High positive end-expiratory pressure: Only a dam against oedema formation?

Alessandro Protti, Davide T. Andreis, Giacomo E. Iapichino, Massimo Monti, Beatrice Comini, Marta Milesi, Loredana Zani, Stefano Gatti, Luciano Lombardi, Luciano Gattinoni

Research output: Contribution to journalArticle

Abstract

Introduction: Healthy piglets ventilated with no positive end-expiratory pressure (PEEP) and with tidal volume (VT) close to inspiratory capacity (IC) develop fatal pulmonary oedema within 36 h. In contrast, those ventilated with high PEEP and low VT, resulting in the same volume of gas inflated (close to IC), do not. If the real threat to the blood-gas barrier is lung overinflation, then a similar damage will occur with the two settings. If PEEP only hydrostatically counteracts fluid filtration, then its removal will lead to oedema formation, thus revealing the deleterious effects of overinflation.Methods: Following baseline lung computed tomography (CT), five healthy piglets were ventilated with high PEEP (volume of gas around 75% of IC) and low VT (25% of IC) for 36 h. PEEP was then suddenly zeroed and low VT was maintained for 18 h. Oedema was diagnosed if final lung weight (measured on a balance following autopsy) exceeded the initial one (CT).Results: Animals were ventilated with PEEP 18 ± 1 cmH2O (volume of gas 875 ± 178 ml, 89 ± 7% of IC) and VT 213 ± 10 ml (22 ± 5% of IC) for the first 36 h, and with no PEEP and VT 213 ± 10 ml for the last 18 h. On average, final lung weight was not higher, and actually it was even lower, than the initial one (284 ± 62 vs. 347 ± 36 g; P = 0.01).Conclusions: High PEEP (and low VT) do not merely impede fluid extravasation but rather preserve the integrity of the blood-gas barrier in healthy lungs.

Original languageEnglish
Article numberR131
JournalCritical Care
Volume17
Issue number4
DOIs
Publication statusPublished - Jul 11 2013

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Positive-Pressure Respiration
Inspiratory Capacity
Edema
Gases
Lung
Tomography
Weights and Measures
Tidal Volume
Pulmonary Edema
Autopsy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Protti, A., Andreis, D. T., Iapichino, G. E., Monti, M., Comini, B., Milesi, M., ... Gattinoni, L. (2013). High positive end-expiratory pressure: Only a dam against oedema formation? Critical Care, 17(4), [R131]. https://doi.org/10.1186/cc12810

High positive end-expiratory pressure : Only a dam against oedema formation? / Protti, Alessandro; Andreis, Davide T.; Iapichino, Giacomo E.; Monti, Massimo; Comini, Beatrice; Milesi, Marta; Zani, Loredana; Gatti, Stefano; Lombardi, Luciano; Gattinoni, Luciano.

In: Critical Care, Vol. 17, No. 4, R131, 11.07.2013.

Research output: Contribution to journalArticle

Protti, A, Andreis, DT, Iapichino, GE, Monti, M, Comini, B, Milesi, M, Zani, L, Gatti, S, Lombardi, L & Gattinoni, L 2013, 'High positive end-expiratory pressure: Only a dam against oedema formation?', Critical Care, vol. 17, no. 4, R131. https://doi.org/10.1186/cc12810
Protti A, Andreis DT, Iapichino GE, Monti M, Comini B, Milesi M et al. High positive end-expiratory pressure: Only a dam against oedema formation? Critical Care. 2013 Jul 11;17(4). R131. https://doi.org/10.1186/cc12810
Protti, Alessandro ; Andreis, Davide T. ; Iapichino, Giacomo E. ; Monti, Massimo ; Comini, Beatrice ; Milesi, Marta ; Zani, Loredana ; Gatti, Stefano ; Lombardi, Luciano ; Gattinoni, Luciano. / High positive end-expiratory pressure : Only a dam against oedema formation?. In: Critical Care. 2013 ; Vol. 17, No. 4.
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abstract = "Introduction: Healthy piglets ventilated with no positive end-expiratory pressure (PEEP) and with tidal volume (VT) close to inspiratory capacity (IC) develop fatal pulmonary oedema within 36 h. In contrast, those ventilated with high PEEP and low VT, resulting in the same volume of gas inflated (close to IC), do not. If the real threat to the blood-gas barrier is lung overinflation, then a similar damage will occur with the two settings. If PEEP only hydrostatically counteracts fluid filtration, then its removal will lead to oedema formation, thus revealing the deleterious effects of overinflation.Methods: Following baseline lung computed tomography (CT), five healthy piglets were ventilated with high PEEP (volume of gas around 75{\%} of IC) and low VT (25{\%} of IC) for 36 h. PEEP was then suddenly zeroed and low VT was maintained for 18 h. Oedema was diagnosed if final lung weight (measured on a balance following autopsy) exceeded the initial one (CT).Results: Animals were ventilated with PEEP 18 ± 1 cmH2O (volume of gas 875 ± 178 ml, 89 ± 7{\%} of IC) and VT 213 ± 10 ml (22 ± 5{\%} of IC) for the first 36 h, and with no PEEP and VT 213 ± 10 ml for the last 18 h. On average, final lung weight was not higher, and actually it was even lower, than the initial one (284 ± 62 vs. 347 ± 36 g; P = 0.01).Conclusions: High PEEP (and low VT) do not merely impede fluid extravasation but rather preserve the integrity of the blood-gas barrier in healthy lungs.",
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AU - Protti, Alessandro

