Regional distribution of static lung strain induced by positive-end expiratory pressure (PEEP) in healthy, dorsally recumbent, anesthetized and mechanically ventilated dogs

Distribution and Magnitude of Regional Volumetric Lung Strain and Its Modification by PEEP in Healthy Anesthetized and Mechanically Ventilated Dogs

The present study describes the magnitude and spatial distribution of lung strain in healthy anesthetized, mechanically ventilated dogs with and without positive end-expiratory pressure (PEEP). Total lung strain (LS_TOTAL) has a dynamic (LS_DYNAMIC) and a static (LS_STATIC) component. Due to lung heterogeneity, global lung strain may not accurately represent regional total tissue lung strain (TS_TOTAL), which may also be described by a regional dynamic (TS_DYNAMIC) and static (TS_STATIC) component. Six healthy anesthetized beagles (12.4 ± 1.4 kg body weight) were placed in dorsal recumbency and ventilated with a tidal volume of 15 ml/kg, respiratory rate of 15 bpm, and zero end-expiratory pressure (ZEEP). Respiratory system mechanics and full thoracic end-expiratory and end-inspiratory CT scan images were obtained at ZEEP. Thereafter, a PEEP of 5 cmH₂O was set and respiratory system mechanics measurements and end-expiratory and end-inspiratory images were repeated. Computed lung volumes from CT scans were used to evaluate the global LS_TOTAL, LS_DYNAMIC, and LS_STATIC during PEEP. During ZEEP, LS_STATIC was assumed zero; therefore, LS_TOTAL was the same as LS_DYNAMIC. Image segmentation was applied to CT images to obtain maps of regional TS_TOTAL, TS_DYNAMIC, and TS_STATIC during PEEP, and TS_DYNAMIC during ZEEP. Compliance increased (p = 0.013) and driving pressure decreased (p = 0.043) during PEEP. PEEP increased the end-expiratory lung volume (p < 0.001) and significantly reduced global LS_DYNAMIC (33.4 ± 6.4% during ZEEP, 24.0 ± 4.6% during PEEP, p = 0.032). LS_STATIC by PEEP was larger than the reduction in LS_DYNAMIC; therefore, LS_TOTAL at PEEP was larger than LS_DYNAMIC at ZEEP (p = 0.005). There was marked topographic heterogeneity of regional strains. PEEP induced a significant reduction in TS_DYNAMIC in all lung regions (p < 0.05). Similar to global findings, PEEP-induced TS_STATIC was larger than the reduction in TS_DYNAMIC; therefore, PEEP-induced TS_TOTAL was larger than TS_DYNAMIC at ZEEP. In conclusion, PEEP reduced both global and regional estimates of dynamic strain, but induced a large static strain. Given that lung injury has been mostly associated with tidal deformation, limiting dynamic strain may be an important clinical target in healthy and diseased lungs, but this requires further study.