Impact of Fluid Balance on the Development of Lung Injury

<b>Rationale:</b> The pathophysiological relationship among fluid administration, fluid balance, and mechanical ventilation in the development of lung injury is unclear. <b>Objectives:</b> To quantify the relative contributions of mechanical power and fluid balance in the development of lung injury. <b>Methods:</b> Thirty-nine healthy female pigs, divided into four groups, were ventilated for 48 hours with high (∼18 J/min) or low (∼6 J/min) mechanical power and high (∼4 L) or low (∼1 L) targeted fluid balance. <b>Measurements and Main Results:</b> We measured physiological variables (e.g., end-expiratory lung gas volume, respiratory system mechanics, gas exchange, hemodynamics) and pathological variables (i.e., lung weight, wet-to-dry ratio, and histology score of lung injury). End-expiratory lung gas volume, respiratory system elastance, strain, and oxygenation significantly worsened in the two groups assigned to receive high fluid balance, irrespective of the mechanical power received. All four groups had similar lung weights (i.e., lung edema), lung wet-to-dry ratios, and pathological variables. Animals with higher fluid balance developed more ascites, which was associated with a decrease in end-expiratory lung gas volume. <b>Conclusions:</b> Our study did not detect a significant difference in lung injury between high and low mechanical power. Some damage is directly attributable to mechanical power, while additional injury appears to result indirectly from high fluid balance, which reduces end-expiratory lung gas volume, with ascites playing an important role in this process.

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Publication Details

Journal
American Journal of Respiratory and Critical Care Medicine
Published
2024-11-25
DOI
https://doi.org/10.1164/rccm.202406-1240oc
Citations
4
Primary Topic
Cardiac Arrest and Resuscitation
Type
article
Field-Weighted Citation Impact
2.76
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article

Impact of Fluid Balance on the Development of Lung Injury

Giulia Catozzi, Antonio Fioccola, Aurelio Sonzogni, Tommaso Pozzi et al.
4 citations
American Journal of Respiratory and Critical Care Medicine
Cardiac Arrest and Resuscitation
2.76
article

Impact of Fluid Balance on the Development of Lung Injury

Giulia Catozzi, Antonio Fioccola, Aurelio Sonzogni, Tommaso Pozzi, Mara Velati, Francesca Collino, Luigi Camporota, Rosanna D’Albo, Simone Gattarello, John J. Marini, Mattia Busana, Konrad Meissner, Federica Romitti, Peter Herrmann, Isabella Fratti, Alessandro Gatta, Onnen Moerer, Michael Quintel, Luciano Gattinoni, Rosmery Valentina Nicolardi, Domenico Nocera, Valentina Ghidoni, Mauro Galizia, Beatrice Donati, Stefano Giovanazzi
article en
4 citations

Abstract

<b>Rationale:</b> The pathophysiological relationship among fluid administration, fluid balance, and mechanical ventilation in the development of lung injury is unclear. <b>Objectives:</b> To quantify the relative contributions of mechanical power and fluid balance in the development of lung injury. <b>Methods:</b> Thirty-nine healthy female pigs, divided into four groups, were ventilated for 48 hours with high (∼18 J/min) or low (∼6 J/min) mechanical power and high (∼4 L) or low (∼1 L) targeted fluid balance. <b>Measurements and Main Results:</b> We measured physiological variables (e.g., end-expiratory lung gas volume, respiratory system mechanics, gas exchange, hemodynamics) and pathological variables (i.e., lung weight, wet-to-dry ratio, and histology score of lung injury). End-expiratory lung gas volume, respiratory system elastance, strain, and oxygenation significantly worsened in the two groups assigned to receive high fluid balance, irrespective of the mechanical power received. All four groups had similar lung weights (i.e., lung edema), lung wet-to-dry ratios, and pathological variables. Animals with higher fluid balance developed more ascites, which was associated with a decrease in end-expiratory lung gas volume. <b>Conclusions:</b> Our study did not detect a significant difference in lung injury between high and low mechanical power. Some damage is directly attributable to mechanical power, while additional injury appears to result indirectly from high fluid balance, which reduces end-expiratory lung gas volume, with ascites playing an important role in this process.

American Journal of Respiratory and Critical Care MedicineVol. 211(3)
University of Bergamo (IT), Regions Hospital (US), AOL (United States) (US), Vita-Salute San Raffaele University (IT), King's College London (GB), University of Milan (IT), Guy's and St Thomas' NHS Foundation Trust (GB), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Ospedale San Paolo (IT), Azienda Unità Sanitaria Locale Della Romagna (IT), Ospedale San Paolo (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Universitätsmedizin Göttingen (DE), IRCCS Ospedale San Raffaele (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), Azienda Socio Sanitaria Territoriale Bergamo Est, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Florence (IT), University of Brescia (IT), University of Bologna (IT)
Good health and well-being
Openalex Percentile: Top 9%
Cardiac Arrest and Resuscitation
2.76
DOIOpen Access PDFOpenAlex
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