Effect of driving pressure on pulmonary endogenous acute respiratory distress syndrome

doi:10.3877/cma.j.issn.1674-6880.2018.04.005

Abstract

Abstract:

Objective

To investigate the effect of different driving pressure on pulmonary endogenous acute respiratory distress syndrome (ARDS) induced by lipopolysaccharide and its mechanism.

Methods

Forty male Sprague-Dawley rats were divided into the control group, ARDS group, mechanical ventilation low driving pressure group (L group), mechanical ventilation medium driving pressure group (M group), and mechanical ventilation high driving pressure group (H group), 8 rats in each group. The ARDS model was established by intratracheal instillation of lipopolysaccharide (6 mg/kg). Then the corresponding mechanical ventilation strategies were applied to L, M and H groups for 4 h. The expressions of arterial partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂), wet/dry weight ratio of lung tissue (W/D), total protein in bronchoalveolar lavage fluid (BALF), type Ⅲ procollagen (PCⅢ) and interleukin 6 (IL-6) in serum, and the pathological and morphological changes of lung tissue were compared in these five groups.

Results

There were significant differences in the expressions of PaO₂, PaCO₂, wet/dry weight ratio of lung tissu, protein content in BALF, IL-6 in serum and PCⅢ, and the proportion of collapsed alveoli and inflated alveoli in these five groups (F= 25.054, 5.316, 14.306, 84.940, 93.379, 41.983, 49.343, 123.433; all P < 0.05). Further comparison showed that the expressions of PaO₂, W/D of lung tissue, protein content in BALF and IL-6 in serum, and the proportion of collapsed alveoli in L and H groups were significantly different compared with ARDS group (all P < 0.05). The expression of PaCO₂ and the proportion of inflated alveoli in H and ARDS groups were significantly different (both P < 0.05). The PCⅢ expression was significantly lower in the L group than in ARDS group (P < 0.05). The expressions of PaO₂, IL-6 in serum and PCⅢ, and the proportion of collapsed alveoli and inflated alveoli in H and ARDS groups were significantly different (all P < 0.05).

Conclusions

Under low tidal volume ventilation, lower driving pressure can improve gas exchange and reduce pulmonary edema and inflammatory response in lipopolysaccharide induced lung endogenous ARDS rats. High driving pressure may cause excessive lung expansion and lead to lung injury.

Key words: Driving pressure, Acute respiratory distress syndrome, Lipopolysaccharide

Maoxian Yang, Wenjing Zhao, Liyan Wang, Min Kong, Pengcheng Xu, Longsheng Xu, Hui Shen, Housheng Deng, Qiuli He, Yunchao Shi. Effect of driving pressure on pulmonary endogenous acute respiratory distress syndrome[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2018, 11(04): 238-243.

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References 29

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组别	只数	PaO₂(mmHg)	PaCO₂(mmHg)	肺组织湿/干重
对照组	8	108 ± 17	41 ± 9	4.37 ± 0.15
ARDS组	8	55 ± 6^a	53 ± 5^a	5.32 ± 0.42^a
L组	8	79 ± 11^ab	45 ± 4^b	4.91 ± 0.35^ab
M组	8	106 ± 14^bc	43 ± 6^b	4.47 ± 0.20^bc
H组	8	93 ± 12^abc	49 ± 6^ad	4.77 ± 0.17^abd
F值	?	25.054	5.316	14.306
P值	?	< 0.001	0.002	< 0.001

组别	只数	PaO₂(mmHg)	PaCO₂(mmHg)	肺组织湿/干重
对照组	8	108 ± 17	41 ± 9	4.37 ± 0.15
ARDS组	8	55 ± 6^a	53 ± 5^a	5.32 ± 0.42^a
L组	8	79 ± 11^ab	45 ± 4^b	4.91 ± 0.35^ab
M组	8	106 ± 14^bc	43 ± 6^b	4.47 ± 0.20^bc
H组	8	93 ± 12^abc	49 ± 6^ad	4.77 ± 0.17^abd
F值	?	25.054	5.316	14.306
P值	?	< 0.001	0.002	< 0.001

组别	只数	BALF总蛋白(g/L)	PCⅢ(μg/L)	血清IL-6(ng/L)
对照组	8	0.43 ± 0.07	0.78 ± 0.22	111 ± 26
ARDS组	8	1.94 ± 0.13^a	32.85 ± 9.98	840 ± 141^a
L组	8	1.26 ± 0.28^ab	28.07 ± 5.58^a	453 ± 78^ab
M组	8	0.95 ± 0.16^abc	29.67 ± 3.62^a	278 ± 39^abc
H组	8	1.12 ± 0.12^abd	43.62 ± 9.78^abcd	366 ± 58^abcd
F值	?	84.940	41.983	93.379
P值	?	< 0.001	< 0.001	< 0.001

组别	只数	BALF总蛋白(g/L)	PCⅢ(μg/L)	血清IL-6(ng/L)
对照组	8	0.43 ± 0.07	0.78 ± 0.22	111 ± 26
ARDS组	8	1.94 ± 0.13^a	32.85 ± 9.98	840 ± 141^a
L组	8	1.26 ± 0.28^ab	28.07 ± 5.58^a	453 ± 78^ab
M组	8	0.95 ± 0.16^abc	29.67 ± 3.62^a	278 ± 39^abc
H组	8	1.12 ± 0.12^abd	43.62 ± 9.78^abcd	366 ± 58^abcd
F值	?	84.940	41.983	93.379
P值	?	< 0.001	< 0.001	< 0.001

组别	只数	塌陷肺泡所占比例(%)	膨胀肺泡所占比例(%)
对照组	8	5±3	0
ARDS组	8	46 ± 11^a	0
L组	8	28 ± 6^ab	0
M组	8	21 ± 3^abc	4.8 ± 2.2^abc
H组	8	12 ± 4^abcd	12.8 ± 2.3^abcd
F值	?	49.343	123.433
P值	?	< 0.001	< 0.001

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