Abstract:
INTRODUCTION:Leukocyte infiltration is central to the development of acute lung injury, but it is not known how mechanical ventilation strategy alters the distribution or activation of inflammatory cells. We explored how protective (vs. injurious) ventilation alters the magnitude and distribution of lung leukocyte activation following systemic endotoxin administration. METHODS:Anesthetized sheep received intravenous endotoxin (10 ng/kg/min) followed by 2 h of either injurious or protective mechanical ventilation (n = 6 per group). We used positron emission tomography to obtain images of regional perfusion and shunting with infused ¹³N[nitrogen]-saline and images of neutrophilic inflammation with ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG). The Sokoloff model was used to quantify ¹⁸F-FDG uptake (Ki), as well as its components: the phosphorylation rate (k₃, a surrogate of hexokinase activity) and the distribution volume of ¹⁸F-FDG (Fe) as a fraction of lung volume (Ki = Fe × k₃). Regional gas fractions (fgas) were assessed by examining transmission scans. RESULTS:Before endotoxin administration, protective (vs. injurious) ventilation was associated with a higher ratio of partial pressure of oxygen in arterial blood to fraction of inspired oxygen (PaO₂/FiO₂) (351 ± 117 vs. 255 ± 74 mmHg; P < 0.01) and higher whole-lung fgas (0.71 ± 0.12 vs. 0.48 ± 0.08; P = 0.004), as well as, in dependent regions, lower shunt fractions. Following 2 h of endotoxemia, PaO₂/FiO₂ ratios decreased in both groups, but more so with injurious ventilation, which also increased the shunt fraction in dependent lung. Protective ventilation resulted in less nonaerated lung (20-fold; P < 0.01) and more normally aerated lung (14-fold; P < 0.01). Ki was lower during protective (vs. injurious) ventilation, especially in dependent lung regions (0.0075 ± 0.0043/min vs. 0.0157 ± 0.0072/min; P < 0.01). ¹⁸F-FDG phosphorylation rate (k₃) was twofold higher with injurious ventilation and accounted for most of the between-group difference in Ki. Dependent regions of the protective ventilation group exhibited lower k₃ values per neutrophil than those in the injurious ventilation group (P = 0.01). In contrast, Fe was not affected by ventilation strategy (P = 0.52). Lung neutrophil counts were not different between groups, even when regional inflation was accounted for. CONCLUSIONS:During systemic endotoxemia, protective ventilation may reduce the magnitude and heterogeneity of pulmonary inflammatory cell metabolic activity in early lung injury and may improve gas exchange through its effects predominantly in dependent lung regions. Such effects are likely related to a reduction in the metabolic activity, but not in the number, of lung-infiltrating neutrophils.
journal_name
Crit Carejournal_title
Critical care (London, England)authors
de Prost N,Costa EL,Wellman T,Musch G,Tucci MR,Winkler T,Harris R,Venegas JG,Kavanagh BP,Vidal Melo MFdoi
10.1186/cc12854subject
Has Abstractpub_date
2013-08-15 00:00:00pages
R175issue
4eissn
1364-8535issn
1466-609Xpii
cc12854journal_volume
17pub_type
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