• Raquel S Santos, Ligia de A Maia, Milena V Oliveira, Cíntia L Santos, Lillian Moraes, Eliete F Pinto, Cynthia Dos S Samary, Joana A Machado, Anna Carolinna Carvalho, Marcos Vinícius de S Fernandes, Vanessa Martins, Vera L Capelozzi, Marcelo M Morales, Thea Koch, Gama de Abreu Marcelo M, Paolo Pelosi, Pedro L Silva, and Rocco Patricia R M PRM.
• From the Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (R.S.S., L.d.A.M., M.V.O., C.L.S., L.M., E.F.P., C.d.S.S., J.A.M., A.C.C., M.V.d.S.F., V.M., P.L.S., P.R.M.R.) the Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil (V.M., V.L.C.) the Laboratory of Cellular and Molecular Physiology, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (M.M.M.) the Department of Anesthesiology and Intensive Care Therapy, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany (T.K., M.G.d.A.) the San Martino Policlinico Hospital, IRCCS for Oncology, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy (P.P.).
• Anesthesiology. 2018 Jun 1; 128 (6): 1193-1206.

BackgroundThe authors hypothesized that low tidal volume (VT) would minimize ventilator-induced lung injury regardless of the degree of mechanical power. The authors investigated the impact of power, obtained by different combinations of VT and respiratory rate (RR), on ventilator-induced lung injury in experimental mild acute respiratory distress syndrome (ARDS).MethodsForty Wistar rats received Escherichia coli lipopolysaccharide intratracheally. After 24 h, 32 rats were randomly assigned to be mechanically ventilated (2 h) with a combination of different VT (6 ml/kg and 11 ml/kg) and RR that resulted in low and high power. Power was calculated as energy (ΔP,L/E,L) × RR (ΔP,L = transpulmonary driving pressure; E,L = lung elastance), and was threefold higher in high than in low power groups. Eight rats were not mechanically ventilated and used for molecular biology analysis.ResultsDiffuse alveolar damage score, which represents the severity of edema, atelectasis, and overdistension, was increased in high VT compared to low VT, in both low (low VT: 11 [9 to 14], high VT: 18 [15 to 20]) and high (low VT: 19 [16 to 25], high VT: 29 [27 to 30]) power groups. At high VT, interleukin-6 and amphiregulin expressions were higher in high-power than in low-power groups. At high power, amphiregulin and club cell protein 16 expressions were higher in high VT than in low VT. Mechanical energy and power correlated well with diffuse alveolar damage score and interleukin-6, amphiregulin, and club cell protein 16 expression.ConclusionsIn experimental mild ARDS, even at low VT, high mechanical power promoted ventilator-induced lung injury. To minimize ventilator-induced lung injury, low VT should be combined with low power.

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