Risk factors for ventilator-induced-lung injury develop three to five times faster after a single episode of lung injury
Mechanical ventilator breaths provided to deeply sedated patients have an abnormal volume distribution, encouraging alveolar collapse in dependent regions and promoting alveolar overdistention in non-dependent regions. Collapse and overdistention both start with the first breath and worsen over time...
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| Veröffentlicht in: | Canadian Journal of Respiratory Therapy 2023-01, Vol.59, p.103-110 |
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| container_title | Canadian Journal of Respiratory Therapy |
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| creator | Rohrs, Elizabeth C Bassi, Thiago G Nicholas, Michelle Wittmann, Jessica Ornowska, Marlena Fernandez, Karl C Gani, Matt Reynolds, Steven C |
| description | Mechanical ventilator breaths provided to deeply sedated patients have an abnormal volume distribution, encouraging alveolar collapse in dependent regions and promoting alveolar overdistention in non-dependent regions. Collapse and overdistention both start with the first breath and worsen over time, driving ventilator-induced lung injury (VILI). This is exacerbated when the lung is already injured or has increased heterogeneity. Our study investigated the impact of a single episode of lung injury on lung mechanics and the risk factors for ventilator-induced injury, compared with non-injured lungs.
Two groups of pigs were sedated and ventilated using lung-protective volume-controlled mode at 8 mL/kg, positive end-expiratory pressure (PEEP) 5 cmH
O, with respiratory rate and FiO2 set to maintain normal blood gas values. Animals in one group were ventilated for 50 h (50-Hour MV group, n=10). Animals in the second group had lung injury induced using oleic acid and were ventilated for 12 h post-injury (LI MV group, n=6). Both groups were compared with a never-ventilated control group (NV, n=6). Lung mechanics and injury were measured using electrical impedance tomography, esophageal pressure monitoring and tissue histology.
End-expiratory lung-volume loss was greater in the 50-Hour MV group (P |
| doi_str_mv | 10.29390/cjrt-2022-075 |
| format | Article |
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Two groups of pigs were sedated and ventilated using lung-protective volume-controlled mode at 8 mL/kg, positive end-expiratory pressure (PEEP) 5 cmH
O, with respiratory rate and FiO2 set to maintain normal blood gas values. Animals in one group were ventilated for 50 h (50-Hour MV group, n=10). Animals in the second group had lung injury induced using oleic acid and were ventilated for 12 h post-injury (LI MV group, n=6). Both groups were compared with a never-ventilated control group (NV, n=6). Lung mechanics and injury were measured using electrical impedance tomography, esophageal pressure monitoring and tissue histology.
End-expiratory lung-volume loss was greater in the 50-Hour MV group (P<0.05). Plateau pressure, driving pressure and lung injury score were higher in the LI MV group, (P<0.05).
Risk factors for VILI developed three- to five-times faster in the group with injured lungs, demonstrating that a single lung-injury episode substantially increased the risk of VILI, compared with normal lungs, despite using a lung-protective mechanical ventilation protocol.</description><identifier>ISSN: 1205-9838</identifier><identifier>ISSN: 2368-6820</identifier><identifier>EISSN: 2368-6820</identifier><identifier>DOI: 10.29390/cjrt-2022-075</identifier><identifier>PMID: 37056575</identifier><language>eng</language><publisher>Canada: The Canadian Society of Respiratory Therapists</publisher><subject>acute lung injury ; Lung cancer ; Lung diseases ; mechanical ventilation ; Risk factors ; Ventilation ; ventilator-induced lung injury ; Ventilators</subject><ispartof>Canadian Journal of Respiratory Therapy, 2023-01, Vol.59, p.103-110</ispartof><rights>Copyright The Canadian Society of Respiratory Therapists 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c485t-7e52d207afc13c983db7f3ecd77f6600956faceaa3266b08a4c1227bf41dcba53</citedby><orcidid>0000-0002-9518-2323 ; 0000-0002-2635-1189 ; 0000-0002-6585-4272 ; 0000-0003-1944-3250 ; 0000-0002-2624-640X ; 0000-0001-5570-5057 ; 0009-0004-2127-0154 ; 0000-0003-1128-4443</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10089681/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10089681/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37056575$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rohrs, Elizabeth C</creatorcontrib><creatorcontrib>Bassi, Thiago G</creatorcontrib><creatorcontrib>Nicholas, Michelle</creatorcontrib><creatorcontrib>Wittmann, Jessica</creatorcontrib><creatorcontrib>Ornowska, Marlena</creatorcontrib><creatorcontrib>Fernandez, Karl C</creatorcontrib><creatorcontrib>Gani, Matt</creatorcontrib><creatorcontrib>Reynolds, Steven C</creatorcontrib><title>Risk factors for ventilator-induced-lung injury develop three to five times faster after a single episode of lung injury</title><title>Canadian Journal of Respiratory Therapy</title><addtitle>Can J Respir Ther</addtitle><description>Mechanical ventilator breaths provided to deeply sedated patients have an abnormal volume distribution, encouraging alveolar collapse in dependent regions and promoting alveolar overdistention in non-dependent regions. Collapse and overdistention both start with the first breath and worsen over time, driving ventilator-induced lung injury (VILI). This is exacerbated when the lung is already injured or has increased heterogeneity. Our study investigated the impact of a single episode of lung injury on lung mechanics and the risk factors for ventilator-induced injury, compared with non-injured lungs.
