Open AccessEffects of different fluid management on lung and kidney during pressure‐controlled and pressure‐support ventilation in experimental acute lung injury
Author(s) -
Carvalho Eduardo Butturini,
Fonseca Ana Carolina Fernandes,
Magalhães Raquel Ferreira,
Pinto Eliete Ferreira,
Samary Cynthia dos Santos,
Antunes Mariana Alves,
Baldavira Camila Machado,
Silveira Lizandre Keren Ramos,
Teodoro Walcy Rosolia,
Abreu Marcelo Gama,
Capelozzi Vera Luiza,
Felix Nathane Santanna,
Pelosi Paolo,
Rocco Patrícia Rieken Macêdo,
Silva Pedro Leme
Publication year - 2022
Publication title -
physiological reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 39
ISSN - 2051-817X
DOI - 10.14814/phy2.15429
Subject(s) - medicine , lung , mechanical ventilation , ventilation (architecture) , pulmonary edema , diffuse alveolar damage , anesthesia , pathology , gastroenterology , mechanical engineering , acute respiratory distress , engineering
Optimal fluid management is critical during mechanical ventilation to mitigate lung damage. Under normovolemia and protective ventilation, pulmonary tensile stress during pressure‐support ventilation (PSV) results in comparable lung protection to compressive stress during pressure‐controlled ventilation (PCV) in experimental acute lung injury (ALI). It is not yet known whether tensile stress can lead to comparable protection to compressive stress in ALI under a liberal fluid strategy (LF). A conservative fluid strategy (CF) was compared with LF during PSV and PCV on lungs and kidneys in an established model of ALI. Twenty‐eight male Wistar rats received endotoxin intratracheally. After 24 h, they were treated with CF (minimum volume of Ringer's lactate to maintain normovolemia and mean arterial pressure ≥70 mmHg) or LF (~4 times higher than CF) combined with PSV or PCV (V T = 6 ml/kg, PEEP = 3 cmH 2 O) for 1 h. Nonventilated animals ( n = 4) were used for molecular biology analyses. CF‐PSV compared with LF‐PSV: (1) decreased the diffuse alveolar damage score (10 [7.8–12] vs. 25 [23–31.5], p = 0.006), mainly due to edema in axial and alveolar parenchyma; (2) increased birefringence for occludin and claudin‐4 in lung tissue and expression of zonula‐occludens‐1 and metalloproteinase‐9 in lung. LF compared with CF reduced neutrophil gelatinase‐associated lipocalin and interleukin‐6 expression in the kidneys in PSV and PCV. In conclusion, CF compared with LF combined with PSV yielded less lung epithelial cell damage in the current model of ALI. However, LF compared with CF resulted in less kidney injury markers, regardless of the ventilatory strategy.