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2015 ; 350
(6
): 471-8
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High-Level Pressure Support Ventilation Attenuates Ventilator-Induced Diaphragm
Dysfunction in Rabbits
#MMPMID26517648
Ge H
; Xu P
; Zhu T
; Lu Z
; Yuan Y
; Zhou J
; Ying K
Am J Med Sci
2015[Dec]; 350
(6
): 471-8
PMID26517648
show ga
BACKGROUND: The effects of different modes of mechanical ventilation in the same
ventilatory support level on ventilator-induced diaphragm dysfunction onset were
assessed in healthy rabbits. METHODS: Twenty New Zealand rabbits were randomly
assigned to 4 groups (n = 5 in each group). Group 1: no mechanical ventilation;
group 2: controlled mechanical ventilation (CMV) for 24 hours; group 3:
assist/control ventilation (A/C) mode for 24 hours; group 4: high-level pressure
support ventilation (PSV) mode for 24 hours. Heart rate, mean arterial blood
pressure, PH, partial pressure of arterial oxygen/fraction of inspired oxygen and
partial pressure of arterial carbon dioxide were monitored and diaphragm
electrical activity was analyzed in the 4 groups. Caspase-3 was evaluated by
protein analysis and diaphragm ultra structure was assessed by electron
microscopy. RESULTS: The centroid frequency and the ratio of high frequency to
low frequency were significantly reduced in the CMV, A/C and PSV groups (P <
0.001). The percent change in centroid frequency was significantly lower in the
PSV group than in the CMV and A/C groups (P = 0.001 and P = 0.028, respectively).
Electromyography of diaphragm integral amplitude decreased by 90% ± 1.48%, 67.8%
± 3.13% and 70.2% ± 4.72% in the CMV, A/C and PSV groups, respectively (P <
0.001). Caspase-3 protein activation was attenuated in the PSV group compared
with the CMV and A/C groups (P = 0.035 and P = 0.033, respectively). Irregular
swelling of mitochondria along with fractured and fuzzy cristae was observed in
the CMV group, whereas mitochondrial cristae were dense and rich in the PSV
group. The mitochondrial injury scores (Flameng scores) in the PSV group were the
lowest among the 3 ventilatory groups (0.93 ± 0.09 in PSV versus 2.69 ± 0.05 in
the CMV [P < 0.01] and PSV versus A/C groups [2.02 ± 0.08, P < 0.01]).
CONCLUSIONS: The diaphragm myoelectric activity was reduced in the PSV group,
although excessive oxidative stress and ultra-structural changes of diaphragm
were found. However, partial diaphragm electrical activity was retained and
diaphragm injury was minimized using the PSV mode.