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Fiedler MO, Simeliunas E, Deutsch BL, Diktanaite D, Harms A, Brune M, Dietrich M, Uhle F, Weigand MA, Kalenka A. 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. J Clin Med 2021; 10:jcm10020306. [PMID: 33467666 PMCID: PMC7830768 DOI: 10.3390/jcm10020306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 12/27/2022] Open
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.
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Affiliation(s)
- Mascha O. Fiedler
- Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (E.S.); (D.D.); (M.D.); (F.U.); (M.A.W.)
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), 69120 Heidelberg, Germany;
- Correspondence:
| | - Emilis Simeliunas
- Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (E.S.); (D.D.); (M.D.); (F.U.); (M.A.W.)
- Department of Anesthesiology, Kantonsspital Lucerne, 6004 Lucerne, Switzerland
| | - B. Luise Deutsch
- Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany;
| | - Dovile Diktanaite
- Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (E.S.); (D.D.); (M.D.); (F.U.); (M.A.W.)
- Department of Anesthesiology, Kantonsspital Lucerne, 6004 Lucerne, Switzerland
| | - Alexander Harms
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Maik Brune
- Department of Internal Medicine I and Clinical Chemistry, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Maximilian Dietrich
- Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (E.S.); (D.D.); (M.D.); (F.U.); (M.A.W.)
| | - Florian Uhle
- Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (E.S.); (D.D.); (M.D.); (F.U.); (M.A.W.)
| | - Markus A. Weigand
- Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (E.S.); (D.D.); (M.D.); (F.U.); (M.A.W.)
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), 69120 Heidelberg, Germany;
| | - Armin Kalenka
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), 69120 Heidelberg, Germany;
- Department of Anesthesiology and Intensive Care Medicine, Hospital Bergstrasse, 64646 Heppenheim, Germany
- Faculty of Medicine, University of Heidelberg, 69120 Heidelberg, Germany
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