Hyperinflation deteriorates arterial oxygenation and lung injury in a rabbit model of ARDS with repeated open endotracheal suctioning.

Abstract

BACKGROUND:

Hyperinflation (HI) is performed following open endotracheal suctioning (OES), whose goals include: to stimulate a cough, recover oxygenation and improve compliance. However, it may also induce unintended consequences, including: lung stress and strain, failure to maintain high distending pressure, and subsequently cycling recruitment and derecruitment. Here, our aim was to investigate the effects of hyperinflation after repeated OES on sequential alteration of arterial oxygenation and lung injury profile using a saline lavage-induced surfactant depleted ARDS rabbit model.

METHODS:

Briefly, 30 Japanese White Rabbits were anesthetized and ventilated in pressure-controlled setting with a tidal volume of 6-8 ml/kg. Animals were divided into four groups, i.e.; Control, ARDS, OES, and HI. Saline-lavage-induced lung injury was induced except for Control group. Thereafter, rabbits were ventilated with positive-end expiratory pressure (PEEP) at 10 cm H2O. The ARDS group received ventilation with the same PEEP without derecruitment. As intervention, OES and HI were performed in ARDS animals. OES was performed for 15 seconds at 150 mm Hg, whereas HI was performed with PEEP at 0 cm H2O and peak inspiratory pressure at +5 cm H2O for a minute. Total duration of the experiment was for 3 hours. OES and HI were performed every 15 minutes from beginning of the protocol.

RESULTS:

PaO2 was maintained at about 400 mm Hg in both control and ARDS groups for the duration of this study, while in both OES and HI groups, PaO2 decreased continuously up to 3 hours, dropped to a mean (±SD) of 226 ± 28.9 and 97.0 ± 30.7 mmHg at 3 h, respectively. HI group had the lowest PaO2 in the present investigation. Histological lung injury score was the highest in HI group than other three groups. Pulmonary TNF-α and IL-8 levels were the highest in HI group compared to other groups, but without significant alterations at circulatory level in all the experimental groups.

CONCLUSIONS:

We show in the present study that hyperinflation following repeated OES deteriorate arterial oxygenation and the severity of lung injury in a rabbit model of ARDS undergoing mechanical ventilation.

• Authors: Junko Kamiyama, Subrina Jesmin, Hideaki Sakuramoto, Nobutake Shimojyo, Majedul Islam, Keiichi Hagiya, Masato Sugano, Takeshi Unoki, Masami Oki, Satoru Kawano, Taro Mizutani
• Journal: BMC anesthesiology (BMC Anesthesiol) Vol. 15 Pg. 73 (May 06 2015) ISSN: 1471-2253 [Electronic] England
• PMID: 25943099 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Interleukin-8
• Tumor Necrosis Factor-alpha
• Carbon Dioxide
• Oxygen

Topics

• Analysis of Variance
• Animals
• Carbon Dioxide (blood)
• Disease Models, Animal
• Enzyme-Linked Immunosorbent Assay
• Interleukin-8 (metabolism)
• Lung Injury (etiology)
• Male
• Oxygen (blood)
• Partial Pressure
• Positive-Pressure Respiration (adverse effects)
• Rabbits
• Random Allocation
• Respiratory Distress Syndrome (therapy)
• Suction (adverse effects)
• Tumor Necrosis Factor-alpha (metabolism)