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Open Access Research article

Spatial distribution of sequential ventilation during mechanical ventilation of the uninjured lung: an argument for cyclical airway collapse and expansion

Scott E Sinclair1*, Nayak L Polissar2 and William A Altemeier3

Author Affiliations

1 Department of Medicine, University of Tennessee Health Sciences Center, 956 Court Ave E222, Memphis, TN, 38163 USA

2 The Mountain-Whisper-Light Statistical Consulting, 1827 23rd Ave East, Seattle, WA 98112 USA

3 Department of Medicine, University of Washington, Box 358052, 815 Mercer St, Seattle, WA 98109 USA

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BMC Pulmonary Medicine 2010, 10:25  doi:10.1186/1471-2466-10-25

Published: 5 May 2010

Abstract

Background

Ventilator-induced lung injury (VILI) is a recognized complication of mechanical ventilation. Although the specific mechanism by which mechanical ventilation causes lung injury remains an active area of study, the application of positive end expiratory pressure (PEEP) reduces its severity. We have previously reported that VILI is spatially heterogeneous with the most severe injury in the dorsal-caudal lung. This regional injury heterogeneity was abolished by the application of PEEP = 8 cm H2O. We hypothesized that the spatial distribution of lung injury correlates with areas in which cyclical airway collapse and recruitment occurs.

Methods

To test this hypothesis, rabbits were mechanically ventilated in the supine posture, and regional ventilation distribution was measured under four conditions: tidal volumes (VT) of 6 and 12 ml/kg with PEEP levels of 0 and 8 cm H2O.

Results

We found that relative ventilation was sequentially redistributed towards dorsal-caudal lung with increasing tidal volume. This sequential ventilation redistribution was abolished with the addition of PEEP.

Conclusions

These results suggest that cyclical airway collapse and recruitment is regionally heterogeneous and spatially correlated with areas most susceptible to VILI.