AU - Andreis, Davide T.

AU - Iapichino, Giacomo E.

AU - Monti, Massimo

AU - Comini, Beatrice

AU - Milesi, Marta

AU - Zani, Loredana

AU - Gatti, Stefano

AU - Lombardi, Luciano

AU - Gattinoni, Luciano

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N2 - Introduction: Healthy piglets ventilated with no positive end-expiratory pressure (PEEP) and with tidal volume (VT) close to inspiratory capacity (IC) develop fatal pulmonary oedema within 36 h. In contrast, those ventilated with high PEEP and low VT, resulting in the same volume of gas inflated (close to IC), do not. If the real threat to the blood-gas barrier is lung overinflation, then a similar damage will occur with the two settings. If PEEP only hydrostatically counteracts fluid filtration, then its removal will lead to oedema formation, thus revealing the deleterious effects of overinflation.Methods: Following baseline lung computed tomography (CT), five healthy piglets were ventilated with high PEEP (volume of gas around 75% of IC) and low VT (25% of IC) for 36 h. PEEP was then suddenly zeroed and low VT was maintained for 18 h. Oedema was diagnosed if final lung weight (measured on a balance following autopsy) exceeded the initial one (CT).Results: Animals were ventilated with PEEP 18 ± 1 cmH2O (volume of gas 875 ± 178 ml, 89 ± 7% of IC) and VT 213 ± 10 ml (22 ± 5% of IC) for the first 36 h, and with no PEEP and VT 213 ± 10 ml for the last 18 h. On average, final lung weight was not higher, and actually it was even lower, than the initial one (284 ± 62 vs. 347 ± 36 g; P = 0.01).Conclusions: High PEEP (and low VT) do not merely impede fluid extravasation but rather preserve the integrity of the blood-gas barrier in healthy lungs.

AB - Introduction: Healthy piglets ventilated with no positive end-expiratory pressure (PEEP) and with tidal volume (VT) close to inspiratory capacity (IC) develop fatal pulmonary oedema within 36 h. In contrast, those ventilated with high PEEP and low VT, resulting in the same volume of gas inflated (close to IC), do not. If the real threat to the blood-gas barrier is lung overinflation, then a similar damage will occur with the two settings. If PEEP only hydrostatically counteracts fluid filtration, then its removal will lead to oedema formation, thus revealing the deleterious effects of overinflation.Methods: Following baseline lung computed tomography (CT), five healthy piglets were ventilated with high PEEP (volume of gas around 75% of IC) and low VT (25% of IC) for 36 h. PEEP was then suddenly zeroed and low VT was maintained for 18 h. Oedema was diagnosed if final lung weight (measured on a balance following autopsy) exceeded the initial one (CT).Results: Animals were ventilated with PEEP 18 ± 1 cmH2O (volume of gas 875 ± 178 ml, 89 ± 7% of IC) and VT 213 ± 10 ml (22 ± 5% of IC) for the first 36 h, and with no PEEP and VT 213 ± 10 ml for the last 18 h. On average, final lung weight was not higher, and actually it was even lower, than the initial one (284 ± 62 vs. 347 ± 36 g; P = 0.01).Conclusions: High PEEP (and low VT) do not merely impede fluid extravasation but rather preserve the integrity of the blood-gas barrier in healthy lungs.

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