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Acute Lung Injury Causes Asynchronous Alveolar Ventilation That Can Be Corrected by Individual Sighs

Tabuchi, Arata; Nickles, Hannah T; Kim, Michael; Semple, John W LU ; Koch, Edmund; Brochard, Laurent; Slutsky, Arthur S; Pries, Axel R and Kuebler, Wolfgang M (2016) In American Journal of Respiratory and Critical Care Medicine 193(4). p.396-406
Abstract

RATIONALE: Improved ventilation strategies have been the mainstay for reducing mortality in acute respiratory distress syndrome. Their unique clinical effectiveness is, however, unmatched by our understanding of the underlying mechanobiology, and their impact on alveolar dynamics and gas exchange remains largely speculative.

OBJECTIVES: To assess changes in alveolar dynamics and associated effects on local gas exchange in experimental models of acute lung injury (ALI) and their responsiveness to sighs.

METHODS: Alveolar dynamics and local gas exchange were studied in vivo by darkfield microscopy and multispectral oximetry in experimental murine models of ALI induced by hydrochloric acid, Tween instillation, or in... (More)

RATIONALE: Improved ventilation strategies have been the mainstay for reducing mortality in acute respiratory distress syndrome. Their unique clinical effectiveness is, however, unmatched by our understanding of the underlying mechanobiology, and their impact on alveolar dynamics and gas exchange remains largely speculative.

OBJECTIVES: To assess changes in alveolar dynamics and associated effects on local gas exchange in experimental models of acute lung injury (ALI) and their responsiveness to sighs.

METHODS: Alveolar dynamics and local gas exchange were studied in vivo by darkfield microscopy and multispectral oximetry in experimental murine models of ALI induced by hydrochloric acid, Tween instillation, or in antibody-mediated transfusion-related ALI.

MEASUREMENTS AND MAIN RESULTS: Independent of injury mode, ALI resulted in asynchronous alveolar ventilation characteristic of alveolar pendelluft, which either spontaneously resolved or progressed to a complete cessation or even inversion of alveolar ventilation. The functional relevance of the latter phenomena was evident as impaired blood oxygenation in juxtaposed lung capillaries. Individual sighs (2 × 10 s at inspiratory plateau pressure of 30 cm H2O) largely restored normal alveolar dynamics and gas exchange in acid-induced ALI, yet not in Tween-induced surfactant depletion.

CONCLUSIONS: We describe for the first time in detail the different forms and temporal sequence of impaired alveolar dynamics in the acutely injured lung and report the first direct visualization of alveolar pendelluft. Moreover, we identify individual sighs as an effective strategy to restore intact alveolar ventilation by a mechanism independent of alveolar collapse and reopening.

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author
publishing date
type
Contribution to journal
publication status
published
keywords
Acute Lung Injury, Animals, Disease Models, Animal, Exhalation, Male, Mice, Mice, Inbred BALB C, Oximetry, Pulmonary Alveoli, Respiratory Mechanics, Journal Article, Research Support, Non-U.S. Gov't
in
American Journal of Respiratory and Critical Care Medicine
volume
193
issue
4
pages
11 pages
publisher
Am Thoracic Soc
external identifiers
  • scopus:84962962027
ISSN
1535-4970
DOI
10.1164/rccm.201505-0901OC
language
English
LU publication?
no
id
5af244ba-9228-4f5b-91d9-777b618bacbb
date added to LUP
2016-09-23 11:57:09
date last changed
2017-07-23 05:18:13
@article{5af244ba-9228-4f5b-91d9-777b618bacbb,
  abstract     = {<p>RATIONALE: Improved ventilation strategies have been the mainstay for reducing mortality in acute respiratory distress syndrome. Their unique clinical effectiveness is, however, unmatched by our understanding of the underlying mechanobiology, and their impact on alveolar dynamics and gas exchange remains largely speculative.</p><p>OBJECTIVES: To assess changes in alveolar dynamics and associated effects on local gas exchange in experimental models of acute lung injury (ALI) and their responsiveness to sighs.</p><p>METHODS: Alveolar dynamics and local gas exchange were studied in vivo by darkfield microscopy and multispectral oximetry in experimental murine models of ALI induced by hydrochloric acid, Tween instillation, or in antibody-mediated transfusion-related ALI.</p><p>MEASUREMENTS AND MAIN RESULTS: Independent of injury mode, ALI resulted in asynchronous alveolar ventilation characteristic of alveolar pendelluft, which either spontaneously resolved or progressed to a complete cessation or even inversion of alveolar ventilation. The functional relevance of the latter phenomena was evident as impaired blood oxygenation in juxtaposed lung capillaries. Individual sighs (2 × 10 s at inspiratory plateau pressure of 30 cm H2O) largely restored normal alveolar dynamics and gas exchange in acid-induced ALI, yet not in Tween-induced surfactant depletion.</p><p>CONCLUSIONS: We describe for the first time in detail the different forms and temporal sequence of impaired alveolar dynamics in the acutely injured lung and report the first direct visualization of alveolar pendelluft. Moreover, we identify individual sighs as an effective strategy to restore intact alveolar ventilation by a mechanism independent of alveolar collapse and reopening.</p>},
  author       = {Tabuchi, Arata and Nickles, Hannah T and Kim, Michael and Semple, John W and Koch, Edmund and Brochard, Laurent and Slutsky, Arthur S and Pries, Axel R and Kuebler, Wolfgang M},
  issn         = {1535-4970},
  keyword      = {Acute Lung Injury,Animals,Disease Models, Animal,Exhalation,Male,Mice,Mice, Inbred BALB C,Oximetry,Pulmonary Alveoli,Respiratory Mechanics,Journal Article,Research Support, Non-U.S. Gov't},
  language     = {eng},
  month        = {02},
  number       = {4},
  pages        = {396--406},
  publisher    = {Am Thoracic Soc},
  series       = {American Journal of Respiratory and Critical Care Medicine},
  title        = {Acute Lung Injury Causes Asynchronous Alveolar Ventilation That Can Be Corrected by Individual Sighs},
  url          = {http://dx.doi.org/10.1164/rccm.201505-0901OC},
  volume       = {193},
  year         = {2016},
}