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This Article Full Text Full Text (PDF) All Versions of this Article: 287/2/L402    most recent 00435.2003v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by Kurahashi, K. Articles by Yamada, Y. Search for Related Content PubMed PubMed Citation Articles by Kurahashi, K. Articles by Yamada, Y.

Effect of lung-protective ventilation on severe Pseudomonas aeruginosa pneumonia and sepsis in rats

Departments of ¹Anesthesiology and Critical Care Medicine, ²Molecular Pathology and Oncology, and ³Cellular Pathobiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan 236-0004

Submitted 5 December 2003 ; accepted in final form 19 April 2004

Pneumonia caused by Pseudomonas aeruginosa carries a high rate of morbidity and mortality. A lung-protective strategy using low tidal volume (V_T) ventilation for acute lung injury improves patient outcomes. The goal of this study was to determine whether low V_T ventilation has similar utility in severe P. aeruginosa infection. A cytotoxic P. aeruginosa strain, PA103, was instilled into the left lung of rats anesthetized with pentobarbital. The lung-protective effect of low V_T (6 ml/kg) with or without high positive end-expiratory pressure (PEEP, 10 or 3 cmH₂O) was then compared with high V_T with low PEEP ventilation (V_T 12 ml/kg, PEEP 3 cmH₂O). Severe lung injury and septic shock was induced. Although ventilatory mode had little effect on the involved lung or septic physiology, injury to noninvolved regions was attenuated by low V_T ventilation as indicated by the wet-to-dry weight ratio (W/D; 6.13 ± 0.78 vs. 3.78 ± 0.26, respectively) and confirmed by histopathological examinations. High PEEP did not yield a significant protective effect (W/D, 4.03 ± 0.32) but, rather, caused overdistension of noninvolved lungs. Bronchoalveolar lavage revealed higher concentrations of TNF- in the fluid of noninvolved lung undergoing high V_T ventilation compared with those animals receiving low V_T. We conclude that low V_T ventilation is protective in noninvolved regions and that the application of high PEEP attenuated the beneficial effects of low V_T ventilation, at least short term. Furthermore, low V_T ventilation cannot protect the involved lung, and high PEEP did not significantly alter lung injury over a short time course.

acute lung injury; ventilator-induced lung injury; lung protective strategy; cytokines; bacterial toxins

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