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1 Pathophysiology Research Laboratory, National Children's Medical Research Center, Tokyo 154-8509, Japan; and 2 Division of Respiratory and Critical Care, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada M5B 1W8
This study compared
pathophysiological and biochemical indexes of acute lung injury in a
saline-lavaged rabbit model with different ventilatory strategies: a
control group consisting of moderate tidal volume (VT)
(10-12 ml/kg) and low positive end-expiratory pressure (PEEP)
(4-5 cmH2O); and three protective groups:
1) low VT (5-6 ml/kg) high PEEP, 2-3
cmH2O greater than the lower inflection point;
2) low VT (5-6 ml/kg), high PEEP (8-10
cmH2O); and 3) high-frequency oscillatory
ventilation (HFOV). The strategy using PEEP > inflection point
resulted in hypotension and barotrauma. HFOV attenuated the decrease in
pulmonary compliance, the lung inflammation assessed by
polymorphonuclear leukocyte infiltration and tumor necrosis factor-
concentration in the alveolar space, and pathological changes of the
small airways and alveoli. Conventional mechanical ventilation using
lung protection strategies (low VT high PEEP) only
attenuated the decrease in oxygenation and pulmonary compliance. Therefore, HFOV may be a preferable option as a lung protection strategy.
ventilator-induced lung injury; volume recruitment; tumor necrosis factor; conventional mechanical ventilation
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