Cheng Jiangli, Yang Jing, Ma Aijia, Dong Meiling, Yang Jie, Wang Peng, Xue Yang, Zhou Yongfang, Kang Yan
Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China.
Front Physiol. 2022 Jul 22;13:927507. doi: 10.3389/fphys.2022.927507. eCollection 2022.
The aim of the study was to compare the effects of APRV and LTV ventilation on pulmonary permeability in severe ARDS. Mini Bama adult pigs were randomized into the APRV group ( = 5) and LTV group ( = 5). A severe ARDS animal model was induced by the whole lung saline lavage. Pigs were ventilated and monitored continuously for 48 h. Compared with the LTV group, CStat was significantly better ( < 0.05), and the PaO/FiO ratio showed a trend to be higher throughout the period of the experiment in the APRV group. The extravascular lung water index and pulmonary vascular permeability index showed a trend to be lower in the APRV group. APRV also significantly mitigates lung histopathologic injury determined by the lung histopathological injury score ( < 0.05) and gross pathological changes of lung tissues. The protein contents of occludin ( < 0.05), claudin-5 ( < 0.05), E-cadherin ( < 0.05), and VE-cadherin ( < 0.05) in the middle lobe of the right lung were higher in the APRV group than in the LTV group; among them, the contents of occludin ( < 0.05) and E-cadherin ( < 0.05) of the whole lung were higher in the APRV group. Transmission electron microscopy showed that alveolar-capillary barrier damage was more severe in the middle lobe of lungs in the LTV group. In comparison with LTV, APRV could preserve the alveolar-capillary barrier architecture, mitigate lung histopathologic injury, increase the expression of cell junction protein, improve respiratory system compliance, and showed a trend to reduce extravascular lung water and improve oxygenation. These findings indicated that APRV might lead to more profound beneficial effects on the integrity of the alveolar-capillary barrier architecture and on the expression of biomarkers related to pulmonary permeability.
本研究的目的是比较气道压力释放通气（APRV）和肺保护性通气（LTV）对重症急性呼吸窘迫综合征（ARDS）患者肺通透性的影响。将小型巴马成年猪随机分为APRV组（n = 5）和LTV组（n = 5）。通过全肺盐水灌洗建立重症ARDS动物模型。对猪进行通气并连续监测48小时。与LTV组相比，APRV组的静态顺应性（CStat）显著更好（P < 0.05），并且在整个实验期间，APRV组的动脉血氧分压与吸入氧浓度比值（PaO₂/FiO₂）呈升高趋势。血管外肺水指数和肺血管通透性指数在APRV组呈降低趋势。APRV还显著减轻了通过肺组织病理学损伤评分（P < 0.05）和肺组织大体病理变化所确定的肺组织病理学损伤。APRV组右肺中叶紧密连接蛋白（occludin，P < 0.05）、Claudin-5（P < 0.05）、E-钙黏蛋白（E-cadherin，P < 0.05）和血管内皮钙黏蛋白（VE-cadherin，P < 0.05）的蛋白含量高于LTV组；其中，APRV组全肺的occludin（P < 0.05）和E-cadherin（P < 0.05）含量更高。透射电子显微镜显示，LTV组肺中叶的肺泡 - 毛细血管屏障损伤更严重。与LTV相比，APRV可以维持肺泡 - 毛细血管屏障结构，减轻肺组织病理学损伤，增加细胞连接蛋白的表达，改善呼吸系统顺应性，并呈降低血管外肺水和改善氧合的趋势。这些结果表明，APRV可能对肺泡 - 毛细血管屏障结构的完整性以及与肺通透性相关的生物标志物的表达产生更深远的有益影响。
