Recruitment Maneuver Does not Increase the Risk of Ventilator Induced Lung Injury

Öz

Background: Mechanical ventilation (MV) may induce lung injury. Aims: To assess and evaluate the role of different mechanical ventilation strategies on ventilator-induced lung injury (VILI) in comparison to a strategy which includes recruitment manoeuvre (RM). Study design: Randomized animal experiment. Methods: Thirty male Sprague-Dawley rats were anaesthetised, tracheostomised and divided into 5 groups randomly according to driving pressures; these were mechanically ventilated with following peak alveolar opening (Pao) and positive end-expiratory pressures (PEEP) for 1 hour: Group 15-0: 15 cmH2O Pao and 0 cmH2O PEEP; Group 30-10: 30 cmH2O Pao and 10 cmH2O PEEP; Group 30-5: 30 cmH2O Pao and 5 cmH2O PEEP; Group 30-5&RM: 30 cmH2O Pao and 5 cmH2O PEEP with additional 45 cmH2O CPAP for 30 seconds in every 15 minutes; Group 45-0: 45 cmH2O Pao and 0 cmH2O PEEP Before rats were sacrificed, blood samples were obtained for the evaluation of cytokine and chemokine levels; then, the lungs were subsequently processed for morphologic evaluation. Results: Oxygenation results were similar in all groups; however, the groups were lined as follows according to the increasing severity of morphometric evaluation parameters: Group 15-0: (0±0.009) < Group 30-10: (0±0.14) < Group 30-5&RM: (1±0.12) < Group 30-5: (1±0.16) < Group 45-0: (2±0.16). Besides, inflammatory responses were the lowest in 30-5&RM group compared to all other groups. TNF-α, IL-1β, IL-6, MCP-1 levels were significantly different between group 30-5&RM and group 15-0 vs. group 45-0 in each group. Conclusion: RM with low PEEP reduces the risk of ventilator-induced lung injury with a lower release of systemic inflammatory mediators in response to mechanical ventilation. Turkish Başlık: Yeniden Kazandırma Manevrası Ventilatör İlişkili Akciğer Hasarı Riskini Artırmaz Arka Plan: Mekanik ventilasyon (MV) akciğer hasarına neden olabilir. Amaç: Farklı MV stratejilerinin ventilatör ilişkili akciğer hasarı üzerine etkilerini kazandırma manevrasını (RM) da içeren bir ventilasyon stratejisiyle karşılaştırarak değerlendirmek. Çalışma Tasarımı: Randomize hayvan çalışması. Yöntemler: Otuz erkek Sprague-Dawley sıçanı, anestezi uygulamasını takiben trakeostomize edildi ve uygulanacak ventilatör basınçlarına göre rastgele 5 gruba ayrılarak 1 saat süreyle aşağıdaki peak alveoler basınç (Pao) ve pozitif ekspiryum sonu basınç (PEEP) değerleriyle ventile edildiler. Grup 15-0: 15 cmH2O Pao ve 0 cm H2O PEEP; Grup 30-10: 30 cmH2O Pao ve 10 cmH2O PEEP; Grup 30-5: 30 cmH2O Pao ve 5 cmH2O PEEP; Grup 30-5&RM: 30 cmH2O Pao ve 5 cmH2O PEEP'e ek olarak her 15 dakikada bir 30 saniye süreli 45 cmH2O CPAP; Grup 45-0: 45 cmH2O Pao ve 0 cmH2O PEEP Sıçanlar sakrifiye edilmeden önce sitokin ve kemokin düzeylerinin değerlendirilmesi için kan örnekleri alındı. Sonrasında akciğerler morfolojik değerlendirme için işleme tabi tutuldu. Bulgular: Oksijenasyon sonuçları tüm gruplarda benzerdi, ancak morfometrik değerlendirme parametrelerinin artan şiddetine göre gruplar şu şekilde sıralandı. Grup 15-0: (0±0.009) < Grup 30-10: (0±0.14) < Grup 30-5&RM: (1±0.12) < Grup 30-5: (1±0.16) < Grup 45-0: (2±0.16). Bununla birlikte, diğer gruplarla kıyaslandığında inflamatuar yanıt 30-5&RM grubunda en düşüktü. TNF-a, IL-1 b, IL-6, MCP-1 seviyeleri grup 30-5&RM ve grup 15-0' da grup 45-0 ile kıyaslandıklarında anlamlı farklılık gösterdi. Sonuç: Düşük PEEP'le birlikte RM, MV'a yanıt olarak salınan sistemik inflamatuar

Anahtar Kelimeler

• Recruitment manoeuvre, ventilator-induced lung injury, TNF-α, IL-1β, IL-6, MCP-1

Recruitment Maneuver Does not Increase the Risk of Ventilator Induced Lung Injury

Öz

Kaynakça

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