Positive end-expiratory pressure modulates local and systemic inflammatory responses in a sepsis-induced lung injury model

Abstract

The use of a PEEP level above the inflection point in a sepsis-induced acute lung injury animal model modulates the pulmonary and systemic inflammatory responses associated with sepsis and decreases mortality during 3 h of MV.

Inflammatory Consequences of Lung Ischemia-Reperfusion Injury and Low-Pressure Ventilation

“…IL-6 is a pleiotropic cytokine, which can exert both proinflammatory and anti-inflammatory effects depending on the environment and the expression of soluble IL-6R complex formation [20]. Herrera et al creased IL-6 levels both locally in the lung and systemically after injurious ventilation [21]. In contrast, Farivar et al showed that recombinant IL-6 improved LIRI by reducing pro-inflammatory cytokines and chemokines [22].…”

Mechanisms of Acute Respiratory Distress Syndrome in Children and Adults

“…Experimental studies suggest that important synergistic interactions exist between activation of innate immunity pathways and mechanical ventilation (123,(138)(139)(140)(141)(142)(143). These studies show increases in alveolar neutrophil recruitment, proinflammatory cytokines, and lung injury when mechanical ventilation is combined with activation of the innate immune system by bacterial products, either in the lungs or the systemic circulation.…”

From ventilator‐induced lung injury to physician‐induced lung injury: Why the reluctance to use small tidal volumes?

“…In patients with ARDS, mechanical ventilation with large tidal volumes and no PEEP induces bronchiolar and alveolar distension (16). By contrast, experimental studies and clinical trials have shown that the application of so-called 'protective' ventilatory strategies are associated with decreased serum cytokine levels (14,15,18), decreased extrapulmonary organ dysfunction (14,15), and decreased mortality (17,18). In addition, some authors have hypothesized that the non-judicious use of mechanical ventilation is responsible for the development or progression of the multiple system organ dysfunction that very often is present in ARDS patients and is the main cause of death (19).…”

“…Experimental and clinical studies (10,(12)(13)(14)(15)(16)(17)(18) have shown that cyclic stress caused by ventilating the lungs with high inspiratory volumes or low positive end-expiratory pressures (PEEP) leads to VILI which is accompanied by the development of a pulmonary and systemic inflammatory response with release of cytokines from a variety of lung cells. This ventilatorinduced inflammatory response can cause and/or worsen lung injury and offset outcome by altering cellular pathways that are important for the normal function of tissues and organs.…”