by Motta-Ribeiro, Gabriel C, Hashimoto, Soshi, Winkler, Tilo, Baron, Rebecca M, Grogg, Kira, Paula, Luís F S C, Santos, Arnoldo, Zeng, Congli, Hibbert, Kathryn, Harris, Robert S, Bajwa, Ednan and Vidal Melo, Marcos F
Abstract:
RATIONALE:The contribution of aeration heterogeneity to lung injury during early mechanical ventilation of uninjured lungs is unknown. OBJECTIVE:Test the hypotheses that a strategy consistent with clinical practice does not protect from worsening in lung strains during the first 24h of ventilation of initially normal lungs exposed to mild systemic endotoxemia in supine versus prone position, and that local neutrophilic inflammation is associated with local strain and blood volume at global strains below a proposed injurious threshold. METHODS:Voxel level aeration and tidal strain were assessed by computed tomography in sheep ventilated with low tidal volume and positive end-expiratory pressure while receiving intravenous endotoxin. Regional inflammation and blood volume were estimated from 2-deoxy-2-[(18)F]fluoro-D-glucose (18F-FDG) positron emission tomography. MEASUREMENTS AND MAIN RESULTS:Spatial heterogeneity of aeration and strain increased only in supine lungs (P70%) than in normally-aerated regions (P<0.01), with differential mechanistically-relevant regional gene expression. 18F-FDG phosphorylation rate was associated with strain and blood volume. Imaging findings were confirmed in ventilated septic patients. CONCLUSIONS:Mechanical ventilation consistent with clinical practice did not generate excessive regional strain in heterogeneously aerated supine lungs. However, it allowed worsening of spatial strain distribution in these lungs, associated with increased inflammation. Our results support the implementation of early aeration homogenization in normal lungs.
Reference:
Deterioration of Regional Lung Strain and Inflammation during Early Lung Injury. (Motta-Ribeiro, Gabriel C, Hashimoto, Soshi, Winkler, Tilo, Baron, Rebecca M, Grogg, Kira, Paula, Luís F S C, Santos, Arnoldo, Zeng, Congli, Hibbert, Kathryn, Harris, Robert S, Bajwa, Ednan and Vidal Melo, Marcos F), In American journal of respiratory and critical care medicine, 2018.
Bibtex Entry:
@article{MottaRibeiro:2018cy,
author = {Motta-Ribeiro, Gabriel C and Hashimoto, Soshi and Winkler, Tilo and Baron, Rebecca M and Grogg, Kira and Paula, Lu{'i}s F S C and Santos, Arnoldo and Zeng, Congli and Hibbert, Kathryn and Harris, Robert S and Bajwa, Ednan and Vidal Melo, Marcos F},
title = {{Deterioration of Regional Lung Strain and Inflammation during Early Lung Injury.}},
journal = {American journal of respiratory and critical care medicine},
year = {2018},
pages = {rccm.201710--2038OC},
month = may,
affiliation = {Massachusetts General Hospital, 2348, Anesthesia, Critical Care and Pain Medicine, Boston, Massachusetts, United States.},
doi = {10.1164/rccm.201710-2038OC},
pmid = {29787304},
language = {English},
rating = {0},
date-added = {2018-06-19T14:35:56GMT},
date-modified = {2018-07-16T12:55:59GMT},
abstract = {RATIONALE:The contribution of aeration heterogeneity to lung injury during early mechanical ventilation of uninjured lungs is unknown.

OBJECTIVE:Test the hypotheses that a strategy consistent with clinical practice does not protect from worsening in lung strains during the first 24h of ventilation of initially normal lungs exposed to mild systemic endotoxemia in supine versus prone position, and that local neutrophilic inflammation is associated with local strain and blood volume at global strains below a proposed injurious threshold.

METHODS:Voxel level aeration and tidal strain were assessed by computed tomography in sheep ventilated with low tidal volume and positive end-expiratory pressure while receiving intravenous endotoxin. Regional inflammation and blood volume were estimated from 2-deoxy-2-[(18)F]fluoro-D-glucose (18F-FDG) positron emission tomography.

MEASUREMENTS AND MAIN RESULTS:Spatial heterogeneity of aeration and strain increased only in supine lungs (P<0.001), with higher strains and atelectasis than prone at 24h. Absolute strains were lower than those considered globally injurious. Strains redistributed to higher aeration areas as lung injury progressed in supine lungs. At 24h, tissue-normalized 18F-FDG-uptake increased more in atelectatic and moderately high-aeration regions (>70%) than in normally-aerated regions (P<0.01), with differential mechanistically-relevant regional gene expression. 18F-FDG phosphorylation rate was associated with strain and blood volume. Imaging findings were confirmed in ventilated septic patients.

CONCLUSIONS:Mechanical ventilation consistent with clinical practice did not generate excessive regional strain in heterogeneously aerated supine lungs. However, it allowed worsening of spatial strain distribution in these lungs, associated with increased inflammation. Our results support the implementation of early aeration homogenization in normal lungs.},
url = {https://www.atsjournals.org/doi/10.1164/rccm.201710-2038OC},
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uri = {url{papers3://publication/doi/10.1164/rccm.201710-2038OC}}
}