Recruitment Maneuver Does not Increase the Risk of Ventilator Induced Lung Injury

Background: Mechanical ventilation (MV) may induce lung injury. Aims: To assess and evaluate the role of different mechanical ventilation strategies on ventilator-induced lung injury (VILI) in comparison to a strategy which includes recruitment manoeuvre (RM). Study design: Randomized animal experiment. Methods: Thirty male Sprague-Dawley rats were anaesthetised, tracheostomised and divided into 5 groups randomly according to driving pressures; these were mechanically ventilated with following peak alveolar opening (Pao) and positive end-expiratory pressures (PEEP) for 1 hour: Group 15-0: 15 cmH2O Pao and 0 cmH2O PEEP; Group 30-10: 30 cmH2O Pao and 10 cmH2O PEEP; Group 30-5: 30 cmH2O Pao and 5 cmH2O PEEP; Group 30-5aamp;RM: 30 cmH2O Pao and 5 cmH2O PEEP with additional 45 cmH2O CPAP for 30 seconds in every 15 minutes; Group 45-0: 45 cmH2O Pao and 0 cmH2O PEEP Before rats were sacrificed, blood samples were obtained for the evaluation of cytokine and chemokine levels; then, the lungs were subsequently processed for morphologic evaluation. Results: Oxygenation results were similar in all groups; however, the groups were lined as follows according to the increasing severity of morphometric evaluation parameters: Group 15-0: (0aplusmn;0.009) alt; Group 30-10: (0aplusmn;0.14) alt; Group 30-5aamp;RM: (1aplusmn;0.12) alt; Group 30-5: (1aplusmn;0.16) alt; Group 45-0: (2aplusmn;0.16). Besides, inflammatory responses were the lowest in 30-5aamp;RM group compared to all other groups. TNF-aalpha;, IL-1abeta;, IL-6, MCP-1 levels were significantly different between group 30-5aamp;RM and group 15-0 vs. group 45-0 in each group. Conclusion: RM with low PEEP reduces the risk of ventilator-induced lung injury with a lower release of systemic inflammatory mediators in response to mechanical ventilation. Turkish Baslik: Yeniden Kazandirma Manevrasi Ventilator Iliskili Akciger Hasari Riskini Artirmaz Arka Plan: Mekanik ventilasyon (MV) akciger hasarina neden olabilir. Amac: Farkli MV stratejilerinin ventilator iliskili akciger hasari uzerine etkilerini kazandirma manevrasini (RM) da iceren bir ventilasyon stratejisiyle karsilastirarak degerlendirmek. Calisma Tasarimi: Randomize hayvan calismasi. Yontemler: Otuz erkek Sprague-Dawley sicani, anestezi uygulamasini takiben trakeostomize edildi ve uygulanacak ventilator basinclarina gore rastgele 5 gruba ayrilarak 1 saat sureyle asagidaki peak alveoler basinc (Pao) ve pozitif ekspiryum sonu basinc (PEEP) degerleriyle ventile edildiler. Grup 15-0: 15 cmH2O Pao ve 0 cm H2O PEEP; Grup 30-10: 30 cmH2O Pao ve 10 cmH2O PEEP; Grup 30-5: 30 cmH2O Pao ve 5 cmH2O PEEP; Grup 30-5aamp;RM: 30 cmH2O Pao ve 5 cmH2O PEEP'e ek olarak her 15 dakikada bir 30 saniye sureli 45 cmH2O CPAP; Grup 45-0: 45 cmH2O Pao ve 0 cmH2O PEEP Sicanlar sakrifiye edilmeden once sitokin ve kemokin duzeylerinin degerlendirilmesi icin kan ornekleri alindi. Sonrasinda akcigerler morfolojik degerlendirme icin isleme tabi tutuldu. Bulgular: Oksijenasyon sonuclari tum gruplarda benzerdi, ancak morfometrik degerlendirme parametrelerinin artan siddetine gore gruplar su sekilde siralandi. Grup 15-0: (0aplusmn;0.009) alt; Grup 30-10: (0aplusmn;0.14) alt; Grup 30-5aamp;RM: (1aplusmn;0.12) alt; Grup 30-5: (1aplusmn;0.16) alt; Grup 45-0: (2aplusmn;0.16). Bununla birlikte, diger gruplarla kiyaslandiginda inflamatuar yanit 30-5aamp;RM grubunda en dusuktu. TNF-a, IL-1 b, IL-6, MCP-1 seviyeleri grup 30-5aamp;RM ve grup 15-0' da grup 45-0 ile kiyaslandiklarinda anlamli farklilik gosterdi. Sonuc: Dusuk PEEP'le birlikte RM, MV'a yanit olarak salinan sistemik inflamatuar