Distribution of regional lung aeration and perfusion during conventional and noisy pressure support ventilation in experimental lung injury

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Alysson R. Carvalho - , Universidade Federal do Rio de Janeiro, Department of Anesthesiology and Intensive Care Medicine (Author)
  • Peter M. Spieth - , Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus Dresden, University of Toronto (Author)
  • Andreas Güldner - , Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus Dresden (Author)
  • Maximilano Cuevas - , University Hospital Carl Gustav Carus Dresden, Department of Anesthesiology and Intensive Care Medicine (Author)
  • Nadja C. Carvalho - , University Hospital Carl Gustav Carus Dresden, Department of Anesthesiology and Intensive Care Medicine (Author)
  • Alessandro Beda - , University Hospital Carl Gustav Carus Dresden, Department of Anesthesiology and Intensive Care Medicine (Author)
  • Stephanie Spieth - , Institute and Polyclinic of Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden (Author)
  • Christian Stroczynski - , University Hospital Carl Gustav Carus Dresden, Institute and Polyclinic of Diagnostic and Interventional Radiology (Author)
  • Bärbel Wiedemann - , University of Genoa (Author)
  • Thea Koch - , Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus Dresden (Author)
  • Paolo Pelosi - , University of Genoa (Author)
  • Marcelo Gama De Abreu - , Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus Dresden (Author)

Abstract

Distribution of regional lung aeration and perfusion during conventional and noisy pressure support ventilation in experimental lung injury. J Appl Physiol 110: 1083-1092, 2011. First published January 26, 2011; doi:10.1152/japplphysiol.00804.2010.-In acute lung injury (ALI), pressure support ventilation (PSV) may improve oxygenation compared with pressure-controlled ventilation (PCV), and\ benefit from random variation of pressure support (noisy PSV). We investigated the effects of PCV, PSV, and noisy PSV on gas exchange as well as the distribution of lung aeration and perfusion in 12 pigs with ALI induced by saline lung lavage in supine position. After injury, animals were mechanically ventilated with PCV, PSV, and noisy PSV for 1 h/mode in random sequence. The driving pressure was set to a mean tidal volume of 6 ml/kg and positive end-expiratory pressure to 8 cmH2O in all modes. Functional variables were measured, and the distribution of lung aeration was determined by static and dynamic computed tomography (CT), whereas the distribution of pulmonary blood flow (PBF) was determined by intravenously administered fluorescent microspheres. PSV and noisy PSV improved oxygenation and reduced venous admixture compared with PCV. Mechanical ventilation with PSV and noisy PSV did not decrease nonaerated areas but led to a redistribution of PBF from dorsal to ventral lung regions and reduced tidal reaeration and hyperinflation compared with PCV. Noisy PSV further improved oxygenation and redistributed PBF from caudal to cranial lung regions compared with conventional PSV. We conclude that assisted ventilation with PSV and noisy PSV improves oxygenation compared with PCV through redistribution of PBF from dependent to nondependent zones without lung recruitment. Random variation of pressure support further redistributes PBF and improves oxygenation compared with conventional PSV.

Details

Original languageEnglish
Pages (from-to)1083-1092
Number of pages10
JournalJournal of applied physiology
Volume110
Issue number4
Publication statusPublished - 1 Apr 2011
Peer-reviewedYes

External IDs

PubMed 21270348
ORCID /0000-0003-3953-3253/work/165878042

Keywords

ASJC Scopus subject areas

Keywords

  • Assisted mechanical ventilation, Pulmonary gas exchange, Respiratory insufficiency, Ventilation-perfusion matching