Surfactant impairment after mechanical ventilation with large alveolar surface area changes and effects of positive end-expiratory pressure |
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Authors: | Verbrugge SJC; Bohm S H; Gommers D; Zimmerman LJI; Lachmann B |
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Institution: | Department of Anaesthesiology, Erasmus University Rotterdam, Postbox 1738, 3000 DR Rotterdam, The Netherlands; Department of Paediatrics, Erasmus University Rotterdam, Postbox 1738, 3000 DR Rotterdam, The Netherlands |
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Abstract: | We have assessed the effects of overinflation on surfactant function and
composition in rats undergoing ventilation for 20 min with 100% oxygen at a
peak inspiratory pressure of 45 cm H2O, with or without PEEP 10 cm H2O
(groups 45/10 and 45/0, respectively). Mean tidal volumes were 48.4 (SEM
0.3) ml kg-1 in group 45/0 and 18.3 (0.1) ml kg- 1 in group 45/10. Arterial
oxygenation in group 45/0 was reduced after 20 min compared with group
45/10 (305 (71) vs 564 (10) mm Hg); maximal compliance of the P-V curve was
decreased (2.09 (0.13) vs 4.16 (0.35) ml cm H2O-1 kg-1); total lung volume
at a transpulmonary pressure of 5 cm H2O was reduced (6.5 (1.0) vs 18.8
(1.4) ml kg-1) and the Gruenwald index was less (0.22 (0.02) vs 0.40
(0.05)). Bronchoalveolar lavage fluid from the group of animals who
underwent ventilation without PEEP had a greater protein concentration
(2.18 (0.11) vs 0.76 (0.22) mg ml- 1) and a greater minimal surface tension
(37.2 (6.3) vs 24.5 (2.8) mN m- 1) than in those who underwent ventilation
with PEEP. Group 45/0 had an increase in non-active to active total
phosphorus compared with nonventilated controls (0.90 (0.16) vs 0.30
(0.07)). We conclude that ventilation in healthy rats with peak inspiratory
pressures of 45 cm H2O without PEEP for 20 min caused severe impairment of
pulmonary surfactant composition and function which can be prevented by the
use of PEEP 10 cm H2O.
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