Imaging atelectrauma in Ventilator-Induced Lung Injury using 4D X-ray microscopy

Mechanical ventilation can damage the lungs, a condition called Ventilator-Induced Lung Injury (VILI). However, the mechanisms leading to VILI at the microscopic scale remain poorly understood. Here we investigated the within-tidal dynamics of cyclic recruitment/derecruitment (R/D) using synchrotron...

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Bibliographic Details
Published in:Scientific reports 2021-02, Vol.11 (1), p.4236-4236, Article 4236
Main Authors: Fardin, Luca, Broche, Ludovic, Lovric, Goran, Mittone, Alberto, Stephanov, Olivier, Larsson, Anders, Bravin, Alberto, Bayat, Sam
Format: Article
Language:English
Subjects:
631/443/1784
639/766/400/1106
639/766/930/2735
692/699/1785/3193
Alveoli
Humanities and Social Sciences
Infiltration
Life Sciences
Lungs
Mechanical ventilation
multidisciplinary
Parenchyma
Respiratory distress syndrome
Science
Science (multidisciplinary)
Ventilation
Ventilators
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Summary:Mechanical ventilation can damage the lungs, a condition called Ventilator-Induced Lung Injury (VILI). However, the mechanisms leading to VILI at the microscopic scale remain poorly understood. Here we investigated the within-tidal dynamics of cyclic recruitment/derecruitment (R/D) using synchrotron radiation phase-contrast imaging (PCI), and the relation between R/D and cell infiltration, in a model of Acute Respiratory Distress Syndrome in 6 anaesthetized and mechanically ventilated New-Zealand White rabbits. Dynamic PCI was performed at 22.6 µm voxel size, under protective mechanical ventilation [tidal volume: 6 ml/kg; positive end-expiratory pressure (PEEP): 5 cmH 2 O]. Videos and quantitative maps of within-tidal R/D showed that injury propagated outwards from non-aerated regions towards adjacent regions where cyclic R/D was present. R/D of peripheral airspaces was both pressure and time-dependent, occurring throughout the respiratory cycle with significant scatter of opening/closing pressures. There was a significant association between R/D and regional lung cellular infiltration ( p  = 0.04) suggesting that tidal R/D of the lung parenchyma may contribute to regional lung inflammation or capillary-alveolar barrier dysfunction and to the progression of lung injury. PEEP may not fully mitigate this phenomenon even at high levels. Ventilation strategies utilizing the time-dependence of R/D may be helpful in reducing R/D and associated injury.
ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-020-77300-x