Effects of airway pressure release ventilation on multi-organ injuries in severe acute respiratory distress syndrome pig models

Aijia Ma; Bo Wang; Jiangli Cheng; Meiling Dong; Yang Li; Canzheng Wei; Yongfang Zhou; Yang Xue; Hui Gao; Lican Zhao; Siyu Li; Yiwei Qin; Mengni Zhang; Qin Wu; Jing Yang; Yan Kang

doi:10.1186/s12890-022-02238-x

Effects of airway pressure release ventilation on multi-organ injuries in severe acute respiratory distress syndrome pig models

BMC Pulm Med. 2022 Dec 7;22(1):468. doi: 10.1186/s12890-022-02238-x.

Authors

Aijia Ma^#¹, Bo Wang^#¹, Jiangli Cheng¹, Meiling Dong¹, Yang Li¹, Canzheng Wei¹, Yongfang Zhou¹, Yang Xue¹, Hui Gao², Lican Zhao², Siyu Li², Yiwei Qin³, Mengni Zhang⁴, Qin Wu¹, Jing Yang⁵, Yan Kang⁶

Affiliations

¹ Department of Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China.
² Department of Nursing, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
³ Department of Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, China.
⁴ Department of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
⁵ Department of Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China. [email protected].
⁶ Department of Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China. [email protected].

^# Contributed equally.

Abstract

Background: Extra-pulmonary multi-organ failure in patients with severe acute respiratory distress syndrome (ARDS) is a major cause of high mortality. Our purpose is to assess whether airway pressure release ventilation (APRV) causes more multi-organ damage than low tidal volume ventilation (LTV).

Methods: Twenty one pigs were randomized into control group (n = 3), ARDS group (n = 3), LTV group (n = 8) and APRV group (n = 7). Severe ARDS model was induced by repeated bronchial saline lavages. Pigs were ventilated and monitored continuously for 48 h. Respiratory data, hemodynamic data, serum inflammatory cytokines were collected throughout the study. Histological injury and apoptosis were assessed by two pathologists.

Results: After severe ARDS modeling, pigs in ARDS, LTV and APRV groups experienced significant hypoxemia and reduced lung static compliance (C_stat). Oxygenation recovered progressively after 16 h mechanical ventilation (MV) in LTV and APRV group. The results of the repeated measures ANOVA showed no statistical difference in the PaO₂/FiO₂ ratio between the APRV and LTV groups (p = 0.54). The C_stat showed a considerable improvement in APRV group with statistical significance (p < 0.01), which was significantly higher than in the LTV group since 16 h (p = 0.04). Histological injury scores showed a significantly lower injury score in the middle and lower lobes of the right lung in the APRV group compared to LTV (p_middle = 0.04, p_lower = 0.01), and no significant increase in injury scores for extra-pulmonary organs, including kidney (p = 0.10), small intestine (p = 1.0), liver (p = 0.14, p = 0.13) and heart (p = 0.20). There were no significant differences in serum inflammatory cytokines between the two groups.

Conclusion: In conclusion, in the experimental pig models of severe ARDS induced by repetitive saline lavage, APRV improved lung compliance with reduced lung injury of middle and lower lobes, and did not demonstrate more extra-pulmonary organ injuries as compared with LTV.

Keywords: Acute respiratory distress syndrome; Airway pressure release ventilation; Low tidal volume; Mechanical ventilation; Multi-organ dysfunction syndrome.

MeSH terms

Animals
Apoptosis
Continuous Positive Airway Pressure*
Respiratory Distress Syndrome* / therapy
Swine

Abstract

MeSH terms

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