Oscillatory ventilation enhances oxygenation and reduces inflammation in an animal model of acute respiratory distress syndrome: an experimental study
Ventilação oscilatória melhora a oxigenação e reduz a inflamação em um modelo animal de síndrome do desconforto respiratório agudo: um estudo experimental
Luiz Alberto Forgiarini Junior, Luiz Felipe Forgiarini Arthur de Oliveira Paludo, Rodrigo Mariano, Mikael Marcelo de Moraes, Elaine Aparecida Felix, Cristiano Feijó Andrade
Abstract
Background
This study aims to compare the use of variable mechanical ventilation with conventional mechanical ventilation in a porcine model of ARDS induced by oleic acid.
Methods
The animals were divided into two groups (n = 6), Conventional Ventilation (CO) and variable ventilation with Bi-Oscillatory PEEP (BiPEEP). ARDS was induced using intravenous oleic acid (0.15 mL.kg-1). After, the animals were evaluated during 180 minutes and, measurements were taken every 30 minutes until the end of the observation period. The animals in the CO group were then ventilated under controlled pressure (Tidal Volume target at 6 mL.kg-1) and 5cmH2OPEEP. Variable ventilation was characterized by the oscillation of PEEP from 5 to 10 cm H2O every 4 respiratory cycles. Ventilatory, hemodynamic parameters, oxidative stress, antioxidant enzymes, Interleukin 8 (IL8) and 17-a (IL17a) were evaluated. Histological samples were collected from the upper and the lower portion of the left lungs and analyzed separately.
Results
BiPEEP improved lung compliance and PaO2 in comparison to control (p < 0.05). The levels of oxidative stress and antioxidant enzymes showed no significant difference. There was no difference in IL17a between groups. IL8 was significantly increased in the lung base of CO group in relation to BiPEEP group and it was reduced in the apex of BiPEEP group in comparsion to COgroup. The BiPEEP group showed less changes in histopathological patterns.
Conclusions
Variable ventilation with bi-oscillatory level of PEEP demonstrated a potential ventilatory strategy for lung protection in an experimental model of ARDS.
Keywords
Resumo
Introdução
Este estudo tem como objetivo comparar o uso da ventilação mecânica variável com a ventilação mecânica convencional em um modelo suíno de SDRA induzida por ácido oleico.
Métodos
Os animais foram divididos em dois grupos (n = 6), Ventilação Convencional (CO) e Ventilação Variável com PEEP Bi-Oscilatória (BiPEEP). A SDRA foi induzida usando ácido oleico intravenoso (0,15 mL.kg−1). Em seguida, os animais foram avaliados durante 180 minutos e as medidas foram feitas a cada 30 minutos até o final do período de observação. Os animais do grupo CO foram então ventilados sob pressão controlada (Volume Corrente alvo em 6 mL.kg−1) e PEEP de 5 cm H2O. A ventilação variável foi caracterizada pela oscilação da PEEP de 5 a 10 cm H2O a cada 4 ciclos respiratórios. Parâmetros ventilatórios, hemodinâmicos, estresse oxidativo, enzimas antioxidantes, Interleucina 8 (IL8) e 17-a (IL17a) foram avaliados. Amostras histológicas foram coletadas da porção superior e inferior dos pulmões esquerdos e analisadas separadamente.
Resultados
A BiPEEP melhorou a complacência pulmonar e a PaO2 em comparação ao controle (p < 0,05). Os níveis de estresse oxidativo e enzimas antioxidantes não apresentaram diferença significativa. Não houve diferença na IL17a entre os grupos. A IL8 aumentou significativamente na base pulmonar do grupo CO em relação ao grupo BiPEEP e foi reduzida no ápice do grupo BiPEEP em comparação ao grupo CO. O grupo BiPEEP apresentou menos alterações nos padrões histopatológicos.
Conclusions
A ventilação variável com nível bi-oscilatório de PEEP demonstrou uma estratégia ventilatória potencial para proteção pulmonar em um modelo experimental de SDRA.
Palavras-chave
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Submitted date:
02/15/2024
Accepted date:
11/09/2024
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