title: High levels of positive end-expiratory pressure preserve diaphragmatic contractility during acute respiratory distress syndrome in rats.
abstract: What is the central question of this study? Higher levels of positive end-expiratory pressure (PEEP) have recently been used in patients with acute respiratory distress syndrome (ARDS). In normal physiological conditions, the ability of the diaphragm to generate pressure is reduced when the lung volume is elevated beyond its functional residual capacity. It is unknown whether higher levels of PEEP will have a negative impact on diaphragmatic contraction in the presence of the pathophysiology of ARDS. What is the main finding and its importance? Mechanical ventilation with higher levels of PEEP reduced lung injury, improved diaphragmatic contractility and increased the expression of both dihydropyridine receptor and ryanodine receptor in the diaphragms of rats with ARDS. Higher levels of positive end-expiratory pressure (PEEP) have recently been used in patients with acute respiratory distress syndrome (ARDS). In normal physiological conditions, the ability of the diaphragm to generate pressure is reduced when the lung volume is elevated beyond its functional residual capacity. Thus, it is critical to understand whether higher levels of PEEP will have a negative impact on diaphragmatic contraction in the presence of the pathophysiology of ARDS. This study was designed to determine whether higher levels of PEEP reduce diaphragmatic contractility in a rat model of ARDS generated using i.p. lipopolysaccharide. Forty rats were randomly assigned to the following five groups: a control group with no special treatment; an ARDS group with no mechanical ventilation; and three ARDS groups with mechanical ventilation with PEEP at 0, 5 or 10 cmH2 O, respectively. We found that mechanical ventilation with PEEP reduced lung injury, improved diaphragmatic contractility and increased the expression of both dihydropyridine receptor and ryanodine receptor in the diaphragms of rats with ARDS. These changes were most significant at a PEEP of 10 cmH2 O among all applied levels of PEEP. In conclusion, using a rat ARDS model, this study confirmed that diaphragmatic contractility was preserved by mechanical ventilation with high levels of PEEP.
authors.affiliation: Respiratory Department and Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
authors.forename: Guang-Yu
authors.initials: GY
authors.lastname: Jiao
authors.affiliation: Department of Pharmaceutical Toxicology, School of Pharmaceutical Sciences, China Medical University, Shenyang, People's Republic of China.
authors.forename: Li-Ying
authors.initials: LY
authors.lastname: Hao
authors.affiliation: Respiratory Department and Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
authors.forename: Lie
authors.initials: L
authors.lastname: Chen
authors.affiliation: Respiratory Department and Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
authors.forename: Chun-E
authors.initials: CE
authors.lastname: Gao
authors.affiliation: Department of Pharmaceutical Toxicology, School of Pharmaceutical Sciences, China Medical University, Shenyang, People's Republic of China.
authors.forename: Rui
authors.initials: R
authors.lastname: Feng
authors.affiliation: Department of Pharmaceutical Toxicology, School of Pharmaceutical Sciences, China Medical University, Shenyang, People's Republic of China.
authors.forename: Hui-Yuan
authors.initials: HY
authors.lastname: Hu
authors.affiliation: Respiratory Department and Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
authors.forename: Shu-Tao
authors.initials: ST
authors.lastname: Tan
authors.affiliation: Respiratory Department and Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
authors.forename: Meng-Meng
authors.initials: MM
authors.lastname: Wang
authors.affiliation: Respiratory Department and Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhong
authors.affiliation: Respiratory Department and Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
authors.forename: Ping-Ping
authors.initials: PP
authors.lastname: Wang
mesh_terms: D000818:Animals; D003964:Diaphragm / Q000502:physiology*; D008297:Male; D009119:Muscle Contraction / Q000502:physiology*; D009924:Organ Culture Techniques; D011175:Positive-Pressure Respiration / Q000379:methods*; D051381:Rats; D017207:Rats, Sprague-Dawley; D012128:Respiratory Distress Syndrome / Q000503:physiopathology* / Q000628:therapy*