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1 Istituto di Fisiologia Umana I, Universita di Milano, Milano, Italy
2 Dipartimento di Medicina Clinica e Sperimentale, Universita di Padova, Padova, Italy
3 Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
* To whom correspondence should be addressed. E-mail: edgardo.dangelo{at}unimi.it.
Lung mechanics and morphometry were assessed in two groups of 9 normal open-chest rabbits mechanically ventilated (MV) for 3-4 h at zero end-expiratory pressure (ZEEP) with physiologic tidal volumes (VT=11 ml. kg-1) and high (group A) or low (group B) inflation flow (44 or 6.1 ml. kg-1. s-1). Relative to initial MV on PEEP (2.3 cmH2O), MV on ZEEP increased quasi-static elastance (Est), airway (Rint) and viscoelastic resistance (Rvisc) more in group A (+251, +393, and +225%, respectively) than B (+180, +247, and +183%, respectively), with no change in viscoelastic time constant. After restoration of PEEP, Est and Rvisc returned to control, whilst Rint, still relative to initial values, remained elevated more in group A (+86%) than B (+33%). In contrast, prolonged high flow MV on PEEP had no effect on lung mechanics of 7 open-chest rabbits (group C). Gas exchange on PEEP was equally preserved in all groups and the lung wet/dry ratios were normal. Relative to group C, both group A and B had an increased percentage of abnormal alveolar-bronchiolar attachments and number of polymorphonuclear leukocytes in alveolar septa, the latter being significantly larger in group A than B. Thus, prolonged MV on ZEEP with cyclic opening-closing of peripheral airways causes alveolar-bronchiolar uncoupling and parenchymal inflammation with concurrent, persistent increase in Rint, that are worsened by high inflation flow.
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