Mechanical Power and Development of Ventilator-induced Lung Injury

2016/02/12 by Massimo Cressoni, Miriam Gotti, Chiara Chiurazzi +19 · 28 citations
Medicine · #Respiratory Support and Mechanisms #Nosocomial Infections in ICU #Inhalation and Respiratory Drug Delivery

paper · doi:10.1097/aln.0000000000001056

Abstract

AbstractAbstract Twenty-four anesthetized piglets ventilated with a range of tidal volume and respiratory rate developed widespread lung injury above a threshold of 12 J/min. This finding suggests that mechanical power applied may be taken into account for ventilator-induced lung injury prevention. Supplemental Digital Content is available in the text. Background The ventilator works mechanically on the lung parenchyma. The authors set out to obtain the proof of concept that ventilator-induced lung injury (VILI) depends on the mechanical power applied to the lung. Methods Mechanical power was defined as the function of transpulmonary pressure, tidal volume (TV), and respiratory rate. Three piglets were ventilated with a mechanical power known to be lethal (TV, 38 ml/kg; plateau pressure, 27 cm H 2 O; and respiratory rate, 15 breaths/min). Other groups (three piglets each) were ventilated with the same TV per kilogram and transpulmonary pressure but at the respiratory rates of 12, 9, 6, and 3 breaths/min. The authors identified a mechanical power threshold for VILI and did nine additional experiments at the respiratory rate of 35 breaths/min and mechanical power below (TV 11 ml/kg) and above (TV 22 ml/kg) the threshold. Results In the 15 experiments to detect the threshold for VILI, up to a mechanical power of approximately 12 J/min (respiratory rate, 9 breaths/min), the computed tomography scans showed mostly isolated densities, whereas at the mechanical power above approximately 12 J/min, all piglets developed whole-lung edema. In the nine confirmatory experiments, the five piglets ventilated above the power threshold developed VILI, but the four piglets ventilated below did not. By grouping all 24 piglets, the authors found a significant relationship between the mechanical power applied to the lung and the increase in lung weight ( r 2 = 0.41, P = 0.001) and lung elastance ( r 2 = 0.33, P < 0.01) and decrease in Pa o 2 /F io 2 ( r 2 = 0.40, P < 0.001) at the end of the study. Conclusion In piglets, VILI develops if a mechanical power threshold is exceeded.

Citations

• Pressure-Volume Curve of Total Respiratory System in Acute Respiratory Failure: Computed Tomographic Scan Study

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