title: Neurally adjusted ventilatory assist decreases  ventilator-induced lung injury  and non-pulmonary organ dysfunction  in rabbits with acute lung injury.
abstract: OBJECTIVE
  To determine if neurally adjusted ventilatory assist (NAVA) that delivers pressure in proportion to diaphragm electrical activity is as protective to acutely injured lungs (ALI) and non-pulmonary organs as volume controlled (VC), low tidal volume (Vt), high positive end-expiratory pressure (PEEP) ventilation.
  
  
  METHODS
  Prospective, randomized, laboratory animal study.
  
  
  METHODS
  Twenty-seven male New Zealand white rabbits.
  
  
  METHODS
  Anesthetized rabbits with hydrochloric acid-induced ALI were randomized (n = 9 per group) to 5.5 h NAVA (non-paralyzed), VC (paralyzed; Vt 6-ml/kg), or VC (paralyzed; Vt 15-ml/kg). PEEP was adjusted to hemodynamic goals in NAVA and VC6-ml/kg, and was 1 cmH2O in VC15-ml/kg.
  
  
  RESULTS
  PaO2/FiO2; lung wet-to-dry ratio; lung histology; interleukin-8 (IL-8) concentrations in broncho-alveolar-lavage (BAL) fluid, plasma, and non-pulmonary organs; plasminogen activator inhibitor type-1 and tissue factor in BAL fluid and plasma; non-pulmonary organ apoptosis rate; creatinine clearance; echocardiography. PEEP was similar in NAVA and VC6-ml/kg. During NAVA, Vt was lower (3.1 +/- 0.9 ml/kg), whereas PaO2/ FiO2, respiratory rate, and PaCO2 were higher compared to VC6-ml/kg (p<0.05 for all). Variables assessing ventilator-induced lung injury (VILI), IL-8 levels, non-pulmonary organ apoptosis rate, and kidney as well as cardiac performance were similar in NAVA compared to VC6-ml/kg. VILI and non-pulmonary organ dysfunction was attenuated in both groups compared to VC15-ml/kg.
  
  
  CONCLUSIONS
  In anesthetized rabbits with early experimental ALI, NAVA is as effective as VC6-ml/kg in preventing VILI, in attenuating excessive systemic and remote organ inflammation, and in preserving cardiac and kidney function.
authors.affiliation: Interdepartmental Division of Critical Care Medicine, Department of Critical Care Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
authors.forename: Lukas
authors.initials: L
authors.lastname: Brander
authors.forename: Christer
authors.initials: C
authors.lastname: Sinderby
authors.forename: François
authors.initials: F
authors.lastname: Lecomte
authors.forename: Howard
authors.initials: H
authors.lastname: Leong-Poi
authors.forename: David
authors.initials: D
authors.lastname: Bell
authors.forename: Jennifer
authors.initials: J
authors.lastname: Beck
authors.forename: James N
authors.initials: JN
authors.lastname: Tsoporis
authors.forename: Rosanna
authors.initials: R
authors.lastname: Vaschetto
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Parker
authors.forename: Jesús
authors.initials: J
authors.lastname: Villar
authors.forename: Haibo
authors.initials: H
authors.lastname: Zhang
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Slutsky
mesh_terms: D055371:Acute Lung Injury / Q000503:physiopathology / Q000628:therapy*; D000704:Analysis of Variance; D000818:Animals; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D003964:Diaphragm / Q000503:physiopathology; D004195:Disease Models, Animal; D055724:Electrophysiological Phenomena / Q000502:physiology; D025461:Feedback, Physiological / Q000502:physiology*; D016209:Interleukin-8 / Q000032:analysis / Q000097:blood; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis / Q000097:blood; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D011817:Rabbits; D011897:Random Allocation; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D018709:Statistics, Nonparametric; D013925:Thromboplastin / Q000032:analysis; D013990:Tidal Volume / Q000502:physiology*; D055397:Ventilator-Induced Lung Injury / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*
chemical_list: D016209:Interleukin-8; D017395:Plasminogen Activator Inhibitor 1; D013925:Thromboplastin