Mariangela Pellegrini, Mayson L A Sousa, Sebastian Dubo, Luca S Menga, Vanessa Hsing, Martin Post, Laurent J Brochard
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Airway closure and lung collapse were measured with electrical impedance tomography as well as ventilation/perfusion ratio (V/Q). After AOP detection, the effect of iNO (10ppm) was studied with PEEP set randomly above or below regional AOP. Respiratory mechanics, hemodynamics, and gas-exchange were recorded.</p><p><strong>Results: </strong>All pigs presented airway closure (AOP > 0.5cmH<sub>2</sub>O) after injury. In bilateral injury, iNO was associated with an improved mean pulmonary pressure from 49 ± 8 to 42 ± 7mmHg; (p = 0.003), and ventilation/perfusion matching, caused by a reduction in pixels with low V/Q and shunt from 16%[IQR:13-19] to 9%[IQR:4-12] (p = 0.03) only at PEEP set above AOP. iNO had no effect on hemodynamics or gas exchange for PEEP below AOP (low V/Q 25%[IQR:16-30] to 23%[IQR:14-27]; p = 0.68). In asymmetrical injury, iNO improved pulmonary hemodynamics and ventilation/perfusion matching independently from the PEEP set. iNO was associated with improved oxygenation in all cases.</p><p><strong>Conclusions: </strong>In an animal model of bilateral lung injury, PEEP level relative to AOP markedly influences iNO efficacy on pulmonary hemodynamics and ventilation/perfusion match, independently of oxygenation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"14 1","pages":"149"},"PeriodicalIF":5.7000,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420414/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of airway closure and lung collapse on inhaled nitric oxide effect in acute lung injury: an experimental study.\",\"authors\":\"Mariangela Pellegrini, Mayson L A Sousa, Sebastian Dubo, Luca S Menga, Vanessa Hsing, Martin Post, Laurent J Brochard\",\"doi\":\"10.1186/s13613-024-01378-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Efficacy of inhaled therapy such as Nitric Oxide (iNO) during mechanical ventilation may depend on airway patency. We hypothesized that airway closure and lung collapse, countered by positive end-expiratory pressure (PEEP), influence iNO efficacy. This could support the role of an adequate PEEP titration for inhalation therapy. The main aim of this study was to assess the effect of iNO with PEEP set above or below the airway opening pressure (AOP) generated by airway closure, on hemodynamics and gas exchange in swine models of acute respiratory distress syndrome. Fourteen pigs randomly underwent either bilateral or asymmetrical two-hit model of lung injury. Airway closure and lung collapse were measured with electrical impedance tomography as well as ventilation/perfusion ratio (V/Q). After AOP detection, the effect of iNO (10ppm) was studied with PEEP set randomly above or below regional AOP. Respiratory mechanics, hemodynamics, and gas-exchange were recorded.</p><p><strong>Results: </strong>All pigs presented airway closure (AOP > 0.5cmH<sub>2</sub>O) after injury. 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引用次数: 0
摘要
背景:机械通气期间一氧化氮(iNO)等吸入疗法的疗效可能取决于气道的通畅程度。我们假设气道关闭和肺塌陷会影响一氧化氮的疗效,而呼气末正压(PEEP)则会反作用于气道关闭和肺塌陷。这将支持适当的 PEEP 滴定在吸入疗法中的作用。本研究的主要目的是评估 iNO 的 PEEP 设置高于或低于气道关闭产生的气道开放压(AOP)对急性呼吸窘迫综合征猪模型的血液动力学和气体交换的影响。14 头猪随机接受了双侧或不对称双击肺损伤模型。电阻抗断层扫描测量了气道闭合和肺塌陷情况以及通气/灌注比(V/Q)。检测到 AOP 后,在 PEEP 随机设置为高于或低于区域 AOP 的情况下,研究 iNO(10ppm)的效果。记录呼吸力学、血液动力学和气体交换:结果:所有猪在受伤后均出现气道闭合(AOP > 0.5cmH2O)。在双侧损伤中,iNO 可改善平均肺压,从 49 ± 8 降至 42 ± 7mmHg;(p = 0.003)并改善通气/灌注匹配,这是因为低 V/Q 和分流的像素从 16%[IQR:13-19] 降至 9%[IQR:4-12] (p = 0.03)。iNO 对低于 AOP 的 PEEP 的血液动力学或气体交换没有影响(低 V/Q 25%[IQR:16-30] 至 23%[IQR:14-27]; p = 0.68)。在不对称损伤中,iNO 可改善肺血流动力学和通气/灌注匹配,而不受 PEEP 设置的影响:结论:在双侧肺损伤动物模型中,PEEP 水平相对于 AOP 显著影响 iNO 对肺血流动力学和通气/灌注匹配的疗效,而与氧合无关。
Impact of airway closure and lung collapse on inhaled nitric oxide effect in acute lung injury: an experimental study.
Background: Efficacy of inhaled therapy such as Nitric Oxide (iNO) during mechanical ventilation may depend on airway patency. We hypothesized that airway closure and lung collapse, countered by positive end-expiratory pressure (PEEP), influence iNO efficacy. This could support the role of an adequate PEEP titration for inhalation therapy. The main aim of this study was to assess the effect of iNO with PEEP set above or below the airway opening pressure (AOP) generated by airway closure, on hemodynamics and gas exchange in swine models of acute respiratory distress syndrome. Fourteen pigs randomly underwent either bilateral or asymmetrical two-hit model of lung injury. Airway closure and lung collapse were measured with electrical impedance tomography as well as ventilation/perfusion ratio (V/Q). After AOP detection, the effect of iNO (10ppm) was studied with PEEP set randomly above or below regional AOP. Respiratory mechanics, hemodynamics, and gas-exchange were recorded.
Results: All pigs presented airway closure (AOP > 0.5cmH2O) after injury. In bilateral injury, iNO was associated with an improved mean pulmonary pressure from 49 ± 8 to 42 ± 7mmHg; (p = 0.003), and ventilation/perfusion matching, caused by a reduction in pixels with low V/Q and shunt from 16%[IQR:13-19] to 9%[IQR:4-12] (p = 0.03) only at PEEP set above AOP. iNO had no effect on hemodynamics or gas exchange for PEEP below AOP (low V/Q 25%[IQR:16-30] to 23%[IQR:14-27]; p = 0.68). In asymmetrical injury, iNO improved pulmonary hemodynamics and ventilation/perfusion matching independently from the PEEP set. iNO was associated with improved oxygenation in all cases.
Conclusions: In an animal model of bilateral lung injury, PEEP level relative to AOP markedly influences iNO efficacy on pulmonary hemodynamics and ventilation/perfusion match, independently of oxygenation.
期刊介绍:
Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.