Open lung approach associated with high-frequency oscillatory or low tidal volume mechanical ventilation improves respiratory function and minimizes lung injury in healthy and injured rats 英文参考文献.docVIP

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Open lung approach associated with high-frequency oscillatory or low tidal volume mechanical ventilation improves respiratory function and minimizes lung injury in healthy and injured rats 英文参考文献.doc

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Open lung approach associated with high-frequency oscillatory or low tidal volume mechanical ventilation improves respiratory function and minimizes lung injury in healthy and injured rats 英文参考文献

Krebsetal.CriticalCare2010,14:R183 /content/14/5/R183 RESEARCH OpenAccess Openlungapproachassociatedwithhigh- frequencyoscillatoryorlowtidalvolume mechanicalventilationimprovesrespiratory functionandminimizeslunginjuryinhealthy andinjuredrats JoergKrebs1,PaoloPelosi2,CharalambosTsagogiorgas1,LiesaZoeller1,PatriciaRMRocco3,BenitoYard4, ThomasLuecke1* Abstract Introduction:Totestthehypothesisthatopenlung(OL)ventilatorystrategiesusinghigh-frequencyoscillatory ventilation(HFOV)orcontrolledmechanicalventilation(CMV)comparedtoCMVwithlowerpositiveend-expiratory pressure(PEEP)improverespiratoryfunctionwhileminimizinglunginjuryaswellassystemicinflammation,a prospectiverandomizedstudywasperformedatauniversityanimallaboratoryusingthreedifferentlung conditions. Methods:Seventy-eight adult male Wistar rats were randomly assigned to three groups: (1) uninjured (UI), (2) saline washout (SW), and (3) intraperitoneal/intravenous Escherichia coli lipopolysaccharide (LPS)-induced lung injury. Within each group, animals were further randomized to (1) OL with HFOV, (2) OL with CMV with “best” PEEP set according to the minimal static elastance of the respiratory system (BP-CMV), and (3) CMV with low PEEP (LP-CMV). They were then ventilated for 6hours. HFOV was set with mean airway pressure (PmeanHFOV )at 2 cm H2Oabove the mean airway pressure recorded at BP-CMV (PmeanBP-CMV)following arecruitment manoeuvre. Six animals served as unventilated controls (C). Gas-exchange, respiratory system mechanics, lung histology, plasma cytokines, as well as cytokines and types Iand III procollagen (PCI and PCIII) mRNA expression in lung tissue were measured. Results:Wefoundthat(1)inbothSWandLPS,HFOVandBP-CMVimprovedgasexchangeandmechanicswith lowerlunginjurycomparedtoLP-CMV,(2)inSW;HFOVyieldedbetteroxygenationthanBP-CMV;(3)inSW, interleukin(IL)-6mRNAexpressionwaslowerduringBP-CMVandHFOVcomparedtoLP-CMV,whileinLPS inflammatoryresponsewasindependentoftheventilatorymode;and(4)PCIIImRNAexpressiondecrease