Ulus Travma Acil Cerrahi Derg. 2016; 22(2): 127-133 | DOI: 10.5505/tjtes.2015.05406

Effects of different recruitment maneuvers on bacterial translocation and ventilator- induced lung injury

Perihan Ergin Ozcan¹, Ozkan Ibrahim Akinci¹, Ipek Edipoglu¹, Evren Senturk¹, Sevil Baylan¹, Atahan Arif Cagatay², Kemal H Turkoz³, Figen Esen¹, Lutfi Telci¹, Nahit Cakar^1
1Department Of Anesthesiology, Istanbul Faculty Of Medicine, Istanbul University, Istanbul, Turkey
²Department Of Infectious Diseases And Clinical Microbiology, Istanbul Faculty Of Medicine, Istanbul University, Istanbul, Turkey
³Department Of Pathology, Marmara University School Of Medicine, Istanbul, Turkey

BACKGROUND: Investigated in the present study were the effects of various recruitment maneuvers (RMs) using the same inflation pressure-time product on bacterial translocation from lung to blood, and ventilator-induced lung injury (VILI).
METHODS: Tracheotomy was performed on anesthetized rats, and ventilation was initiated using pressure-controlled mode. Subsequently, Pseudomonas aeruginosa was inoculated through the tracheotomy tube and ventilated for 30 minutes before rats were randomly separated into 4 groups. Group 1 underwent sustained inflation (SI), Group 2 underwent low-pressure SI, Group 3 underwent modified sigh, and Group 4 was a control group. Blood cultures were taken at baseline, 15 minutes after randomization (after each RM for the first hour), and finally at 75 minutes after the last RM. The rats were euthanized and the lungs were extirpated. The left lung was taken for measurement of wet: dry weight ratio, and the right lung was used for pathologic evaluation.
RESULTS: Positive blood cultures were found to be higher in Group 3 at early study periods. Total pathological scores were also higher in Group 3.
CONCLUSION: Higher severity of ventilator-induced lung injury occurred in the modified sigh group, evidenced by bacterial translocation and results of histopathological evaluation.

Keywords: Bacterial translocation, mechanical ventilation, recruitment maneuver, SIGH; ventilator-induced lung injury.

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Farklý yeniden kazandýrma manevralarýnýn bakteri translokasyonu ve ventilatör iliþkili akciðer hasarýna etkisi

Perihan Ergin Ozcan¹, Ozkan Ibrahim Akinci¹, Ipek Edipoglu¹, Evren Senturk¹, Sevil Baylan¹, Atahan Arif Cagatay², Kemal H Turkoz³, Figen Esen¹, Lutfi Telci¹, Nahit Cakar^1
1Istanbul.üniversitesi, Istanbul Týp Fakültesi, Anesteziyoloji Anabilim Dalý, Istanbul
²Istanbul.üniversitesi, Istanbul Týp Fakültesi, Infeksiyon Hastalýklarý Ve Klinik Mikrobiyoloji Anabilim Dalý, Istanbul
³Marmara Üniversitesi Týp Fakültesi, Patoloji Anabilim Dalý, Istanbul

AMAÇ: Bu çalýþmada, ayný basýnç-zaman ürünlü farklý yeniden kazandýrma manevralarýnýn akciðerden kana bakteri geçiþine ve ventilatör iliþkili akciðer hasarýna etkisi araþtýrýldý.
GEREÇ VE YÖNTEM: Sýçanlara anestezi uygulandýktan sonra trakeotomi açýldý ve basýnç kontrollü ventilasyon modunda ventilasyona baþlandý. Ardýndan Pseudomonas aeruginosa içeren solüsyon trakeotomi kanulünden verilip, ventilasyona bu þekilde 30 dakika devam edildikten sonra sýçanlar rastgele dört gruba ayrýldý. Grup 1: “Sustained inflation” (SI); Grup 2: Düþük basýnç SI (LPSI); Grup 3: Modifiye Sigh; Grup 4: Kontrol grubu. Kan kültürleri bakteri verilmeden önce, ilk bir saat her yeniden kazandýrma manevrasýndan sonra ve son manevradan 75 dakika sonra olmak üzere toplam altý kez alýndý. Daha sonra sýçanlar arter içine verilen sodium tiyopental ile sakrifiye edilerek toraks açýlýp akciðerler çýkarýldý. Sol akciðer yaþ kuru aðýrlýk (WW/DW) oraný için, sað akciðer patolojik inceleme için kullanýldý.
BULGULAR: Kan kültürlerine bakýldýðýnda Grup 3 de daha erken dönemde kan kültürlerinde üreme tespit edildi. Grup 3’de patolojik skorlar daha yüksek bulundu.
TARTIÞMA: Bakteriyel translokasyon ve histopatolojik deðerlendirmelerle modifiye Sigh ile daha ciddi ventilatör iliþkili akciðer hasarý oluþmuþtur.

Anahtar Kelimeler: Bakteriyel translokasyon, mekanik ventilasyon, sign, ventilator iliþkili akciðer hasarý; yeniden kazandýrma manevrasý.

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