title: Tidal volume increases do not affect alveolar mechanics in normal lung but cause alveolar overdistension and exacerbate alveolar instability after surfactant deactivation.
abstract: OBJECTIVE
  We utilized microscopy to measure the impact of increasing tidal volume on individual alveolar mechanics (i.e., the dynamic change in alveolar size during tidal ventilation) in the living porcine lung.
  
  
  METHODS
  In three anesthetized, mechanically ventilated pigs, we observed normal alveoli (n = 27) and alveoli after surfactant deactivation by Tween 20 lavage (n = 26) at three different tidal volumes (6, 12, and 15 mL/kg). Alveolar area was measured at peak inspiration (I) and at end expiration (E) by image analysis and I minus E was calculated as an index of alveolar stability (I-Edelta).
  
  
  RESULTS
  In normal alveoli, increasing tidal volume did not change alveolar area at I (6 mL/kg = 9726 +/- 848 microm; 15 mL/kg = 9,637 +/- 884 microm ), E (6 mL/kg = 9747 +/- 800 microm; 15 mL/kg = 9742 +/- 853 microm ), or I-Edelta (6 mL/kg = -21 +/- 240 microm; 15 mL/kg = -105 +/- 229 microm ). In contrast, with surfactant deactivation, increasing tidal volume significantly increased alveolar area at I (6 mL/kg = 11,413 +/- 1032 microm; 15 mL/kg = 13,917 +/- 1214 microm ), at E (6 mL/kg = 10,462 +/- 906 microm; 15 mL/kg = 12,000 +/- 1066 microm ), and I-Edelta (6 mL/kg = 825 +/- 276 microm; 15 mL/kg = 1917 +/- 363 microm ). Moreover, alveolar instability (increased I-Edelta) was significantly increased at all tidal volumes with altered surface tension when compared with normal alveoli.
  
  
  CONCLUSIONS
  We conclude that high tidal volume ventilation does not alter alveolar mechanics in the normal lung; however, in the surfactant-deactivated lung, it causes alveolar overdistension and exacerbates alveolar instability.
authors.affiliation: Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Steinberg
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Schiller
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Halter
authors.forename: Louis A
authors.initials: LA
authors.lastname: Gatto
authors.forename: Monica
authors.initials: M
authors.lastname: Dasilva
authors.forename: Marcelo
authors.initials: M
authors.lastname: Amato
authors.forename: Ulysse G
authors.initials: UG
authors.lastname: McCann
authors.forename: Gary F
authors.initials: GF
authors.lastname: Nieman
mesh_terms: D000818:Animals; D018893:Bronchoalveolar Lavage; D018715:Microscopy, Video; D011136:Polysorbates / Q000008:administration & dosage; D011650:Pulmonary Alveoli / Q000502:physiology*; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D015656:Respiratory Mechanics; D013501:Surface-Active Agents / Q000008:administration & dosage; D013552:Swine; D013990:Tidal Volume / Q000502:physiology*
chemical_list: D011136:Polysorbates; D013501:Surface-Active Agents