Mechanical Power Correlates With Lung Inflammation Assessed by Positron-Emission Tomography in Experimental Acute Lung Injury in Pigs
Background: Mechanical ventilation (MV) may initiate or worsen lung injury, so-called ventilator-induced lung injury (VILI). Although different mechanisms of VILI have been identified, research mainly focused on single ventilator parameters. The mechanical power (MP) summarizes the potentially damag...
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2021
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oai:doaj.org-article:ee0ac394038845c1ad7717bf131f04d72021-11-22T06:36:24ZMechanical Power Correlates With Lung Inflammation Assessed by Positron-Emission Tomography in Experimental Acute Lung Injury in Pigs1664-042X10.3389/fphys.2021.717266https://doaj.org/article/ee0ac394038845c1ad7717bf131f04d72021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fphys.2021.717266/fullhttps://doaj.org/toc/1664-042XBackground: Mechanical ventilation (MV) may initiate or worsen lung injury, so-called ventilator-induced lung injury (VILI). Although different mechanisms of VILI have been identified, research mainly focused on single ventilator parameters. The mechanical power (MP) summarizes the potentially damaging effects of different parameters in one single variable and has been shown to be associated with lung damage. However, to date, the association of MP with pulmonary neutrophilic inflammation, as assessed by positron-emission tomography (PET), has not been prospectively investigated in a model of clinically relevant ventilation settings yet. We hypothesized that the degree of neutrophilic inflammation correlates with MP.Methods: Eight female juvenile pigs were anesthetized and mechanically ventilated. Lung injury was induced by repetitive lung lavages followed by initial PET and computed tomography (CT) scans. Animals were then ventilated according to the acute respiratory distress syndrome (ARDS) network recommendations, using the lowest combinations of positive end-expiratory pressure and inspiratory oxygen fraction that allowed adequate oxygenation. Ventilator settings were checked and adjusted hourly. Physiological measurements were conducted every 6 h. Lung imaging was repeated 24 h after first PET/CT before animals were killed. Pulmonary neutrophilic inflammation was assessed by normalized uptake rate of 2-deoxy-2-[18F]fluoro-D-glucose (KiS), and its difference between the two PET/CT was calculated (ΔKiS). Lung aeration was assessed by lung CT scan. MP was calculated from the recorded pressure–volume curve. Statistics included the Wilcoxon tests and non-parametric Spearman correlation.Results: Normalized 18F-FDG uptake rate increased significantly from first to second PET/CT (p = 0.012). ΔKiS significantly correlated with median MP (ρ = 0.738, p = 0.037) and its elastic and resistive components, but neither with median peak, plateau, end-expiratory, driving, and transpulmonary driving pressures, nor respiratory rate (RR), elastance, or resistance. Lung mass and volume significantly decreased, whereas relative mass of hyper-aerated lung compartment increased after 24 h (p = 0.012, p = 0.036, and p = 0.025, respectively). Resistance and PaCO2 were significantly higher (p = 0.012 and p = 0.017, respectively), whereas RR, end-expiratory pressure, and MP were lower at 18 h compared to start of intervention.Conclusions: In this model of experimental acute lung injury in pigs, pulmonary neutrophilic inflammation evaluated by PET/CT increased after 24 h of MV, and correlated with MP.Martin ScharffenbergJakob WittensteinXi RanXi RanYingying ZhangYingying ZhangAnja BrauneRaphael TheilenLorenzo MaielloLorenzo MaielloGiulia BenziGiulia BenziThomas BluthThomas KissThomas KissPaolo PelosiPaolo PelosiPatricia R. M. RoccoMarcus J. SchultzJörg KotzerkeMarcelo Gama de AbreuMarcelo Gama de AbreuMarcelo Gama de AbreuRobert HuhleFrontiers Media S.A.articlemechanical ventilationacute respiratory distress syndromeARDSventilator- induced lung injuryVILImechanical powerPhysiologyQP1-981ENFrontiers in Physiology, Vol 12 (2021) |
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| collection |
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| topic |
mechanical ventilation acute respiratory distress syndrome ARDS ventilator- induced lung injury VILI mechanical power Physiology QP1-981 |
| spellingShingle |
mechanical ventilation acute respiratory distress syndrome ARDS ventilator- induced lung injury VILI mechanical power Physiology QP1-981 Martin Scharffenberg Jakob Wittenstein Xi Ran Xi Ran Yingying Zhang Yingying Zhang Anja Braune Raphael Theilen Lorenzo Maiello Lorenzo Maiello Giulia Benzi Giulia Benzi Thomas Bluth Thomas Kiss Thomas Kiss Paolo Pelosi Paolo Pelosi Patricia R. M. Rocco Marcus J. Schultz Jörg Kotzerke Marcelo Gama de Abreu Marcelo Gama de Abreu Marcelo Gama de Abreu Robert Huhle Mechanical Power Correlates With Lung Inflammation Assessed by Positron-Emission Tomography in Experimental Acute Lung Injury in Pigs |
