partial arterial CO2 pressure (PaCO(2)). We hypothesised that TGI limited peak inspiratory pressure (PIP) and V(T) and would minimize conventional mechanical ventilation (CMV) induced pulmonary surfactant dysfunction and thereby attenuate VILI in rabbits with acute lung injury (ALI). METHODS:ALI was induced by intratracheal administration of lipopolysaccharide in anaesthetized, ventilated healthy adult rabbits randomly assigned to continuous TGI at 0.5 L/min (TGI group) or CMV group (n = 8 for each group), and subsequently ventilated with limited PIP and V(T) to maintain PaCO(2) within 35 to 45 mmHg for 4 hours. Physiological dead space to V(T) ratio (V(D)/V(T)), dynamic respiratory compliance (Cdyn) and partial arterial O(2) pressure (PaO(2)) were monitored. After ventilation, lungs were analysed for total phospholipids (TPL), total proteins (TP), pulmonary surfactant small to large aggregates ratio (SA/LA) in bronchoalveolar lavage fluid (BALF) and for determination of alveolar volume density (V(V)), myeloperoxidase and interleukin (IL)-8. RESULTS:TGI resulted in significant (P < 0.05 or P < 0.01) decrease in PIP [(22.4 +/- 1.8) cmH2O vs (29.5 +/- 1.1) cmH2O], V(T) [(6.9 +/- 1.3) ml/kg vs (9.8 +/- 1.11) ml/kg], V(D)/V(T) [(32 +/- 5)% vs (46 +/- 2)%], TP [(109 +/- 22) mg/kg vs (187 +/- 25) mg/kg], SA/LA (2.5 +/- 0.4 vs 5.4 +/- 0.7), myeloperoxidase [(6.2 +/- 0.5) U/g tissue vs (12.3 +/- 0.8) U/g tissue] and IL-8 [(987 +/- 106) ng/g tissue vs (24 +/- 3) mN/m] of BALF, and significant (P < 0.05) increase in Cdyn [(0.47 +/- 0.02) ml.cmH2O(-1).kg(-1) vs (0.31 +/- 0.02) ml.cmH2O(-1).kg(-1)], PaO(2) [(175 +/- 24) mmHg vs (135 +/- 26) mmHg], TPL/TP (52 +/- 8 vs 33 +/- 11) and Vv (0.65 +/- 0.05 vs 0.44 +/- 0.07) as compared with CMV. CONCLUSIONS:In this animal model of ALI, TGI decreased ventilatory requirements (PIP, V(T) and V(D)/V(T)), resulted in more favourable alveolar pulmonary surfactant composition and function and less severity of lung injury than CMV. TGI in combination with pressure limited ventilation may be a lung protective strategy for ALI.

译文

背景:肺表面活性物质功能障碍可能导致呼吸机诱发的肺损伤(VILI)的发展。气管注气(TGI)是一种将新鲜气体引入气管并通过减少通气系统的死腔,降低通气压力和潮气量(V(T))并同时保持恒定的部分动脉CO2压力来增强通气的技术( PaCO(2))。我们假设TGI限制了峰值吸气压力(PIP)和V(T),并且将传统机械通气(CMV)引起的肺表面活性剂功能异常减至最小,从而减轻了急性肺损伤(ALI)兔的VILI。
方法:通过气管内脂多糖经气管内给药的麻醉,通风的健康成年兔随机分为0.5 L / min(TGI组)或CMV组(每组n = 8),然后在有限的PIP和通气条件下通气,以诱导ALI。 V(T)将PaCO(2)维持在35至45 mmHg的范围内4个小时。监测生理死区与V(T)的比率(V(D)/ V(T)),动态呼吸顺应性(Cdyn)和部分动脉O(2)压力(PaO(2))。通气后,对肺中的总磷脂(TPL),总蛋白(TP),支气管肺泡灌洗液(BALF)中的肺表面活性剂小到大聚集比(SA / LA)进行分析,并测定肺泡体积密度(V(V)) ),髓过氧化物酶和白介素(IL)-8。
结果:TGI导致PIP显着降低(P <0.05或P <0.01)[(22.4 /-1.8)cmH2O与(29.5 /-1.1)cmH2O],V(T)[(6.9 /-1.3)ml / kg vs(9.8 /-1.11)ml / kg],V(D)/ V(T)[(32 /-5)%vs(46 /-2)%],TP [(109 /-22)mg / kg vs(187 /-25)mg / kg],SA / LA(2.5 /-0.4 vs 5.4 /-0.7),髓过氧化物酶[(6.2 /-0.5)U / g组织vs(12.3 /-0.8)U / g组织]和IL-8 [(987 /-106)ng / g组织vs(24 /-3)mN / m] BALF,Cdyn [(0.47 /-0.02)ml.cmH2O显着(P <0.05)增加(-1).kg(-1)vs(0.31 /-0.02)ml.cmH2O(-1).kg(-1)],PaO(2)[(175 /-24)mmHg vs(135 /-26 )mmHg],TPL / TP(52 /-8 vs 33 /-11)和Vv(0.65 /-0.05 vs 0.44 /-0.07)。
结论:在这种ALI动物模型中,TGI降低了通气需求(PIP,V(T)和V(D)/ V(T)),与CMV相比,肺泡表面活性剂的肺泡表面活性剂组成和功能更佳,肺部损伤的严重程度更低。 TGI结合限压通气可能是ALI的肺保护策略。

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