Impact of Different Ventilation Strategies on Driving Pressure, Mechanical Power, and Biological Markers During Open Abdominal Surgery in Rats

Maia, Lígia de Albuquerque; Samary, Cynthia S.; Oliveira, Milena V.; Santos, Carlos Antônio Cabral; Huhle, Robert; Capelozzi, Vera Luíza; Morales, Marcelo M.; Schultz, Marcus J.; Abreu, Marcelo Gama de; Pelosi, Paolo; Silva, Pedro L.; Rocco, Patrícia Rieken Macêdo

doi:10.1213/ane.0000000000002348

Cited by 26 publications

(13 citation statements)

References 41 publications

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“…Recurrent delivery of tidal energy inflicts VILI when stress and strain exceed the limits of tissue tolerance. Experimental work linked mechanical power > 12 J/min to the development of VILI [18][19][20][21] and adverse outcome in clinical studies in adults [7,8,22]. To date, there are no pediatric studies that have examined such relationship.…”

Section: Discussionmentioning

confidence: 99%

Energy transmission in mechanically ventilated children: a translational study

et al. 2020

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Background Recurrent delivery of tidal mechanical energy (ME) inflicts ventilator-induced lung injury (VILI) when stress and strain exceed the limits of tissue tolerance. Mechanical power (MP) is the mathematical description of the ME delivered to the respiratory system over time. It is unknown how ME relates to underlying lung pathology and outcome in mechanically ventilated children. We therefore tested the hypothesis that ME per breath with tidal volume (Vt) normalized to bodyweight correlates with underlying lung pathology and to study the effect of resistance on the ME dissipated to the lung. Methods We analyzed routinely collected demographic, physiological, and laboratory data from deeply sedated and/or paralyzed children < 18 years with and without lung injury. Patients were stratified into respiratory system mechanic subgroups according to the Pediatric Mechanical Ventilation Consensus Conference (PEMVECC) definition. The association between MP, ME, lung pathology, and duration of mechanical ventilation as a primary outcome measure was analyzed adjusting for confounding variables and effect modifiers. The effect of endotracheal tube diameter (ETT) and airway resistance on energy dissipation to the lung was analyzed in a bench model with different lung compliance settings. Results Data of 312 patients with a median age of 7.8 (1.7–44.2) months was analyzed. Age (p < 0.001), RR p < 0.001), and Vt < 0.001) were independently associated with MPrs. ME but not MP correlated significantly (p < 0.001) better with lung pathology. Competing risk regression analysis adjusting for PRISM III 24 h score and PEMVECC stratification showed that ME on day 1 or day 2 of MV but not MP was independently associated with the duration of mechanical ventilation. About 33% of all energy generated by the ventilator was transferred to the lung and highly dependent on lung compliance and airway resistance but not on endotracheal tube size (ETT) during pressure control (PC) ventilation. Conclusions ME better related to underlying lung pathology and patient outcome than MP. The delivery of generated energy to the lung was not dependent on ETT size during PC ventilation. Further studies are needed to identify injurious MErs thresholds in ventilated children.

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Section: Discussionmentioning

confidence: 99%

Energy transmission in mechanically ventilated children: a translational study

et al. 2020

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“…In patients with severe ARDS receiving extracorporeal membrane oxygenation (ECMO), higher driving pressure during the rst 3 days of ECMO support was independently associated with increased mortality [6]. In a rat-model of open abdominal surgery, lower driving pressure was associated with reduced lung damage [7]. In patients with severe pneumonia without ARDS, higher driving pressure was associated with 28-day mortality [8].…”

Section: The Association Between Mechanical Power and Mortality In Vementioning

confidence: 99%

The Association Between Mechanical Power and Mortality in Ventilated Patients with Pneumonia

Chu

Chuang

et al. 2020

Preprint

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Background: Recent studies reported that mechanical power (MP) has been associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). We aimed to investigate the association between 28-day mortality and MP in patients with severe pneumonia. Methods: In total, 313 patients with severe pneumonia were enrolled. Serial MP was recorded daily for either 21 days or until ventilator support was no longer required. The associations between all variables and 28-day mortality were analyzed using binary logistic regression analyses. Results: The ARDS group (106 patients) demonstrated lower age, higher Acute Physiology and Chronic Health Evaluation II score, lower history of diabetes mellitus, high incidences of shock and jaundice, higher MP and driving pressure on Day 1, and higher death within 28 days than the non-ARDS group. Regression analysis revealed that MP was an independent factor associated with 28-day mortality (odds ratio, 1.041; 95% confidence interval, 1.013-1.071). MP persisted high in non-survivors and low in survivors among the ARDS group, the non-ARDS group and all patients.Conclusions: MP was associated with the 28-day mortality in ventilated patients with severe pneumonia both in the ARDS and non-ARDS groups. MP had better predicted value for 28-day mortality than driving pressure.

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“…The right lower lung was immersed in immunohistochemistry solution. To evaluate the degree of epithelial cell damage, expression of E-cadherin (the major transmembrane protein of the adherens junction) was analyzed (Maia et al, 2017). Immunohistochemical procedures were performed on lung sections using a mouse polyclonal antibody against E-cadherin (cat.…”

Section: Immunohistochemistrymentioning

confidence: 99%

“…Nevertheless, since rats have a higher metabolic basal rate, a period of 150 days in rats would correspond to 14 years in humans (West and West, 2013). Third, our model of open abdominal surgery (laparotomy plus bowel manipulation), despite widespread use for experimental research (Maia et al, 2017), does not reproduce all aspects of the complex clinical scenario, where surgical trauma may be accompanied by bleeding and hemodynamic impairment. Fourth, in order to properly compare lung morphometry among groups, all animals had their PEEP level adjusted to 3 cmH 2 O for 2 min.…”

Section: Limitationsmentioning

confidence: 99%

“…In the iPROVE trial (Ferrando et al, 2018), higher PEEP or individualized PEEP setting compared with lower PEEP did not result in fewer PPCs. In an animal model of open abdominal surgery, both low-V T and moderate to high-PEEP and RMs resulted in lower driving pressure, mechanical power, and lung damage (Maia et al, 2017). The PROBESE trial (Bluth et al, 2019) compared high-PEEP and RM versus low-PEEP at low V T and found no significant differences in PPCs.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Protective Mechanical Ventilation With Different PEEP Levels on Alveolar Damage and Inflammation in a Model of Open Abdominal Surgery: A Randomized Study in Obese Versus Non-obese Rats

et al. 2019

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Impact of Different Ventilation Strategies on Driving Pressure, Mechanical Power, and Biological Markers During Open Abdominal Surgery in Rats

Abstract: In this model of open abdominal surgery based on the mechanical ventilation strategies used in IMPROVE and PROVHILO trials, lower mechanical power and its surrogate ΔPRS were associated with reduced lung damage.

Cited by 26 publications

References 41 publications

Energy transmission in mechanically ventilated children: a translational study

Energy transmission in mechanically ventilated children: a translational study

The Association Between Mechanical Power and Mortality in Ventilated Patients with Pneumonia

Effects of Protective Mechanical Ventilation With Different PEEP Levels on Alveolar Damage and Inflammation in a Model of Open Abdominal Surgery: A Randomized Study in Obese Versus Non-obese Rats

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