Alveolar edema dispersion and alveolar protein permeability during high volume ventilation: effect of positive end-expiratory pressure.
OBJECTIVE
To evaluate whether PEEP affects intrapulmonary alveolar edema liquid movement and alveolar permeability to proteins during high volume ventilation.


METHODS
Experimental study in an animal research laboratory.


METHODS
46 male Wistar rats.


METHODS
A (99m)Tc-labeled albumin solution was instilled in a distal airway to produce a zone of alveolar flooding. Conventional ventilation (CV) was applied for 30 min followed by various ventilation strategies for 3 h: CV, spontaneous breathing, and high volume ventilation with different PEEP levels (0, 6, and 8 cmH(2)O) and different tidal volumes. Dispersion of the instilled liquid and systemic leakage of (99m)Tc-albumin from the lungs were studied by scintigraphy.


RESULTS
The instillation protocol produced a zone of alveolar flooding that stayed localized during CV or spontaneous breathing. High volume ventilation dispersed alveolar liquid in the lungs. This dispersion was prevented by PEEP even when tidal volume was the same and thus end-inspiratory pressure higher. High volume ventilation resulted in the leakage of instilled (99m)Tc-albumin from the lungs. This increase in alveolar albumin permeability was reduced by PEEP. Albumin permeability was more affected by the amplitude of tidal excursions than by overall lung distension.


CONCLUSIONS
PEEP prevents the dispersion of alveolar edema liquid in the lungs and lessens the increase in alveolar albumin permeability due to high volume ventilation.
de Prost
Nicolas
N
Centre de Recherche Bichat Beaujon CRB3, INSERM U773, site Bichat BP 416, Université Paris 7, Denis Diderot, 75018, Paris, France.
Roux
Damien
D
Dreyfuss
Didier
D
Ricard
Jean-Damien
JD
Le Guludec
Dominique
D
Saumon
Georges
G
D000818:Animals; D008297:Male; D011175:Positive-Pressure Respiration; D011650:Pulmonary Alveoli / Q000187:drug effects; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D011877:Radionuclide Imaging; D051381:Rats; D017208:Rats, Wistar; D012121:Respiration, Artificial; D013668:Technetium Tc 99m Aggregated Albumin / Q000494:pharmacology; D013990:Tidal Volume
D013668:Technetium Tc 99m Aggregated Albumin