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Alveolar stability under different combinations of positive end-expiratory pressure and tidal volume: alveolar microscopy in isolated injured rat lungs

LIU Hui Claudius A. Stahl Knut Moeller Matthias Schneider Steven Ganzert ZHAO Zhan-qi TONG Xiao-wen Josef Guttmann

中华医学杂志（英文版）2010，Vol.123Issue(4)：406-411,6.

中华医学杂志（英文版）2010，Vol.123Issue(4)：406-411,6.DOI:10.3760/cma.j.issn.0366-6999.2010.04.005

Alveolar stability under different combinations of positive end-expiratory pressure and tidal volume: alveolar microscopy in isolated injured rat lungs

LIU Hui ¹Claudius A. Stahl ²Knut Moeller ²Matthias Schneider ³Steven Ganzert ²ZHAO Zhan-qi ²TONG Xiao-wen ³Josef Guttmann⁴

作者信息

1. Department of Breast Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
2. Department of Anesthesiology and Critical Care Medicine,University Medical Center, Freiburg 79106, Germany
3. Biomedical Engineering, Furtwangen University,VS-Schwenningen 78056, Germany
4. Woman Health Care Center of Tongji University, Shanghai 200065, China
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摘要

Abstract

Background High positive end-expiratory pressure (PEEP) and low tidal volume (VT) ventilation is thought to be a protective ventilation strategy. It is hypothesized that the stabilization of collapsible aiveoli during expiration contributes to lung protection. However, this hypothesis came from analysis of indirect indices like the analysis of the pressure-volume curve of the lung. The purpose of this study was to investigate isolated healthy and injured rat lungs by means of alveolar microscopy, in which combination of PEEP and VI- is beneficial with respect to alveolar stability (I-E%).Methods Alveolar stability was investigated in isolated, non-perfused mechanically ventilated rat lungs. Injured lungs were compared with normal lungs. For both groups three PEEP settings (5, 10, 20 cmH_2O) were combined with three VT settings (6, 10, 15 ml/kg) resulting in nine PEEP-VT combinations per group. Analysis was performed by alveolar microscopy.Results In normal lungs alveolar stability persisted in all PEEP-VT combinations (I-E% (3.2±11.0)%). There was no significant difference using different settings (P >0.01). In contrast, alveoli in injured lungs were extremely instable at PEEP levels of 5 cmH_2O (mean I-E% 100%) and 10 cmH_2O (mean I-E% (30.7±16.8)%); only at a PEEP of 20 cmH_2O were alveoli stabilized (mean I-E% of (0.2±9.3)%).Conclusions In isolated healthy lungs alveolar stability is almost unaffected by different settings of PEEP and VT. In solated injured lungs only a high PEEP level of 20 cmH_2O resulted in stabilized alveoli whereas lower PEEP levels are associated with alveolar instability.

关键词

alveolar microscopy/alveolar mechanics/tidal volume/positive end-expiratory pressure

Key words

alveolar microscopy/alveolar mechanics/tidal volume/positive end-expiratory pressure

引用本文复制引用

LIU Hui,Claudius A. Stahl,Knut Moeller,Matthias Schneider,Steven Ganzert,ZHAO Zhan-qi,TONG Xiao-wen,Josef Guttmann..Alveolar stability under different combinations of positive end-expiratory pressure and tidal volume: alveolar microscopy in isolated injured rat lungs[J].中华医学杂志（英文版）,2010,123(4):406-411,6.

基金项目

This work was supported by a grant from the Deutsche Forschungsgemeinschaft (DFG) (No. GU 561/6-1). （DFG）

中华医学杂志（英文版）

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ISSN：0366-6999

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