The impact of ventilation mode on systemic inflammation and organ dysfunction in a porcine model of abdominal sepsis-associated acute respiratory distress syndrome.

introductionSepsis commonly causes acute respiratory distress syndrome (ARDS), and immune hyperactivation may be a causal link. Ventilator-induced lung injury (VILI) is common in ARDS, and VILI may potentiate organ dysfunction in severe sepsis. We used a porcine model of abdominal sepsis-associated ARDS to test whether ventilation strategy could impact systemic inflammation and organ dysfunction.

methodsFemale Yorkshire pigs (6-8 months) underwent ischemia-reperfusion (I/R) injury of the small bowel and fecal clot implantation or sham laparotomy. The abdominal sepsis animals were ventilated with a volume-controlled (VC) mode using the ARDS-Net low tidal volume (LVt) method to set and adjust the mode, and applied at two time points. Late LVt, was applied once PaO

resultsSham animals showed no evidence of sepsis or ARDS, whereas all experimental animals developed septic shock, requiring fluid resuscitation and vasopressors. Both LVt groups developed ARDS as measured by PaO

conclusionIn a porcine model of abdominal septic shock we found that animals ventilated with a higher mean airway pressure strategy (APRV) had decreased plasma proteomic signatures of inflammation compared to those ventilated with a conventional low tidal volume strategy. Our findings are hypothesis generating and not directly translatable to the clinical setting. Future studies should focus on further elucidating a link between VILI and its effect on systemic inflammation and organ dysfunction.