• Am. J. Respir. Crit. Care Med. · Nov 2024

    Impact of Fluid Balance on the Development of Lung Injury.

    • Simone Gattarello, Tommaso Pozzi, Mauro Galizia, Mattia Busana, Valentina Ghidoni, Giulia Catozzi, Beatrice Donati, Domenico Nocera, Stefano Giovanazzi, Rosanna D'Albo, Antonio Fioccola, Mara Velati, Rosmery Nicolardi, Isabella Fratti, Federica Romitti, Alessandro Gatta, Francesca Collino, Peter Herrmann, Michael Quintel, Konrad Meissner, Aurelio Sonzogni, John J Marini, Luigi Camporota, Onnen Moerer, and Luciano Gattinoni.
    • IRCCS Ospedale San Raffaele, Department of Anesthesia and Intensive Care Medicine; IRCCS San Raffaele Scientific Institute, Milano, Italy.
    • Am. J. Respir. Crit. Care Med. 2024 Nov 25.

    RationaleThe pathophysiological relationship between fluid administration, fluid balance, and mechanical ventilation in the development of lung injury is unclear.ObjectivesTo quantify the relative contribution of mechanical power and fluid balance in the development of lung injury.MethodsThirty-nine healthy female pigs, divided into four groups, were ventilated for 48 hours with high (~18J/min) or low (~6J/min) mechanical power; and high (~4L) or low (~1L) targeted fluid balance.Measurements And Main ResultsWe measured physiological variables e.g., end-expiratory lung gas volume, respiratory-system mechanics, gas-exchange and hemodynamics, and pathological variables, i.e., lung weight, wet-to-dry ratio, and histology score of lung injury. End-expiratory lung gas volume, respiratory system elastance, strain and oxygenation significantly worsened in the two groups assigned to receive high fluid balance, irrespective of the mechanical power received. All four groups had similar lung weight (i.e., lung edema), lung wet-to-dry ratio and pathological variables. Animals with higher fluid balance developed more ascites, which was associated with a decrease in end-expiratory lung gas volume.ConclusionsIn conclusion, our study did not detect a significant difference in lung injury between high and low mechanical power. Some damage is directly attributable to mechanical power, while additional injury appears to result indirectly from high fluid balance, which reduces end-expiratory lung gas volume, with ascites playing an important role in this process.

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