Low tidal volume ventilation in a porcine model of acute lung injury improves cerebral tissue oxygenation.
BACKGROUND
In study, we investigated the effects of different tidal volumes on cerebral tissue oxygenation and cerebral metabolism in a porcine model of acute lung injury (ALI). We hypothesized that mechanical ventilation with low tidal (LT) volumes improves cerebral tissue oxygenation and metabolism after experimentally induced ALI.


METHODS
After inducing experimental ALI by surfactant depletion, we studied two conditions in 10 female pigs: 1) LT volume ventilation with 6 mL/kg body weight, and 2) high tidal (HT) volume ventilation with 12 mL/kg body weight. Variables of gas exchange, hemodynamic, continuous cerebral tissue oxygen tension (p(ti)O2), cerebral microdialysis, and systemic cytokines were analyzed. After induction of ALI, data were collected at 2, 4, and 8 h. The primary end point was the change in p(ti)O2. For group comparisons, a t-test was used. A value of <0.05 was considered to indicate statistical significance.


RESULTS
At baseline and after induction of ALI, no differences between groups were found in p(ti)O2; however, p(ti)O2 was significantly lower in the HT group after 4 and 8 h. PaO2 and PaCO2 showed no significant differences between the groups at all timepoints. Regarding cerebral microdialysis, a significantly higher level of extracellular lactate could be demonstrated after 2, 4, and 8 h in the HT group. The release of cytokines resulted in higher values for interleukin-6 and interleukin-8 in the HT group.


CONCLUSIONS
Protective ventilation with LT yielded a significant improvement in cerebral tissue oxygenation and metabolism compared to HT ventilation in a porcine model of ALI. There was dissociation between arterial and cerebral tissue oxygenation. Cerebral oxygenation and metabolism might have possibly been impaired by a more distinctive inflammatory response in the HT group.
Bickenbach
Johannes
J
Department of Surgical Intensive Care, RWTH University Hospital, Aachen, Germany. jbickenbach@ukaachen.de
Zoremba
Norbert
N
Fries
Michael
M
Dembinski
Rolf
R
Doering
Robert
R
Ogawa
Eileen
E
Rossaint
Rolf
R
Kuhlen
Ralf
R
D055371:Acute Lung Injury / Q000628:therapy*; D000818:Animals; D001794:Blood Pressure; D001835:Body Weight; D001921:Brain / Q000473:pathology*; D004195:Disease Models, Animal; D005260:Female; D006439:Hemodynamics; D007249:Inflammation; D010100:Oxygen / Q000737:chemistry / Q000378:metabolism*; D011659:Pulmonary Gas Exchange; D015656:Respiratory Mechanics; D013552:Swine; D013990:Tidal Volume / Q000502:physiology; D013997:Time Factors
D010100:Oxygen