title: Pulmonary epithelial permeability. An animal study of inverse ratio ventilation and conventional mechanical ventilation.
abstract: OBJECTIVE
  To compare pressure-controlled inverse ratio ventilation (PCIRV) with volume-controlled ventilation with positive end-expiratory pressure (VCV PEEP) at equal levels of end-expiratory alveolar pressure. The primary focus of the study was on pulmonary epithelial permeability. Histologic and gravimetric indicators of lung injury were also studied.
  
  
  METHODS
  Randomized animal study.
  
  
  METHODS
  Experimental investigation at Södersjukhuset, Stockholm, Sweden.
  
  
  METHODS
  Thirty-two New Zealand white rabbits.
  
  
  METHODS
  Ventilation with PCIRV or VCV PEEP for 6 h at an end-expiratory pressure level of 5 cm H2O.
  
  
  RESULTS
  Lung mechanics, heart rate, BP, and gas exchange. Measurement of pulmonary epithelial permeability by 99mTc-DTPA lung clearance. Extravascular lung water by gravimetric analysis. Morphology by light microscopy after a perfusion fixation procedure. Mean and peak airway pressures were 12.4 +/- 4.3 and 15.9 +/- 4.5 cm H2O with PCIRV and 8.6 +/- 0.8 (p < 0.001) and 19.9 +/- 4.1 cm H2O (p < 0.03) with VCV PEEP at 6 h. Mean systemic BP was lower with PCIRV (58 +/- 9 mm Hg) than with VCV PEEP (68 +/- 7 mm Hg) at 6 h (p < 0.003). At 6 h, PaCO2 was lower with PCIRV (3.2 +/- 0.6 kPa) than with VCV PEEP (4.1 +/- 0.8 kPa) (p < 0.02). There was no difference in blood oxygenation between PCIRV and VCV PEEP. 99mTc-DTPA lung clearance curves were monoexponential with both PCIRV and VCV PEEP. Mean lung clearance expressed as T 1/2 was 16 +/- 9 min with PCIRV and 107 +/- 74 min with VCV PEEP (p < 0.001). Morphologic examination revealed no differences between the groups and no evidence of significant lung injury.
  
  
  CONCLUSIONS
  The observations reported in this article imply that PCIRV causes an alteration in lung epithelial or membrane function in comparison to VCV PEEP. This functional difference is most likely caused by the large time-adjusted lung volume produced by pressure control in combination with a prolonged inspiration. It remains to be established whether this early functional effect of PCIRV is relevant with regard to structural lung injury in mechanically ventilated subjects.
authors.affiliation: Department of Medicine, Södersjukhuset, Stockholm, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Ludwigs
authors.forename: A
authors.initials: A
authors.lastname: Philip
authors.forename: B
authors.initials: B
authors.lastname: Robertson
authors.forename: G
authors.initials: G
authors.lastname: Hedenstierna
mesh_terms: D000818:Animals; D004848:Epithelium / Q000378:metabolism; D015633:Extravascular Lung Water / Q000378:metabolism; D006439:Hemodynamics; D008168:Lung / Q000000981:diagnostic imaging / Q000378:metabolism*; D010539:Permeability; D011175:Positive-Pressure Respiration; D011650:Pulmonary Alveoli / Q000378:metabolism*; D011659:Pulmonary Gas Exchange; D011817:Rabbits; D011877:Radionuclide Imaging; D012121:Respiration, Artificial; D015656:Respiratory Mechanics; D016284:Technetium Tc 99m Pentetate
chemical_list: D016284:Technetium Tc 99m Pentetate