CDS Samary

CL Santos

L Maia

M Gama de Abreu

MV de Oliveira

P Pelosi

PL Silva

PRM Rocco

R Huhle

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POSTER PRESENTATION Open Access
Biological impact of different ventilatory strategies
during open abdominal surgery in a rat model
L Maia1*, CDS Samary1, MV de Oliveira1, CL Santos1, R Huhle2, M Gama de Abreu2, P Pelosi3, PL Silva1, PRM Rocco1
From ESICM LIVES 2015
Berlin, Germany. 3-7 October 2015
Introduction
234 million major surgical procedures are performed
worldwide every year. It has been shown that a ventilator
strategy with low tidal volume (VT), high positive end-
expiratory pressure (PEEP) and recruitment maneuvers
(RM)s compared to low VT and low PEEP without RM did
not protect against postoperative pulmonary complica-
tions [1]. So far, no study has evaluated the biological
impact of these ventilator strategies in lung tissue during
open abdominal surgery. We hypothesized that low VT
and low PEEP without RM may result in less biological
impact in lung tissue compared to a ventilator strategy
with low VT, high PEEP and RMs.
Objective
To evaluate the impact of different ventilator strategies on
respiratory system mechanics and biological parameters
during open abdominal surgery in rats.
Methods
28 male Wistar rats (394 ± 60 g) were anesthetized,
paralyzed, and mechanically ventilated. After baseline data
collection, a laparotomy with bowel manipulation was
performed. After this, animals were randomly assigned to
one of four groups (n = 7/group): 1) moderate PEEP
(3 cmH2O), low VT (7 mL/kg), and RM [continuous posi-
tive airway pressure (30 cmH2O, 30 s) every hour; 2) high
PEEP (6 cmH2O), low VT (7 mL/kg) and RMs (at the
beginning and at the end of the experiment]; 3) low PEEP
(1 cmH2O), low VT (7 mL/kg) without RMs; 4) low PEEP
(1 cmH2O), high VT (14 mL/kg) without RMs. All animals
were mechanically ventilated for four hours. Respiratory
system and lung elastances (E,RS and E,L, respectively),
peak airway pressure (Ppeak,RS), peak transpulmonary
pressure (Ppeak,L), and blood gas analysis were evaluated
every hour. At the end of the experiment, lungs were
removed for molecular biology analysis (gene expression
of biological markers associated with inflammation (inter-
leukin (IL)-6, damage inflicted pulmonary stretch (amphir-
egulin) [2], and fibrogenesis (type III procollagen (PCIII))).
Results
All animals improved oxygenation during the time course
of the experiment regardless of ventilator strategy. E,RS,
E,L, Ppeak,RS, and Ppeak,L were lower in groups 1 and 2
(submitted to RMs) compared to groups 3 and 4 (no RMs)
after 4 hours mechanical ventilation. IL-6 expression
increased in all groups independent of the ventilator strat-
egy. Amphiregulin expression was more reduced in group
3 (low PEEP (1 cmH2O), low VT (7 mL/kg) without RMs)
compared to other groups. PCIII mRNA expression was
more increased in group 4 (low PEEP (1 cmH2O), high VT
(14 mL/kg) without RMs) than other groups.
Conclusion
Even though groups ventilated to low VT, moderate and
high PEEP levels, and submitted to RMs improved lung
function, they were associated with higher amphiregulin
expression. Based on functional and molecular parameters,
an intraoperative protective ventilation strategy should
include a low VT and low PEEP, without RM.
Grant Acknowledgment
CNPq, FAPERJ, CAPES, PRONEX
Authors’ details
1Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. 2Dresden
University of Technology, Dresden, Germany. 3University of Genoa, Genoa,
Italy.
1Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
Full list of author information is available at the end of the article
Maia et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A568
http://www.icm-experimental.com/content/3/S1/A568
© 2015 Maia et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://
creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Published: 1 October 2015
References
1. PROVE Network Investigators for the Clinical Trial Network of the European
Society of Anaesthesiology, Hemmes SN, Gama de Abreu M, Pelosi P,
Schultz MJ: High versus low positive end-expiratory pressure during
general anaesthesia for open abdominal surgery (PROVHILO trial): a
multicentre randomised controlled trial. Lancet 2014, 384(9942):495-503.
2. Dolinay T, Kaminski N, Felgendreher M, Kim HP, Reynolds P, Watkins SC,
et al: Gene expression profiling of target genes in ventilator-induced
lung injury. Physiol Genomics 2006, 26(1):68-75.
doi:10.1186/2197-425X-3-S1-A568
Cite this article as: Maia et al.: Biological impact of different ventilatory
strategies during open abdominal surgery in a rat model. Intensive Care
Medicine Experimental 2015 3(Suppl 1):A568.
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Maia et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A568
http://www.icm-experimental.com/content/3/S1/A568
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BIOLOGICAL IMPACT OF DIFFERENT VENTILATORY STRATEGIES DURING OPEN ABDOMINAL SURGERY IN A RAT MODEL

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BIOLOGICAL IMPACT OF DIFFERENT VENTILATORY STRATEGIES DURING OPEN ABDOMINAL SURGERY IN A RAT MODEL

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