| description |
Background: Mechanical ventilation (MV) may initiate or worsen lung injury, so-called ventilator-induced lung injury (VILI). Although different mechanisms of VILI have been identified, research mainly focused on single ventilator parameters. The mechanical power (MP) summarizes the potentially damaging effects of different parameters in one single variable and has been shown to be associated with lung damage. However, to date, the association of MP with pulmonary neutrophilic inflammation, as assessed by positron-emission tomography (PET), has not been prospectively investigated in a model of clinically relevant ventilation settings yet. We hypothesized that the degree of neutrophilic inflammation correlates with MP.Methods: Eight female juvenile pigs were anesthetized and mechanically ventilated. Lung injury was induced by repetitive lung lavages followed by initial PET and computed tomography (CT) scans. Animals were then ventilated according to the acute respiratory distress syndrome (ARDS) network recommendations, using the lowest combinations of positive end-expiratory pressure and inspiratory oxygen fraction that allowed adequate oxygenation. Ventilator settings were checked and adjusted hourly. Physiological measurements were conducted every 6 h. Lung imaging was repeated 24 h after first PET/CT before animals were killed. Pulmonary neutrophilic inflammation was assessed by normalized uptake rate of 2-deoxy-2-[18F]fluoro-D-glucose (KiS), and its difference between the two PET/CT was calculated (ΔKiS). Lung aeration was assessed by lung CT scan. MP was calculated from the recorded pressure–volume curve. Statistics included the Wilcoxon tests and non-parametric Spearman correlation.Results: Normalized 18F-FDG uptake rate increased significantly from first to second PET/CT (p = 0.012). ΔKiS significantly correlated with median MP (ρ = 0.738, p = 0.037) and its elastic and resistive components, but neither with median peak, plateau, end-expiratory, driving, and transpulmonary driving pressures, nor respiratory rate (RR), elastance, or resistance. Lung mass and volume significantly decreased, whereas relative mass of hyper-aerated lung compartment increased after 24 h (p = 0.012, p = 0.036, and p = 0.025, respectively). Resistance and PaCO2 were significantly higher (p = 0.012 and p = 0.017, respectively), whereas RR, end-expiratory pressure, and MP were lower at 18 h compared to start of intervention.Conclusions: In this model of experimental acute lung injury in pigs, pulmonary neutrophilic inflammation evaluated by PET/CT increased after 24 h of MV, and correlated with MP. |
| format |
article |
| author |
Martin Scharffenberg Jakob Wittenstein Xi Ran Xi Ran Yingying Zhang Yingying Zhang Anja Braune Raphael Theilen Lorenzo Maiello Lorenzo Maiello Giulia Benzi Giulia Benzi Thomas Bluth Thomas Kiss Thomas Kiss Paolo Pelosi Paolo Pelosi Patricia R. M. Rocco Marcus J. Schultz Jörg Kotzerke Marcelo Gama de Abreu Marcelo Gama de Abreu Marcelo Gama de Abreu Robert Huhle |
| author_facet |
Martin Scharffenberg Jakob Wittenstein Xi Ran Xi Ran Yingying Zhang Yingying Zhang Anja Braune Raphael Theilen Lorenzo Maiello Lorenzo Maiello Giulia Benzi Giulia Benzi Thomas Bluth Thomas Kiss Thomas Kiss Paolo Pelosi Paolo Pelosi Patricia R. M. Rocco Marcus J. Schultz Jörg Kotzerke Marcelo Gama de Abreu Marcelo Gama de Abreu Marcelo Gama de Abreu Robert Huhle |
| author_sort |
Martin Scharffenberg |
| title |
Mechanical Power Correlates With Lung Inflammation Assessed by Positron-Emission Tomography in Experimental Acute Lung Injury in Pigs |
| title_short |
Mechanical Power Correlates With Lung Inflammation Assessed by Positron-Emission Tomography in Experimental Acute Lung Injury in Pigs |
| title_full |
Mechanical Power Correlates With Lung Inflammation Assessed by Positron-Emission Tomography in Experimental Acute Lung Injury in Pigs |
| title_fullStr |
Mechanical Power Correlates With Lung Inflammation Assessed by Positron-Emission Tomography in Experimental Acute Lung Injury in Pigs |
| title_full_unstemmed |
Mechanical Power Correlates With Lung Inflammation Assessed by Positron-Emission Tomography in Experimental Acute Lung Injury in Pigs |
| title_sort |
mechanical power correlates with lung inflammation assessed by positron-emission tomography in experimental acute lung injury in pigs |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/ee0ac394038845c1ad7717bf131f04d7 |
| work_keys_str_mv |
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