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Real-time effects of PEEP and tidal volume on regional ventilation and perfusion in experimental lung injury
Intensive Care Medicine Experimental Pub Date : 2020-02-21 , DOI: 10.1186/s40635-020-0298-2
João Batista Borges 1 , John N Cronin 1 , Douglas C Crockett 2 , Göran Hedenstierna 3 , Anders Larsson 4 , Federico Formenti 1, 2
Affiliation  

Background Real-time bedside information on regional ventilation and perfusion during mechanical ventilation (MV) may help to elucidate the physiological and pathophysiological effects of MV settings in healthy and injured lungs. We aimed to study the effects of positive end-expiratory pressure (PEEP) and tidal volume ( V T ) on the distributions of regional ventilation and perfusion by electrical impedance tomography (EIT) in healthy and injured lungs. Methods One-hit acute lung injury model was established in 6 piglets by repeated lung lavages ( injured group). Four ventilated piglets served as the control group. A randomized sequence of any possible combination of three V T (7, 10, and 15 ml/kg) and four levels of PEEP (5, 8, 10, and 12 cmH 2 O) was performed in all animals. Ventilation and perfusion distributions were computed by EIT within three regions-of-interest (ROIs): nondependent, middle, dependent. A mixed design with one between-subjects factor (group: intervention or control ), and two within-subjects factors (PEEP and V T ) was used, with a three-way mixed analysis of variance (ANOVA). Results Two-way interactions between PEEP and group, and V T and group, were observed for the dependent ROI ( p = 0.035 and 0.012, respectively), indicating that the increase in the dependent ROI ventilation was greater at higher PEEP and V T in the injured group than in the control group. A two-way interaction between PEEP and V T was observed for perfusion distribution in each ROI: nondependent ( p = 0.030), middle ( p = 0.006), and dependent ( p = 0.001); no interaction was observed between injured and control groups. Conclusions Large PEEP and V T levels were associated with greater pulmonary ventilation of the dependent lung region in experimental lung injury, whereas they affected pulmonary perfusion of all lung regions both in the control and in the experimental lung injury groups.

中文翻译:

PEEP和潮气量对实验性肺损伤区域通气和灌注的实时影响

背景 机械通气 (MV) 期间区域通气和灌注的实时床边信息可能有助于阐明 MV 设置对健康和受伤肺部的生理和病理生理影响。我们旨在通过电阻抗断层扫描 (EIT) 研究呼气末正压 (PEEP) 和潮气量 (VT) 对健康和受伤肺部区域通气和灌注分布的影响。方法 6头仔猪反复肺灌洗建立一击性急性肺损伤模型(损伤组)。四头通风仔猪作为对照组。在所有动物中进行三种 VT(7、10 和 15 ml/kg)和四种 PEEP(5、8、10 和 12 cmH 2 O)水平的任何可能组合的随机序列。通气和灌注分布由 EIT 在三个感兴趣区域 (ROI) 内计算:非依赖、中间、依赖。使用了一种混合设计,其中包含一个受试者间因素(组:干预或控制)和两个受试者内因素(PEEP 和 VT),并采用三向混合方差分析(ANOVA)。结果 观察到依赖 ROI 的 PEEP 和组之间以及 VT 和组之间的双向交互作用(分别为 p = 0.035 和 0.012),表明在受伤的 PEEP 和 VT 较高时,依赖 ROI 通气的增加更大组优于对照组。对于每个 ROI 中的灌注分布,观察到 PEEP 和 VT 之间的双向相互作用:非依赖 (p = 0.030)、中间 (p = 0.006) 和依赖 (p = 0.001);在受伤组和对照组之间没有观察到相互作用。
更新日期:2020-02-21
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