Low-volume ventilation causes peripheral airway injury and increased airway resistance in normal rabbits.
Lung mechanics and morphometry of 10 normal open-chest rabbits (group A), mechanically ventilated (MV) with physiological tidal volumes (8-12 ml/kg), at zero end-expiratory pressure (ZEEP), for 3-4 h, were compared with those of five rabbits (group B) after 3-4 h of MV with a positive end-expiratory pressure (PEEP) of 2.3 cmH(2)O. Relative to initial MV on PEEP, MV on ZEEP caused a progressive increase in quasi-static elastance (+36%) and airway (Rint; +71%) and viscoelastic resistance (+29%), with no change in the viscoelastic time constant. After restoration of PEEP, quasi-static elastance and viscoelastic resistance returned to control levels, whereas Rint remained elevated (+22%). On PEEP, MV had no effect on lung mechanics. Gas exchange on PEEP was equally preserved in groups A and B, and the lung wet-to-dry ratios were normal. Both groups had normal alveolar morphology, whereas only group A had injured respiratory and membranous bronchioles. In conclusion, prolonged MV on ZEEP induces histological evidence of peripheral airway injury with a concurrent increase in Rint, which persists after restoration of normal end-expiratory volumes. This is probably due to cyclic opening and closing of peripheral airways on ZEEP.
D'Angelo
Edgardo
E
Istituto di Fisiologia Umana I, Università di Milano, 20133 Milan, Italy. edgardo.dangelo@unimi.it
Pecchiari
Matteo
M
Baraggia
Paolo
P
Saetta
Marina
M
Balestro
Elisabetta
E
Milic-Emili
Joseph
J
D000403:Airway Resistance; D000818:Animals; D001980:Bronchi / Q000473:pathology*; D001982:Bronchial Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D004548:Elasticity; D008176:Lung Volume Measurements; D011175:Positive-Pressure Respiration; D011312:Pressure; D011817:Rabbits; D012016:Reference Values; D012143:Respiratory Physiological Phenomena; D014783:Viscosity