Two groups of pigs were sedated and ventilated using lung-protective volume-controlled mode at 8 mL/kg, positive end-expiratory pressure (PEEP) 5 cmH
O, with respiratory rate and FiO2 set to maintain normal blood gas values. Animals in one group were ventilated for 50 h (50-Hour MV group, n=10). Animals in the second group had lung injury induced using oleic acid and were ventilated for 12 h post-injury (LI MV group, n=6). Both groups were compared with a never-ventilated control group (NV, n=6). Lung mechanics and injury were measured using electrical impedance tomography, esophageal pressure monitoring and tissue histology.
End-expiratory lung-volume loss was greater in the 50-Hour MV group (P<0.05). Plateau pressure, driving pressure and lung injury score were higher in the LI MV group, (P<0.05).
Risk factors for VILI developed three- to five-times faster in the group with injured lungs, demonstrating that a single lung-injury episode substantially increased the risk of VILI, compared with normal lungs, despite using a lung-protective mechanical ventilation protocol.</description><subject>acute lung injury</subject><subject>Lung cancer</subject><subject>Lung diseases</subject><subject>mechanical ventilation</subject><subject>Risk factors</subject><subject>Ventilation</subject><subject>ventilator-induced lung injury</subject><subject>Ventilators</subject><issn>1205-9838</issn><issn>2368-6820</issn><issn>2368-6820</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNpdkk1v1DAQhi0EokvhyhFZ4sIlZWzHHzkhVPFRqRISgrPlOOOtl2y82MmK_nu8u6VquXjk8TuPZsYvIa8ZXPBOdPDeb_LccOC8AS2fkBUXyjTKcHhKVoyDbDojzBl5UcoGgIFo9XNyJjRIJbVckT_fY_lFg_NzyoWGlOkepzmOrt6bOA2Lx6EZl2lN47RZ8i0dcI9j2tH5JiPSOdEQ9zXGLdZyV2bM1IXjSUuc1iNS3MWSBqQp0Aegl-RZcGPBV3fxnPz8_OnH5dfm-tuXq8uP141vjZwbjZIPHLQLnglfZxl6HQT6QeugFEAnVW0enRNcqR6Maz3jXPehZYPvnRTn5OrEHZLb2F2OW5dvbXLRHhMpr63Lc_QjWg-m7XmrtWfQail6g20HvpfCcy9NV1kfTqzd0m9x8HVT2Y2PoI9fpnhj12lvGYDplGGV8O6OkNPvBctst7F4HEc3YVqK5QZYp5XseJW-_U-6SUue6q6qSiqh678eVBcnlc-plIzhvhsG9ugQe3CIPTjEVofUgjcPZ7iX_7OE-Askrrmc</recordid><startdate>20230101</startdate><enddate>20230101</enddate><creator>Rohrs, Elizabeth C</creator><creator>Bassi, Thiago G</creator><creator>Nicholas, Michelle</creator><creator>Wittmann, Jessica</creator><creator>Ornowska, Marlena</creator><creator>Fernandez, Karl C</creator><creator>Gani, Matt</creator><creator>Reynolds, Steven C</creator><general>The Canadian Society of Respiratory Therapists</general><general>Canadian Society of Respiratory Therapists</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>4T-</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-9518-2323</orcidid><orcidid>https://orcid.org/0000-0002-2635-1189</orcidid><orcidid>https://orcid.org/0000-0002-6585-4272</orcidid><orcidid>https://orcid.org/0000-0003-1944-3250</orcidid><orcidid>https://orcid.org/0000-0002-2624-640X</orcidid><orcidid>https://orcid.org/0000-0001-5570-5057</orcidid><orcidid>https://orcid.org/0009-0004-2127-0154</orcidid><orcidid>https://orcid.org/0000-0003-1128-4443</orcidid></search><sort><creationdate>20230101</creationdate><title>Risk factors for ventilator-induced-lung injury develop three to five times faster after a single episode of lung injury</title><author>Rohrs, Elizabeth C ; Bassi, Thiago G ; Nicholas, Michelle ; Wittmann, Jessica ; Ornowska, Marlena ; Fernandez, Karl C ; Gani, Matt ; Reynolds, Steven C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c485t-7e52d207afc13c983db7f3ecd77f6600956faceaa3266b08a4c1227bf41dcba53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>acute lung injury</topic><topic>Lung cancer</topic><topic>Lung diseases</topic><topic>mechanical ventilation</topic><topic>Risk factors</topic><topic>Ventilation</topic><topic>ventilator-induced lung injury</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rohrs, Elizabeth C</creatorcontrib><creatorcontrib>Bassi, Thiago