title: Effect of lung-protective ventilation on severe Pseudomonas aeruginosa pneumonia and sepsis in rats.
abstract: 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 cmH(2)O) was then compared with high V(T) with low PEEP ventilation (V(T) 12 ml/kg, PEEP 3 cmH(2)O). 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-alpha 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.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan, 236-0004. kiyok@med.yokohama-cu.ac.jp
authors.forename: Kiyoyasu
authors.initials: K
authors.lastname: Kurahashi
authors.forename: Shuhei
authors.initials: S
authors.lastname: Ota
authors.forename: Kyota
authors.initials: K
authors.lastname: Nakamura
authors.forename: Yoji
authors.initials: Y
authors.lastname: Nagashima
authors.forename: Takuya
authors.initials: T
authors.lastname: Yazawa
authors.forename: Minako
authors.initials: M
authors.lastname: Satoh
authors.forename: Asako
authors.initials: A
authors.lastname: Fujita
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Kamiya
authors.forename: Eri
authors.initials: E
authors.lastname: Fujita
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Baba
authors.forename: Kanji
authors.initials: K
authors.lastname: Uchida
authors.forename: Naoto
authors.initials: N
authors.lastname: Morimura
authors.forename: Tomio
authors.initials: T
authors.lastname: Andoh
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Yamada
mesh_terms: D000818:Animals; D016470:Bacteremia / Q000209:etiology / Q000517:prevention & control; D002245:Carbon Dioxide / Q000097:blood; D008297:Male; D010313:Partial Pressure; D018410:Pneumonia, Bacterial / Q000628:therapy*; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D011552:Pseudomonas Infections / Q000628:therapy*; D011550:Pseudomonas aeruginosa; D051381:Rats; D017207:Rats, Sprague-Dawley; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control*; D012720:Severity of Illness Index
chemical_list: D002245:Carbon Dioxide