title: Repeated derecruitments accentuate lung injury during mechanical ventilation.
abstract: OBJECTIVE
  The aim of our study was to assess whether repeated derecruitments induced by the repetitive withdrawal of high positive end-expiratory pressure could induce lung injury in a swine model.
  
  
  METHODS
  Prospective, randomized, experimental animal study.
  
  
  METHODS
  University laboratory.
  
  
  METHODS
  Specific pathogen-free pigs (Choong-Ang Laboratory Animals, Seoul, Korea) weighing around 30 kg.
  
  
  METHODS
  After lung injury was induced by repeated saline lavage, pigs were ventilated in pressure-limited mode with the highest possible positive end-expiratory pressure with a tidal volume of 8 mL/kg and maximum inspiratory pressure of 30 cm H2O. With this initial ventilator setting, the control group (n = 5) received ventilation without derecruitments for 4 hours, and in the derecruitment group (n = 5), derecruitments were repeatedly induced by intentional disconnection of the ventilatory circuit for 30 seconds every 5 minutes for 4 hours.
  
  
  RESULTS
  After the initial increase in positive end-expiratory pressure, the PaO2 increased to greater than 450 mm Hg in both groups. The PaO2 remained at greater than 450 mm Hg in the control group persistently, but in the derecruitment group, PaO2 significantly decreased to 427.7 mm Hg (adjusted p = 0.03) after 2 hours and remained significant for the rest of the study. PaCO2, oxygenation index, and alveolar-arterial oxygen gradient also significantly increased after 2 hours compared with the control group. However, the variables of respiratory mechanics except for minute volume at 2-hour point showed no difference between the two groups for the duration of the study. Histologically, significant bronchiolar injury was observed in the dependent portion of the derecruitment group compared with the controls (p = 0.03), but not in the nondependent area of the lung.
  
  
  CONCLUSIONS
  Repeated derecruitments exacerbated lung injury, particularly at the bronchiolar level in the dependent portion. Strategies to minimize this type of injury should be incorporated when designing optimal ventilator strategies in acute respiratory distress syndrome patients.
authors: 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 3School of Mechanical, Aerospace and Systems Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea. 4Department of Critical Care Medicine, Samsung Medical Center, Seoul, Korea.
authors: Hye Yun
authors: HY
authors: Park
authors: Sang Yun
authors: SY
authors: Ha
authors: Shin Hye
authors: SH
authors: Lee
authors: Saji
authors: S
authors: Kim
authors: Keun-Shik
authors: KS
authors: Chang
authors: Kyeongman
authors: K
authors: Jeon
authors: Sang-Won
authors: SW
authors: Um
authors: Won-Jung
authors: WJ
authors: Koh
authors: Gee Young
authors: GY
authors: Suh
authors: Man Pyo
authors: MP
authors: Chung
authors: Joungho
authors: J
authors: Han
authors: Hojoong
authors: H
authors: Kim
authors: O Jung
authors: OJ
authors: Kwon
mesh_terms: D000818:Animals; D055745:Bronchioles / Q000473:pathology*; D002245:Carbon Dioxide; D018450:Disease Progression; D055370:Lung Injury / Q000139:chemically induced / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011175:Positive-Pressure Respiration / Q000009:adverse effects*; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D011897:Random Allocation; D012965:Sodium Chloride; D013552:Swine; D013990:Tidal Volume; D028761:Withholding Treatment
chemical_list: D002245:Carbon Dioxide; D012965:Sodium Chloride; D010100:Oxygen