与压力控制通气相比，压力支持可减轻大鼠实验性急性缺血性卒中的肺和脑损伤。
Pressure-support compared with pressure-controlled ventilation mitigates lung and brain injury in experimental acute ischemic stroke in rats.
作者信息
da Silva Adriana L, Bessa Camila M, Rocha Nazareth N, Carvalho Eduardo B, Magalhaes Raquel F, Capelozzi Vera L, Robba Chiara, Pelosi Paolo, Samary Cynthia S, Rocco Patricia R M, Silva Pedro L
机构信息
Laboratory of Pulmonary Investigation, Centro de Ciências da Saúde, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, S/N, Bloco G-014, Ilha Do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil.
Department of Physiology and Pharmacology, Biomedical Institute, Fluminense Federal University, Rio de Janeiro, Brazil.
出版信息
Intensive Care Med Exp. 2023 Dec 15;11(1):93. doi: 10.1186/s40635-023-00580-w.
BACKGROUND
We aimed to evaluate the pulmonary and cerebral effects of low-tidal volume ventilation in pressure-support (PSV) and pressure-controlled (PCV) modes at two PEEP levels in acute ischemic stroke (AIS).
METHODS
In this randomized experimental study, AIS was induced by thermocoagulation in 30 healthy male Wistar rats. After 24 h, AIS animals were randomly assigned to PSV or PCV with V = 6 mL/kg and PEEP = 2 cmHO (PSV-PEEP2 and PCV-PEEP2) or PEEP = 5 cmHO (PSV-PEEP5 and PCV-PEEP5) for 2 h. Lung mechanics, arterial blood gases, and echocardiography were evaluated before and after the experiment. Lungs and brain tissue were removed for histologic and molecular biology analysis. The primary endpoint was diffuse alveolar damage (DAD) score; secondary endpoints included brain histology and brain and lung molecular biology markers.
RESULTS
In lungs, DAD was lower with PSV-PEEP5 than PCV-PEEP5 (p < 0.001); interleukin (IL)-1β was lower with PSV-PEEP2 than PCV-PEEP2 (p = 0.016) and PSV-PEEP5 than PCV-PEEP5 (p = 0.046); zonula occludens-1 (ZO-1) was lower in PCV-PEEP5 than PCV-PEEP2 (p = 0.042). In brain, necrosis, hemorrhage, neuropil edema, and CD45 + microglia were lower in PSV than PCV animals at PEEP = 2 cmHO (p = 0.036, p = 0.025, p = 0.018, p = 0.011, respectively) and PEEP = 5 cmHO (p = 0.003, p = 0.003, p = 0.007, p = 0.003, respectively); IL-1β was lower while ZO-1 was higher in PSV-PEEP2 than PCV-PEEP2 (p = 0.009, p = 0.007, respectively), suggesting blood-brain barrier integrity. Claudin-5 was higher in PSV-PEEP2 than PSV-PEEP5 (p = 0.036).
CONCLUSION
In experimental AIS, PSV compared with PCV reduced lung and brain injury. Lung ZO-1 reduced in PCV with PEEP = 2 versus PEEP = 5 cmHO, while brain claudin-5 increased in PSV with PEEP = 2 versus PEEP = 5 cmHO.
背景
我们旨在评估急性缺血性卒中（AIS）患者在两种呼气末正压（PEEP）水平下，压力支持通气（PSV）模式和压力控制通气（PCV）模式下低潮气量通气对肺和脑的影响。
方法
在这项随机实验研究中，通过热凝法在30只健康雄性Wistar大鼠中诱导AIS。24小时后，将AIS动物随机分为PSV或PCV组，潮气量（V）=6 mL/kg，PEEP=2 cmH₂O（PSV-PEEP2和PCV-PEEP2）或PEEP=5 cmH₂O（PSV-PEEP5和PCV-PEEP5），通气2小时。在实验前后评估肺力学、动脉血气和超声心动图。取出肺和脑组织进行组织学和分子生物学分析。主要终点是弥漫性肺泡损伤（DAD）评分；次要终点包括脑组织学以及脑和肺分子生物学标志物。
结果
在肺脏方面，PSV-PEEP5组的DAD低于PCV-PEEP5组（p<0.001）；PSV-PEEP2组的白细胞介素（IL）-1β低于PCV-PEEP2组（p=0.016），PSV-PEEP5组的IL-1β低于PCV-PEEP5组（p=0.046）；PCV-PEEP5组的紧密连接蛋白-1（ZO-1）低于PCV-PEEP2组（p=0.042）。在脑方面，当PEEP=2 cmH₂O时，PSV组的坏死、出血、神经纤维水肿和CD45⁺小胶质细胞低于PCV组（分别为p=0.036、p=0.025、p=0.018、p=0.011），当PEEP=5 cmH₂O时也是如此（分别为p=0.003、p=0.003、p=0.007、p=0.003）；PSV-PEEP2组的IL-1β较低而ZO-1较高，高于PCV-PEEP2组（分别为p=0.009、p=0.007），提示血脑屏障完整性。PSV-PEEP2组的闭合蛋白-5高于PSV-PEEP5组（p=0.036）。
结论
在实验性AIS中，与PCV相比，PSV可减轻肺和脑损伤。当PEEP=2 cmH₂O与PEEP=5 cmH₂O相比时，PCV模式下肺脏的ZO-1降低，而当PEEP=2 cmH₂O与PEEP=5 cmH₂O相比时，PSV模式下脑内的闭合蛋白-5增加。
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