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不同通气设置对猪肺泡和肺微血管尺寸的影响。

Effects of different ventilatory settings on alveolar and pulmonary microvessel dimensions in pigs.

作者信息

Damiani Elisa, Casarotta Erika, Di Bella Caterina, Galosi Margherita, Angorini Alessio, Serino Federica, Tambella Adolfo Maria, Laus Fulvio, Zuccari Samuele, Salvucci Salice Alessio, Domizi Roberta, Carsetti Andrea, Ince Can, Donati Abele

机构信息

Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Trontro 10/a, 60126, Ancona, Italy.

Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy.

出版信息

Sci Rep. 2024 Dec 5;14(1):30391. doi: 10.1038/s41598-024-82244-7.

DOI:10.1038/s41598-024-82244-7
PMID:39639087
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11621561/
Abstract

Mechanical ventilation with high tidal volume (TV) or positive end-expiratory pressure (PEEP) may induce lung overinflation and increased pulmonary vascular resistance to flow. In 8 healthy mechanically ventilated pigs, we evaluated whether incident dark field (IDF) vital microscopy, applied through a small thoracotomy, could be used to evaluate changes in alveolar and pulmonary microvessel dimensions under different ventilator settings. High TV (12 ml/kg) increased alveolar diameters (from 99 ± 13 to 114 ± 6 μm, p < 0.05 repeated measures one way analysis of variance) and reduced septal capillary diameters (from 12.1 ± 1.7 to 10.5 ± 1.4 μm, p < 0.001) as compared to 8 ml/kg TV. This effect was more pronounced in non-dependent lung. Alveolar and microvessel diameters did not change with high PEEP (12 cmHO Vs. 5 cmHO). High FiO (100%) led to pulmonary vasodilation (from 12.1 ± 1.7 to 14.7 ± 1.4 μm, p < 0.001), with no change in alveolar dimensions as compared to 50% FiO. In conclusion, IDF imaging enabled to obtain high-quality images of subpleural alveoli and microvessels. High TV ventilation may induce alveolar distension with compression of septal capillaries, thus potentially increasing dead space ventilation.

摘要

高潮气量（TV）或呼气末正压（PEEP）机械通气可能会导致肺过度膨胀，并增加肺血管对血流的阻力。在8只接受机械通气的健康猪中，我们评估了通过小切口开胸应用的入射暗场（IDF）活体显微镜检查是否可用于评估不同通气设置下肺泡和肺微血管尺寸的变化。与8ml/kg TV相比，高TV（12ml/kg）增加了肺泡直径（从99±13μm增加到114±6μm，重复测量单因素方差分析p<0.05），并减小了间隔毛细血管直径（从12.1±1.7μm减小到10.5±1.4μm，p<0.001）。这种效应在非下垂肺中更为明显。肺泡和微血管直径在高PEEP（12cmH₂O对5cmH₂O）时没有变化。高FiO₂（100%）导致肺血管扩张（从12.1±1.7μm增加到14.7±1.4μm，p<0.001），与50%FiO₂相比肺泡尺寸没有变化。总之，IDF成像能够获得胸膜下肺泡和微血管的高质量图像。高TV通气可能会导致肺泡扩张并压迫间隔毛细血管，从而可能增加无效腔通气。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/39dd/11621561/dd70a9d77c8e/41598_2024_82244_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/39dd/11621561/7d03da74ddea/41598_2024_82244_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/39dd/11621561/213ab82364b6/41598_2024_82244_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/39dd/11621561/1898a314be12/41598_2024_82244_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/39dd/11621561/dd70a9d77c8e/41598_2024_82244_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/39dd/11621561/7d03da74ddea/41598_2024_82244_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/39dd/11621561/213ab82364b6/41598_2024_82244_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/39dd/11621561/1898a314be12/41598_2024_82244_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/39dd/11621561/dd70a9d77c8e/41598_2024_82244_Fig4_HTML.jpg

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本文引用的文献

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Microcirculation-guided resuscitation in sepsis: the next frontier?脓毒症中微循环导向复苏：下一个前沿领域？
Front Med (Lausanne). 2023 Jul 5;10:1212321. doi: 10.3389/fmed.2023.1212321. eCollection 2023.
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Management of severe acute respiratory distress syndrome: a primer.严重急性呼吸窘迫综合征的管理：入门指南。
Crit Care. 2023 Jul 18;27(1):289. doi: 10.1186/s13054-023-04572-w.
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Physiological Regulation of Pulmonary Microcirculation under Mechanical Ventilation at Different Cardiac Outputs and Positive End-Expiratory Pressures in a Porcine Model.猪模型中不同心输出量和呼气末正压下机械通气时肺微循环的生理调节
J Pers Med. 2023 Jan 3;13(1):107. doi: 10.3390/jpm13010107.
5
Perioperative high inspired oxygen fraction induces atelectasis in patients undergoing abdominal surgery: A randomized controlled trial.围手术期高吸入氧分数可导致行腹部手术患者发生肺不张：一项随机对照试验。
J Clin Anesth. 2021 Sep;72:110285. doi: 10.1016/j.jclinane.2021.110285. Epub 2021 Apr 7.
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Oxygen and pulmonary arterial hypertension: effects, mechanisms, and therapeutic benefits.氧气与肺动脉高压：作用、机制与治疗获益。
Eur J Prev Cardiol. 2021 Mar 23;28(1):127-136. doi: 10.1093/eurjpc/zwaa001.
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Changes in shunt, ventilation/perfusion mismatch, and lung aeration with PEEP in patients with ARDS: a prospective single-arm interventional study.急性呼吸窘迫综合征患者 PEEP 治疗时分流、通气/灌注不匹配和肺充气的变化：一项前瞻性单臂干预性研究。
Crit Care. 2020 Mar 23;24(1):111. doi: 10.1186/s13054-020-2834-6.
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