title: Use of low tidal volume in septic shock may decrease severity of subsequent acute lung injury.
abstract: Recent studies have indicated that protective lung strategies may improve outcomes in acute lung injury. We hypothesized that the use of a lower tidal volume early during septic shock may protect against the subsequent development of acute lung injury. Fourteen fasted, anesthetized, invasively monitored, mechanically ventilated, female sheep (26.4 +/- 4.5 kg) underwent cecal ligation and perforation to induce sepsis. Sheep were then randomized to ventilation with low (6 mL/kg) or high (12 mL/kg) tidal volumes. A positive end-expiratory pressure of 10 cm H(2)O was applied in each case. Ringer's lactate was titrated to maintain pulmonary artery occlusion pressure at baseline levels. No vasoactive agents or antibiotics were used. Survival time was longer in the low- than in the high-tidal-volume group (21.8 +/- 2.4 vs. 17.6 +/- 4.1 h, respectively, P < 0.05). The times to develop hypotension and anuria were longer in the low-tidal-volume group (18.1 +/- 3.1 vs. 12.0 +/- 2.8 h, P < 0.05, and 17.6 +/- 1.6 vs. 14.1 +/- 3.8 h, P < 0.05). Although the Pao2/Fio2 tended to be lower in the low- than in the high-tidal-volume group (P = 0.06), postmortem examination showed a lower lung tissue wet/dry ratio in the low- than in the high-tidal-volume group (7.1 +/- 0.5 vs. 9.1 +/- 0.7, P < 0.05). A low-tidal-volume ventilation strategy applied early during septic shock may be beneficial in terms of reducing the amount of lung edema and prolonging survival time.
authors.affiliation: Department of Intensive Care, Erasme Hospital, Brussels, Belgium.
authors.forename: Fuhong
authors.initials: F
authors.lastname: Su
authors.forename: Nam Duc
authors.initials: ND
authors.lastname: Nguyen
authors.forename: Jacques
authors.initials: J
authors.lastname: Creteur
authors.forename: Ying
authors.initials: Y
authors.lastname: Cai
authors.forename: Nathalie
authors.initials: N
authors.lastname: Nagy
authors.forename: Hoang
authors.initials: H
authors.lastname: Anh-Dung
authors.forename: Andre
authors.initials: A
authors.lastname: Amaral
authors.forename: Frederico
authors.initials: F
authors.lastname: Bruzzi de Carvalho
authors.forename: Didier
authors.initials: D
authors.lastname: Chochrad
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000818:Animals; D001794:Blood Pressure; D002432:Cecum / Q000601:surgery; D004487:Edema; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008168:Lung / Q000098:blood supply; D055370:Lung Injury; D009504:Neutrophils; D011312:Pressure; D011654:Pulmonary Edema; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000517:prevention & control*; D012756:Sheep; D012772:Shock, Septic / Q000150:complications / Q000628:therapy*; D013696:Temperature; D013990:Tidal Volume; D013997:Time Factors; D016896:Treatment Outcome