Effects of pulmonary stretch reflex on lung injury in rabbits with acute respiratory distress syndrome

doi:10.5847/wjem.j.1920-8642.2011.04.010

Abstract

Abstract:

BACKGROUND: Pulmonary stretch reflex plays an important role in regulation of respiratory movement. This study aimed to evaluate the effect of pulmonary stretch reflex on lung injury in rabbits with acute respiratory distress syndrome (ARDS).
METHODS: ARDS rabbits were given intratracheal infusion of hydrochloric acid and ventilated with neurally adjusted ventilatory assistance (NAVA) with a tidal volume (V_T) of 6 mL/kg and the electrical activity of diaphragm (EAdi)-determined positive end expiratory pressure. After isolation of the bilateral vagus nerve trunk, the rabbits were randomized into two groups: sham operation (SHAM) group (n=5) and bilateral vagotomy (VAG) group (n=5). Gas exchange and respiratory mechanics were detected at baseline, after lung injury and 1, 2, and 3 hours after ventilation respectively. Pulmonary permeability index, pathological changes and inflammatory response were also measured.
RESULTS: Compared with the SHAM group, PaO₂/FiO₂ in the VAG group decreased significantly 2 and 3 hours after ventilation (P<0.05). There was no significant difference in PaCO₂ between the SHAM and VAG groups (P>0.05), and the VAG group had a high V_T, peak pressure (Ppeak), and mean pressure (Pm) compared with the SHAM group 1, 2, 3 hours after ventilation (P<0.05). Compared to the SHAM group, dead space fraction (V_D/V_T) and respiratory system elastance (Ers) in the VAG group increased (P<0.05) and static pulmonary compliance (Cst) decreased markedly (P<0.05) after ventilation for 3 hours. Lung wet/dry weight ratio (W/D) (8.4±1.2 vs. 6.6±1.0), lung injury score (6.3±1.8 vs. 3.8±1.3), tumor necrosis factor-α (TNF-α) (779±372 pg/mL vs. 355±130 pg/mL) and interleukin-8 (IL-8) (169±21 pg/mL vs. 118±17 pg/mL) increased significantly in the VAG group compared with the SHAM group (P<0.05).
CONCLUSION: Lung injury is aggravated after bilateral vagotomy, demonstrating that pulmonary stretch reflex may have protective effect on the lung.

Key words: Pulmonary stretch reflex, Vagus nerve, Lung injury, Acute respiratory distress syndrome, Electrical activity of diaphragm, Mechanical ventilation

Xiao-yan Wu, Ying-zi Huang, Huo-gen Liu, Dong-ya Huang, Rui Tang, Hai-bo Qiu. Effects of pulmonary stretch reflex on lung injury in rabbits with acute respiratory distress syndrome[J]. World Journal of Emergency Medicine, 2011, 2(4): 296-301.

Figures/Tables 4

Table 1

Table 2

Table 3

Figure 1.

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Variables	Baseline	ARDS	Ventilation 1 h	Ventilation 2 h	Ventilation 3 h
MAP (mmHg)
SHAM	75.5±10.8	81.5±12.2	65.3±5.7	65.7±6.3	62.7±2.7
VAG	83.1±11.2	75.0±12.2	75.0±14.0	73.0±14.4	65.0±2.4
PaO₂/FiO₂(mmHg)
SHAM	367.3±67.9	133.9±28.2	399.1±62.0	399.7±85.7	392.2±47.0
VAG	475.9±89.0	134.4±26.1	298.5±148.3	237.5±83.9^*	285.2±33.1^*
PaCO₂(mmHg)
SHAM	56.1±6.2	53.3±9.5	47.2±6.1	46.3±7.0	47.9±10.9
VAG	59.1±8.4	54.3±17.1	58.8±18.4	47.9±9.0	51.2±7.0
V_D/V_T
SHAM	0.118±0.018	0.380±0.146			0.310±0.037
VAG	0.119±0.045	0.402±0.114			0.445±0.037^*

Variables	Baseline	ARDS	Ventilation 1 h	Ventilation 2 h	Ventilation 3 h
V_T (mL/kg)
SHAM	6.1±0.1	6.2±0.2	5.5±0.5	5.2±0.4	4.7±0.8
VAG	6.3±0.2	6.2±0.2	9.9±3.5^*	8.5±1.2^*	8.9±0.4^*
Ppeak (cmH₂O)
SHAM	7.3±1.6	11.8±3.0	18.1±2.3	19.4±1.4	20.0±1.0
VAG	5.9±1.6	12.4±2.2	29.3±8.3^*	25.7±3.2^*	27.0±1.6^*
Pm (cmH₂O)
SHAM	3.4±0.6	5.1±0.8	13.3±1.4	13.7±1.2	14.0±0.6
VAG	3.1±0.7	5.5±1.1	17.4±4.6^*	16.5±3.2^*	16.1±0.7^*
PEEP (cmH₂O)
SHAM	2.0±0.1	2.6±0.5	10.4±0.9	10.3±1.0	10.6±0.6
VAG	2.0±0.1	2.5±0.6	10.7±2.9	10.7±2.9	11.1±1.2
Ers (cmH₂O/mL)
SHAM	0.35±0.06	0.64±0.12			0.72±0.07
VAG	0.34±0.08	0.72±0.10			0.93±0.03
Cst (mL/cmH₂O)
SHAM	2.90±0.50	1.62±0.31			1.41±0.13
VAG	3.07±0.63	1.41±0.20			1.08±0.03^*

Variables	SHAM	VAG
W/D	6.6±1.0	8.4±1.2^*
Lung injury score	3.8±1.3	6.3±1.8^*
TNF-α (pg/mL)	355±130	779±372^*
IL-8 (pg/mL)	118±17	169±21^*

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