NDLI: Quantifying the Roles of Tidal Volume and PEEP in the Pathogenesis of Ventilator-Induced Lung Injury

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Quantifying the Roles of Tidal Volume and PEEP in the Pathogenesis of Ventilator-Induced Lung Injury

Content Provider	Springer Nature Link
Author	Seah, Adrian S. Grant, Kara A. Aliyeva, Minara Allen, Gilman B. Bates, Jason H. T.
Copyright Year	2010
Abstract	Management of patients with acute lung injury (ALI) rests on achieving a balance between the gas exchanging benefits of mechanical ventilation and the exacerbation of tissue damage in the form of ventilator-induced lung injury (VILI). Optimizing this balance requires an injury cost function relating injury progression to the measurable pressures, flows, and volumes delivered during mechanical ventilation. With this in mind, we mechanically ventilated naive, anesthetized, paralyzed mice for 4 h using either a low or high tidal volume (Vt) with either moderate or zero positive end-expiratory pressure (PEEP). The derecruitability of the lung was assessed every 15 min in terms of the degree of increase in lung elastance occurring over 3 min following a recruitment maneuver. Mice could be safely ventilated for 4 h with either a high Vt or zero PEEP, but when both conditions were applied simultaneously the lung became increasingly unstable, demonstrating worsening injury. We were able to mimic these data using a computational model of dynamic recruitment and derecruitment that simulates the effects of progressively increasing surface tension at the air–liquid interface, suggesting that the VILI in our animal model progressed via a vicious cycle of alveolar leak, degradation of surfactant function, and increasing tissue stress. We thus propose that the task of ventilating the injured lung is usefully understood in terms of the Vt–PEEP plane. Within this plane, non-injurious combinations of Vt and PEEP lie within a “safe region”, the boundaries of which shrink as VILI develops.
Starting Page	1505
Ending Page	1516
Page Count	12
File Format	PDF
ISSN	00906964
Journal	Annals of Biomedical Engineering
Volume Number	39
Issue Number	5
e-ISSN	15739686
Language	English
Publisher	Springer US
Publisher Date	2011-01-04
Publisher Place	Boston
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Acute lung injury/ARDS Lung derecruitment Mechanical ventilation Mouse model Computational model Biochemistry Mechanics Biomedical Engineering Biomedicine general Biophysics and Biological Physics
Content Type	Text
Resource Type	Article
Subject	Biomedical Engineering

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