Protective effects of hypercapnic acidosis on ventilator-induced lung injury

Alain F. Broccard, John R. Hotchkiss, Christine Vannay, Michele Markert, Alain Sauty, François Feihl, Marie Denise Schaller

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170 Scopus citations

Abstract

To investigate whether respiratory acidosis modulates ventilator-induced lung injury (VILI), we perfused (constant flow) 21 isolated sets of normal rabbit lungs, ventilated them for 20 min (pressure controlled ventilation [PCV] = 15 cm H2O) (Baseline) with an inspired CO2 fraction adjusted for the partial pressure of CO2 in the perfusate (Pco2 ≅ 40 mm Hg), and then randomized them into three groups. Group A (control: n = 7) was ventilated with PCV = 15 cm H2O for three consecutive 20-min periods (T1, T2, T3). In Group B (high PCV/normocapnia; n = 7), PCV was given at 20 (T1), 25 (T2), and 30 (T3) cm H2O. The targeted Pco2 was 40 mm Hg in Groups A and B. Group C (high PCV/hypercapnia; n = 7) was ventilated in the same way as Group B, but the targeted Pco2 was ≅ 70 to 100 mm Hg. The changes (from Baseline to T3) in weight gain (ΔWG: g) and in the ultrafiltration coefficient (ΔKf = gr/min/ cm H2O/100g) and the protein and hemoglobin concentrations in bronchoalveolar lavage fluid (BALF) were used to assess injury. Group B experienced a significantly greater ΔWG (14.85 ± 5.49 [mean ± SEM] g) and ΔKf (1.40 ± 0.49 g/min/cm H2O/100 g) than did either Group A (ΔWG = 0.70 ± 0.43; ΔKf = 0.01 ± 0.03) or Group C (ΔWG = 5.27 ± 2.03 g; ΔKf = 0.25 ± 0.12 g/min/cm H2O/ 100 g). BALF protein and hemoglobin concentrations (g/L) were higher in Group B (11.98 ± 3.78 g/L and 1.82 ± 0.40 g/L, respectively) than in Group A (2.92 ± 0.75 g/L and 0.38 ± 0.15 g/L) or Group C (5.71 ± 1.88 g/L and 1.19 ± 0.32 g/L). We conclude that respiratory acidosis decreases the severity of VILI in this model.

Original languageEnglish (US)
Pages (from-to)802-806
Number of pages5
JournalAmerican journal of respiratory and critical care medicine
Volume164
Issue number5
DOIs
StatePublished - Sep 1 2001
Externally publishedYes

Keywords

  • Acute lung injury
  • Hypercapnia
  • Mechanical ventilation
  • Rabbits
  • Respiratory acidosis

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