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High positive end-expiratory pressure levels promote bacterial translocation in experimental pneumonia.
Lachmann, Robert A; van Kaam, Anton H; Haitsma, Jack J; Lachmann, Burkhard.
Afiliação
  • Lachmann RA; Department of Anesthesiology, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. mbwana@gmail.com
Intensive Care Med ; 33(10): 1800-4, 2007 Oct.
Article em En | MEDLINE | ID: mdl-17576531
OBJECTIVE: A previous study in piglets with experimental pneumonia showed that reducing atelectasis by means of open lung ventilation attenuated bacterial translocation compared to conventional ventilation settings. This study examined the effect of open lung ventilation with higher than necessary positive end-expiratory pressures (PEEP) on bacterial translocation. DESIGN AND SETTING: Prospective animal study in a university-affiliated research laboratory. SUBJECTS: Thirty piglets. INTERVENTIONS: Animals were surfactant-depleted by whole-lung lavage and infected with group B streptococci. Thereafter the animals were ventilated for 5 h according to either a conventional ventilation strategy, open lung strategy, or open lung/high-PEEP strategy. Blood samples for blood gas analysis and blood bacterial counts were taken every hour. After 5 h of ventilation surviving animals were killed, and lung colony forming units and lung mechanics parameters were determined. RESULTS: All animals in both open lung groups survived but only 30% of those in the conventional ventilation group. Open lung ventilation resulted in significantly less bacterial translocation than either conventional or high-PEEP ventilation. Lung function in the conventional ventilated group was significantly less than in the two open lung groups. CONCLUSIONS: The lowest level of bacterial translocation was observed during optimal ventilation (open lung) which was achieved by using individually tailored settings. Deviation to either side can be harmful, as shown by the increased bacterial translocation during conventional and high-PEEP ventilation.
Assuntos
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Base de dados: MEDLINE Assunto principal: Respiração com Pressão Positiva / Pneumonia Bacteriana / Translocação Bacteriana Limite: Animals Idioma: En Ano de publicação: 2007 Tipo de documento: Article
Buscar no Google
Base de dados: MEDLINE Assunto principal: Respiração com Pressão Positiva / Pneumonia Bacteriana / Translocação Bacteriana Limite: Animals Idioma: En Ano de publicação: 2007 Tipo de documento: Article