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1 Medicine, University of Vermont, Burlington, United States; Medicine, Fletcher Allen Health Care, Burlington, United States
2 Medicine, University of Vermont, Burlington, United States
* To whom correspondence should be addressed. E-mail: gil.allen{at}uvm.edu.
Low tidal volume ventilation is protective against ventilator-induced lung injury but can promote development of atelectasis. Periodic deep inflation (DI) can open the lung, but if delivered too frequently, may cause damage via repeated overdistention. We therefore examined the effects of varying DI frequency on lung mechanics, gas exchange, and biomarkers of injury in mice. C57BL/6 males were mechanically ventilated with positive end-expiratory pressure (PEEP) of 2cmH2O for 2 hours. One group (HV) received a DI with each breath. Another group (LV) received 2 DIs after each hour of ventilation. A third group (LVDI) received 2 DIs every minute. Control groups included a nonventilated surgical sham and a group receiving high tidal volume with zero PEEP (HVZP). Respiratory impedance was measured every 4 minutes, from which tissue elastance (H) and damping (G) were derived. G and H rose progressively during LV and HVZP, but returned to baseline after hourly DI during LV. During LVDI and HV, G and H remained low, and gas exchange was superior to that of LV. Bronchoalveolar lavage fluid protein was elevated in HV and HVZP but no different between LV and LVDI. Lung tissue interleukin-6 and interleukin-1
levels were elevated in HVZP and lower in LVDI compared to LV. We conclude that frequent DI can safely improve gas exchange and lung mechanics and may confer protection from biotrauma. Differences between LVDI and HV suggest that an optimal DI frequency range exists, within which the benefits of maintaining an open lung outweigh injury incurred from overdistention.
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