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Increased Alveolar Damage after Mechanical Ventilation in a Porcine Model of Thoracic Surgery
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
Institute of Pathology, Charité University Hospital, Berlin, Germany.
Dept. of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Germany.
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2010 (English)In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 24, no 4, 617-623 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Mechanical stress during one-lung ventilation (OLV) results in lung injury. This experiment compares effects of mechanical ventilation, OLV and surgical manipulation on diffuse alveolar damage (DAD) after application of different anesthetic regimes.

Design: Prospective, randomized, controlled, blinded animal experiment.

Setting: University hospital.

Objects: Twenty-one piglets.

Interventions: Animals (27.5kg) were randomized into four groups: spontaneous breathing (SB, n=3); two-lung ventilation (TLV, n=6); OLV during desflurane (n=6) and propofol anesthesia (n=6). SB pigs were killed after induction of anesthesia. Lung tissue samples were analyzed to obtain reference values for alveolar damage.

TLV pigs underwent standard TLV (VT=10ml/kg, FIO2=0.40, PEEP=5cmH2O). In OLV pigs, after lung separation by a bronchial blocker, OLV (VT=10ml/kg) and thoracic surgery were performed. After the procedure the pigs were killed. Lung tissue samples were harvested for histological examination. Lung injury was quantified by DAD score; sequestration of leukocytes was assessed by recruitment of CD45+-cells into the lungs.

Main Results: TLV resulted in increased DAD scores in both lungs (TLV vs. SB: 6.9 vs. 2.7; p<0.05); the number of CD45+-cells was not increased (TLV vs. SB: 8.7 vs. 5.0 cells/view). OLV and surgical manipulation increased DAD and leukocyte sequestration without differences between the ventilated and manipulated lungs. Leukocyte recruitment was not differently affected by the anesthetic regimen (propofol vs. desflurane: CD45+-cells/view: 13.5 vs. 11.3).

Conclusions: TLV resulted in increased DAD scores in the lungs as compared with SB. OLV and thoracic surgery further increased lung injury and leukocyte recruitment independently of the administration of propofol or desflurane anesthesia.

Place, publisher, year, edition, pages
2010. Vol. 24, no 4, 617-623 p.
Keyword [en]
One-Lung Ventilation, Open Thoracic Surgery, Ventilator-Induced Lung Injury, Diffuse Alveolar Damage, Pulmonary Leukocyte Recruitment, General Anesthesia
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-108913DOI: 10.1053/j.jvca.2009.09.016ISI: 000280726000013OAI: oai:DiVA.org:uu-108913DiVA: diva2:241521
Available from: 2009-10-03 Created: 2009-10-03 Last updated: 2010-12-07Bibliographically approved
In thesis
1. Pathophysiological and Histomorphological Effects of One-Lung Ventilation in the Porcine Lung
Open this publication in new window or tab >>Pathophysiological and Histomorphological Effects of One-Lung Ventilation in the Porcine Lung
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Thoracic surgical procedures require partial or complete airway separation and the opportunity to exclude one lung from ventilation (one-lung ventilation, OLV). OLV is commonly associated with profound pathophysiological changes that may affect the postoperative outcome. It is injurious in terms of increased mechanical stress including alveolar cell stretch and overdistension, shear forces secondary to repeated tidal collapse and reopening of alveolar units and compression of alveolar vessels. Ventilation and perfusion distribution may thus be affected during and after OLV. The present studies investigated the influence of OLV on ventilation and perfusion distribution, on the gas/tissue distribution and on the lung histomorphology in a pig model of thoracic surgery.

Anaesthetised and mechanically ventilated piglets were examined. The ventilation and perfusion distribution within the lungs was assessed by single photon emission computed tomography. Computed tomography was used to establish the effects of OLV on dependent lung gas/tissue distribution. The pulmonary histopathology of pigs undergoing OLV and thoracic surgery was compared with that of two-lung ventilation (TLV) and spontaneous breathing.

OLV induced hyperperfusion and significant V/Q mismatch in the ventilated lung persistent in the postoperative course. It increased cyclic tidal recruitment that was associated with a persistent increase of gas content in the ventilated lung. OLV and thoracic surgery as well resulted in alveolar damage.  In the present model of OLV and thoracic surgery, alveolar recruitment manoeuvre (ARM) and protective ventilation approach using low tidal volume preserved the ventilated lung density distribution and did not aggravate cyclic recruitment of alveoli in the ventilated lung.

In conclusion, the present model established significant alveolar damage in response to OLV and thoracic surgery. Lung injury could be related to the profound pathophysiological consequences of OLV including hyperperfusion, ventilation/perfusion mismatch and increased tidal recruitment of lung tissue in the dependent, ventilated lung.  These mechanisms may contribute to the increased susceptibility for respiratory complications in patients undergoing thoracic surgery. A protective approach including sufficient ARM, application of PEEP, and the use of lower tidal volumes may prevent the ventilated lung from deleterious consequences of OLV.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 54 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 493
Alveolar Recruitment Manoeuvre, One-Lung Ventilation, Lung Protective Ventilation, Tidal Volume, Computed Tomography, Tidal Recruitment, Animal Model, Open Thoracic Surgery, Ventilation/ Perfusion Distribution, Single Photon Emission Computed Tomography, Diffuse Alveolar Damage
National Category
Biomedical Laboratory Science/Technology
Research subject
urn:nbn:se:uu:diva-108850 (URN)978-91-554-7647-2 (ISBN)
Public defence
2009-12-09, Enghoffsalen, Akademiska sjukhuset, 751 85 Uppsala, Ing. 50, 13:15 (English)
Available from: 2009-11-19 Created: 2009-09-30 Last updated: 2009-11-19Bibliographically approved

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