The effect of hypocapnia and mechanical pulmonary stress on lung tissue in newborn lambs.

Positive pressure ventilation, using high inspiratory pressures, often causes lung damage. When associated with hypocapnia, it can produce severe focal alveolar alkalosis and can cause damage in areas of low blood flow. A vein-to-vein extracorporeal membrane oxygenator (ECMO) system was used to control blood gases independently of mechanical ventilation in 12 healthy newborn lambs. After connection to the ECMO system, ventilation was started with a peak inspiratory pressure of 35 cm H2O and a positive end-expiratory pressure of 5 cm H2O; the ventilator rate was 40/min with I:E = 1.5 and FiO2 = 1.0. In 6 of the 12 lambs sweep gases through the silicone membrane were regulated to assure arterial normocapnia. The other 6 were ventilated with the same settings and perfused with the same pump flow, but PaCO2 was allowed to fall to hypocapnic levels. The lambs were ventilated for 4 h. Average pH and PaCO2 were 7.62 +/- 0.14 and 2.11 +/- 0.54 kPa, respectively, in the hypocapnic group and 7.39 +/- 0.11 and 4.79 +/- 0.51 kPa in the normocapnic group. After sacrificing the lambs, the lungs were inspected macroscopically and microscopically by computer-assisted morphometry to assess atelectasis and lung edema. Macroscopically there were no hemorrhages, barotrauma or widespread atelectasis of the lungs in either group. The thickness of interlobular lung septa in the right upper lobe was 32.5 +/- 18.0 microns for the hypocapnic group and 29.7 +/- 12.5 microns for the normocapnic group. The parenchymal-alveolar area ratio in the right upper lobe was 28.4 +/- 5.04 and 24.6 +/- 3.75% in the hypocapnic and normocapnic groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)