Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, 75185, Uppsala, Sweden.
Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.
BMC Pulm Med. 2020 Apr 25;20(1):106. doi: 10.1186/s12890-020-1138-6.
Mechanical ventilation (MV), compared to spontaneous breathing (SB), has been found to increase abdominal edema and inflammation in experimental sepsis. Our hypothesis was that in primary acute respiratory distress syndrome (ARDS) MV would enhance inflammation and edema in the abdomen.
Thirteen piglets were randomized into two groups (SB and MV) after the induction of ARDS by lung lavage and 1 h of injurious ventilation. 1. SB: continuous positive airway pressure 15 cmHO, fraction of inspired oxygen (FIO) 0.5 and respiratory rate (RR) maintained at about 40 cycles min by titrating remifentanil infusion. 2. MV: volume control, tidal volume 6 ml kg, positive end-expiratory pressure 15 cmHO, RR 40 cycles min, FIO 0.5.
abdominal edema, assessed by tissues histopathology and wet-dry weight; abdominal inflammation, assessed by cytokine concentration in tissues, blood and ascites, and tissue histopathology.
The groups did not show significant differences in hemodynamic or respiratory parameters. Moreover, edema and inflammation in the abdominal organs were similar. However, blood IL6 increased in the MV group in all vascular beds (p < 0.001). In addition, TNFα ratio in blood increased through the lungs in MV group (+ 26% ± 3) but decreased in the SB group (- 17% ± 3).
There were no differences between the MV and SB group for abdominal edema or inflammation. However, the systemic increase in IL6 and the TNFα increase through the lungs suggest that MV, in this model, was harmful to the lungs.
与自主呼吸（SB）相比，机械通气（MV）已被发现会增加实验性脓毒症中的腹部水肿和炎症。我们的假设是，在原发性急性呼吸窘迫综合征（ARDS）中，MV 会增强腹部的炎症和水肿。
在通过肺灌洗和 1 小时的损伤性通气诱导 ARDS 后，将 13 头小猪随机分为两组（SB 和 MV）。1. SB：持续气道正压 15cmH2O，吸入氧分数（FIO）为 0.5，通过滴定瑞芬太尼输注来维持呼吸频率（RR）约为 40 次/分钟。2. MV：容量控制，潮气量 6ml/kg，呼气末正压 15cmH2O，RR 为 40 次/分钟，FIO 为 0.5。
通过组织组织病理学和干湿重评估腹部水肿；通过组织、血液和腹水细胞因子浓度以及组织组织病理学评估腹部炎症。
两组在血流动力学或呼吸参数方面没有显著差异。此外，腹部器官的水肿和炎症也相似。然而，MV 组所有血管床的血液白细胞介素 6（IL6）均增加（p<0.001）。此外，MV 组血液中 TNFα 比值通过肺部增加（+26%±3），而 SB 组则减少（-17%±3）。
MV 组和 SB 组之间在腹部水肿或炎症方面没有差异。然而，IL6 的全身增加以及 TNFα 通过肺部的增加表明，在这种模型中，MV 对肺部有害。
