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Continuous positive airway pressure causes lung injury in a model of sepsis.

Authors :
Tsuchida, Shinya
Engelberts, Doreen
Roth, Matthias
McKerlie, Cohn
Post, Martin
Kavanagh, Brian P.
Source :
American Journal of Physiology: Lung Cellular & Molecular Physiology. Oct2005, Vol. 289, pL554-L564. 11p. 4 Color Photographs, 21 Graphs.
Publication Year :
2005

Abstract

Continuous positive airway pressure, aimed at preventing pulmonary atelectasis, has been used for decades to reduce lung injury in critically ill patients. In neonatal practice, it is increasingly used worldwide as a primary form of respiratory support due to its low cost and because it reduces the need for endotracheal intubation and conventional mechanical ventilation. We studied the anesthetized in vivo rat and determined the optimal circuit design for delivery of continuous positive airway pressure. We investigated the effects of continuous positive airway pressure following lipopolysaccharide administration in the anesthetized rat. Whereas neither continuous positive airway pressure nor lipopolysaccharide alone caused lung injury, continuous positive airway pressure applied following intravenous lipopolysaccharide resulted in increased microvascular permeability, elevated cytokine protein and mRNA production, and impaired static compliance. A dose-response relationship was demonstrated whereby higher levels of continuous positive airway pressure (up to 6 cmH2O) caused greater lung injury. Lung injury was attenuated by pretreatment with dexamethasone. These data demonstrate that despite optimal circuit design, continuous positive airway pressure causes significant lung injury (proportional to the airway pressure) in the setting of circulating lipopolysaccharide. Although we would currently avoid direct extrapolation of these findings to clinical practice, we believe that in the context of increasing clinical use, these data are grounds for concern and warrant further investigation. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
10400605
Volume :
289
Database :
Academic Search Index
Journal :
American Journal of Physiology: Lung Cellular & Molecular Physiology
Publication Type :
Academic Journal
Accession number :
18405546
Full Text :
https://doi.org/10.1152/ajplung.00143.2005