title: Effects of different mechanical ventilation strategies on the mucociliary system.
abstract: OBJECTIVE
  To evaluate the effects of different mechanical ventilation (MV) strategies on the mucociliary system.
  
  
  METHODS
  Experimental study.
  
  
  METHODS
  Twenty-seven male New Zealand rabbits.
  
  
  METHODS
  After anesthesia, animals were tracheotomized and ventilated with standard ventilation [tidal volume (Vt) 8 ml/kg, positive end expiratory pressure (PEEP) 5 cmH(2)O, flow 3 L/min, FiO(2) 0.4] for 30 min. Next, animals were randomized into three groups and ventilated for 3 h with low volume (LV): Vt 8 ml/kg, PEEP 5 cmH(2)O, flow 3 L/min (n = 6); high volume (HV): Vt 16 ml/kg, PEEP 5 cmH(2)O, flow 5 L/min (n = 7); or high pressure (HP): Ppeak 30 cmH(2)O, PEEP 12 cmH(2)O (n = 8). Six animals (controls) were ventilated for 10 min with standard ventilation. Vital signals, blood lactate, and respiratory system mechanics were verified. Tracheal tissue was collected before and after MV.
  
  
  METHODS
  Lung and tracheal tissue sections were stained to analyze inflammation and mucosubstances by the point-counting method. Electron microscopy verified tracheal cell ultrastructure. In situ tracheal ciliary beating frequency (CBF), determined using a videoscopic technique, and tracheal mucociliary transport (TMCT), assessed by stereoscopic microscope, were evaluated before and after MV.
  
  
  RESULTS
  Respiratory compliance decreased in the HP group. The HV and HP groups showed higher lactate levels after MV. Macroscopy showed areas of atelectasis and congestion on HV and HP lungs. Lung inflammatory infiltrate increased in all ventilated groups. Compared to the control, ventilated animals also showed a reduction of total and acid mucus on tracheal epithelium. Under electron microscopy, injury was observed in the ciliated cells of the HP group. CBF decreased significantly after MV only in the HP group. TMCT did not change significantly in the ventilated groups.
  
  
  CONCLUSIONS
  Different MV strategies induce not only distal lung alterations but also morphological and physiological tracheal alterations leading to mucociliary system dysfunction.
authors.affiliation: Department of Pathology, University of São Paulo School of Medicine, São Paulo, Brazil. vspiccin@uol.com.br
authors.forename: Vivien S
authors.initials: VS
authors.lastname: Piccin
authors.forename: Christiane
authors.initials: C
authors.lastname: Calciolari
authors.forename: Kelly
authors.initials: K
authors.lastname: Yoshizaki
authors.forename: Susimeire
authors.initials: S
authors.lastname: Gomes
authors.forename: Cláudia
authors.initials: C
authors.lastname: Albertini-Yagi
authors.forename: Marisa
authors.initials: M
authors.lastname: Dolhnikoff
authors.forename: Mariângela
authors.initials: M
authors.lastname: Macchione
authors.forename: Elia G
authors.initials: EG
authors.lastname: Caldini
authors.forename: Paulo H N
authors.initials: PH
authors.lastname: Saldiva
authors.forename: Elnara M
authors.initials: EM
authors.lastname: Negri
mesh_terms: D000818:Animals; D008297:Male; D009079:Mucociliary Clearance / Q000502:physiology*; D011817:Rabbits; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*