G</creatorcontrib><creatorcontrib>Nicholas, Michelle</creatorcontrib><creatorcontrib>Wittmann, Jessica</creatorcontrib><creatorcontrib>Ornowska, Marlena</creatorcontrib><creatorcontrib>Fernandez, Karl C</creatorcontrib><creatorcontrib>Gani, Matt</creatorcontrib><creatorcontrib>Reynolds, Steven C</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Docstoc</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Canadian Journal of Respiratory Therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rohrs, Elizabeth C</au><au>Bassi, Thiago G</au><au>Nicholas, Michelle</au><au>Wittmann, Jessica</au><au>Ornowska, Marlena</au><au>Fernandez, Karl C</au><au>Gani, Matt</au><au>Reynolds, Steven C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors for ventilator-induced-lung injury develop three to five times faster after a single episode of lung injury</atitle><jtitle>Canadian Journal of Respiratory Therapy</jtitle><addtitle>Can J Respir Ther</addtitle><date>2023-01-01</date><risdate>2023</risdate><volume>59</volume><spage>103</spage><epage>110</epage><pages>103-110</pages><issn>1205-9838</issn><issn>2368-6820</issn><eissn>2368-6820</eissn><abstract>Mechanical ventilator breaths provided to deeply sedated patients have an abnormal volume distribution, encouraging alveolar collapse in dependent regions and promoting alveolar overdistention in non-dependent regions. Collapse and overdistention both start with the first breath and worsen over time, driving ventilator-induced lung injury (VILI). This is exacerbated when the lung is already injured or has increased heterogeneity. Our study investigated the impact of a single episode of lung injury on lung mechanics and the risk factors for ventilator-induced injury, compared with non-injured lungs.
Two groups of pigs were sedated and ventilated using lung-protective volume-controlled mode at 8 mL/kg, positive end-expiratory pressure (PEEP) 5 cmH
O, with respiratory rate and FiO2 set to maintain normal blood gas values. Animals in one group were ventilated for 50 h (50-Hour MV group, n=10). Animals in the second group had lung injury induced using oleic acid and were ventilated for 12 h post-injury (LI MV group, n=6). Both groups were compared with a never-ventilated control group (NV, n=6). Lung mechanics and injury were measured using electrical impedance tomography, esophageal pressure monitoring and tissue histology.
End-expiratory lung-volume loss was greater in the 50-Hour MV group (P<0.05). Plateau pressure, driving pressure and lung injury score were higher in the LI MV group, (P<0.05).
Risk factors for VILI developed three- to five-times faster in the group with injured lungs, demonstrating that a single lung-injury episode substantially increased the risk of VILI, compared with normal lungs, despite using a lung-protective mechanical ventilation protocol.</abstract><cop>Canada</cop><pub>The Canadian Society of Respiratory Therapists</pub><pmid>37056575</pmid><doi>10.29390/cjrt-2022-075</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-9518-2323</orcidid><orcidid>https://orcid.org/0000-0002-2635-1189</orcidid><orcidid>https://orcid.org/0000-0002-6585-4272</orcidid><orcidid>https://orcid.org/0000-0003-1944-3250</orcidid><orcidid>https://orcid.org/0000-0002-2624-640X</orcidid><orcidid>https://orcid.org/0000-0001-5570-5057</orcidid><orcidid>https://orcid.org/0009-0004-2127-0154</orcidid><orcidid>https://orcid.org/0000-0003-1128-4443</orcidid><oa>free_for_read</oa></addata></record> |
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| source | DOAJ Directory of Open Access Journals; PubMed Central |
| subjects | acute lung injury Lung cancer Lung diseases mechanical ventilation Risk factors Ventilation ventilator-induced lung injury Ventilators |
| title | Risk factors for ventilator-induced-lung injury develop three to five times faster after a single episode of lung injury |
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