Pressure-support compared with pressure-controlled ventilation mitigates lung and brain injury in experimental acute ischemic stroke in rats

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Tipo de produção
article
Data de publicação
2023
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
SPRINGER
Autores
SILVA, Adriana L. da
BESSA, Camila M.
ROCHA, Nazareth N.
CARVALHO, Eduardo B.
MAGALHAES, Raquel F.
ROBBA, Chiara
PELOSI, Paolo
SAMARY, Cynthia S.
ROCCO, Patricia R. M.
Citação
INTENSIVE CARE MEDICINE EXPERIMENTAL, v.11, n.1, article ID 93, 12p, 2023
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background We aimed to evaluate the pulmonary and cerebral effects of low-tidal volume ventilation in pressure-support (PSV) and pressure-controlled (PCV) modes at two PEEP levels in acute ischemic stroke (AIS).Methods In this randomized experimental study, AIS was induced by thermocoagulation in 30 healthy male Wistar rats. After 24 h, AIS animals were randomly assigned to PSV or PCV with V-T = 6 mL/kg and PEEP = 2 cmH(2)O (PSV-PEEP2 and PCV-PEEP2) or PEEP = 5 cmH(2)O (PSV-PEEP5 and PCV-PEEP5) for 2 h. Lung mechanics, arterial blood gases, and echocardiography were evaluated before and after the experiment. Lungs and brain tissue were removed for histologic and molecular biology analysis. The primary endpoint was diffuse alveolar damage (DAD) score; secondary endpoints included brain histology and brain and lung molecular biology markers.Results In lungs, DAD was lower with PSV-PEEP5 than PCV-PEEP5 (p < 0.001); interleukin (IL)-1 beta was lower with PSV-PEEP2 than PCV-PEEP2 (p = 0.016) and PSV-PEEP5 than PCV-PEEP5 (p = 0.046); zonula occludens-1 (ZO-1) was lower in PCV-PEEP5 than PCV-PEEP2 (p = 0.042). In brain, necrosis, hemorrhage, neuropil edema, and CD45 + microglia were lower in PSV than PCV animals at PEEP = 2 cmH(2)O (p = 0.036, p = 0.025, p = 0.018, p = 0.011, respectively) and PEEP = 5 cmH(2)O (p = 0.003, p = 0.003, p = 0.007, p = 0.003, respectively); IL-1 beta was lower while ZO-1 was higher in PSV-PEEP2 than PCV-PEEP2 (p = 0.009, p = 0.007, respectively), suggesting blood-brain barrier integrity. Claudin-5 was higher in PSV-PEEP2 than PSV-PEEP5 (p = 0.036).Conclusion In experimental AIS, PSV compared with PCV reduced lung and brain injury. Lung ZO-1 reduced in PCV with PEEP = 2 versus PEEP = 5 cmH(2)O, while brain claudin-5 increased in PSV with PEEP = 2 versus PEEP = 5 cmH(2)O.
Palavras-chave
Acute ischemic stroke, Mechanical ventilation, Lung injury, Brain injury
URI
https://observatorio.fm.usp.br/handle/OPI/58041
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MPT
Artigos e Materiais de Revistas Científicas - LIM/03
Artigos e Materiais de Revistas Científicas - ODS/03