Deterioration of Regional Lung Strain and Inflammation during Early Lung Injury

The contribution of aeration heterogeneity to lung injury during early mechanical ventilation of uninjured lungs is unknown. To test the hypotheses that a strategy consistent with clinical practice does not protect from worsening in lung strains during the first 24 hours of ventilation of initially...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine 2018-10, Vol.198 (7), p.891-902
Main Authors: Motta-Ribeiro, Gabriel C, Hashimoto, Soshi, Winkler, Tilo, Baron, Rebecca M, Grogg, Kira, Paula, Luís F S C, Santos, Arnoldo, Zeng, Congli, Hibbert, Kathryn, Harris, Robert S, Bajwa, Ednan, Vidal Melo, Marcos F
Format: Article
Language:English
Subjects:
Acute Lung Injury - diagnostic imaging
Acute Lung Injury - etiology
Acute Lung Injury - pathology
Analysis of Variance
Animals
Biopsy, Needle
Blood
Blood Gas Analysis
Clinical medicine
Disease Models, Animal
Endotoxemia - etiology
Endotoxemia - physiopathology
Endotoxins - pharmacology
Female
Fluorodeoxyglucose F18
Gene expression
Homogenization
Humans
Hypotheses
Immunohistochemistry
Inflammation
Infusions, Intravenous
Intensive care
Linear Models
Lungs
Medical imaging
Multivariate Analysis
Original
Positron-Emission Tomography - methods
Pulmonary Atelectasis - diagnostic imaging
Pulmonary Atelectasis - etiology
Random Allocation
Respiration, Artificial - adverse effects
Respiration, Artificial - methods
Respiratory distress syndrome
Respiratory Distress Syndrome, Adult - diagnostic imaging
Respiratory Distress Syndrome, Adult - etiology
Respiratory Distress Syndrome, Adult - pathology
Respiratory Function Tests
Respiratory therapy
Risk Factors
Sepsis
Sheep
Tidal Volume - physiology
Time Factors
Tomography, X-Ray Computed - methods
Ventilators
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Summary:The contribution of aeration heterogeneity to lung injury during early mechanical ventilation of uninjured lungs is unknown. To test the hypotheses that a strategy consistent with clinical practice does not protect from worsening in lung strains during the first 24 hours of ventilation of initially normal lungs exposed to mild systemic endotoxemia in supine versus prone position, and that local neutrophilic inflammation is associated with local strain and blood volume at global strains below a proposed injurious threshold. Voxel-level aeration and tidal strain were assessed by computed tomography in sheep ventilated with low Vt and positive end-expiratory pressure while receiving intravenous endotoxin. Regional inflammation and blood volume were estimated from 2-deoxy-2-[(18)F]fluoro-d-glucose ( F-FDG) positron emission tomography. Spatial heterogeneity of aeration and strain increased only in supine lungs (P 70%) than in normally aerated regions (P 
ISSN:1073-449X
1535-4970
DOI:10.1164/rccm.201710-2038oc