Am. J. Respir. Crit. Care Med., Volume 163, Number 4, March 2001, 958-964

Mechanical Ventilation-induced Air-Space Enlargement during Experimental Pneumonia in Piglets

IVAN GOLDSTEIN, MARIA-TERESA BUGHALO, CHARLES-HUGO MARQUETTE, GILLES LENAOUR, QIN LU, JEAN-JACQUES ROUBY, and the Experimental ICU Study Group

Reanimation Chirurgicale Pierre Viars, Department of Anesthesiology, and the Department of Pathology, Pitié-Salpêtrière Hospital, University of Paris VI, Paris, France; Unité INSERM 416 of Institut Pasteur and Department Hospitalo-Universitaire de Recherche Expérimentale, University of Medicine, Lille, France; and General ICU, Hospital Distrital de Santarem, Santarem, Portugal

Mechanical ventilation-induced air-space enlargement was investigated in a porcine model of multifocal pneumonia. Following the intrabronchial inoculation of Escherichia coli, 9 piglets (22 ± 2 kg) were ventilated with a tidal volume (VT) of 15 ml/kg for 43 ± 15 h. Five noninoculated piglets ventilated for 60 h with the same VT served as control animals. Following death, the lungs were fixed and lung morphometry was assessed. In inoculated animals, unventilated infected and normally ventilated noninfected pulmonary lobules coexisted. In normally ventilated lung regions (1) emphysema-like lesions were present, (2) mean alveolar area and mean linear intercept were significantly greater in inoculated than in control animals, and (3) the degree of alveolar distension correlated with the decrease in respiratory compliance. In unventilated lung areas (1) pseudocysts were frequent, (2) alveolar edema was rare, (3) bronchiolectasis was frequent, (4) mean bronchiolar area was greater in inoculated than in control animals, and (5) the degree of bronchiolar distension correlated with the increase in inspiratory plateau pressure. In conclusion, in piglets with severe bronchopneumonia, air-space enlargement rather than pulmonary edema was the major feature of mechanical ventilation-induced lung barotrauma and resembled lesions previously reported in critically ill patients ventilated using high inspiratory pressures.

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