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CRITICAL CARE AND TRAUMA

The Effects of Airway Pressure and Inspiratory Time on Bacterial Translocation

Perihan Ergin Ozcan, MD^*, Nahit Cakar, MD^*, Simru Tugrul, MD^*, Ozkan Akinci, MD^*, Atahan Cagatay, MD, Dilek Yilmazbayhan, MD, Figen Esen, MD^*, Lutfi Telci, MD^*, and Kutay Akpir, MD^*

From the *Departments of Anesthesiology and Intensive Care; Infectious Disease and Clinical Microbiology; and Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Address correspondence and reprint requests to Perihan Ergin Ozcan, MD, Department of Anesthesiology and Intensive Care, Istanbul Medical Faculty, Istanbul University, Capa Klinikleri 34093, Capa, Istanbul, Turkey. Address e-mail to pergin{at}istanbul.edu.tr.

BACKGROUND: Mechanical ventilation with high peak inspiratory pressure (PIP) induces lung injury and bacterial translocation from the lung into the systemic circulation. We investigated the effects of increased inspiratory time on translocation of intratracheally inoculated bacteria during mechanical ventilation with and without extrinsic positive end-expiratory pressure (PEEP).

METHODS: Rats were ventilated in pressure-controlled mode with 14 cm H₂O PIP, 0 cm H₂O PEEP, I:E ratio 1/2, and Fio₂ 1.0. Subsequently, 0.5 mL of 10⁵ cfu/mL Pseudomonas aeruginosa was inoculated through tracheostomy and rats were randomly assigned to six groups; two low-pressure groups (LP)1/2, 14 cm H₂O PIP, 0 cm H₂O PEEP, I:E = 1/2, and LP2/1 14 cm H₂O PIP, 0 cm H₂O PEEP, I:E = 2/1; two high-pressure groups (HP)1/2, 30 cm H₂O PIP, 0 cm H₂O PEEP, I:E = 1/2, and HP2/1, 30 cm H₂O PIP, 0 cm H₂O PEEP, I:E = 2/1; two HP PEEP groups (HPP)1/2, 30 cm H₂O PIP, 10 cm H₂O PEEP, I:E = 1/2, and HPP2/1, 30 cm H₂O PIP, 10 cm H₂O PEEP, I:E = 2/1. Blood cultures were obtained every 30 min. The rats were killed and their lungs were processed.

RESULTS: When compared with baseline values, Pao₂ decreased in the LP1/2, LP2/1, HP1/2, and HP2/1 groups at the last time point, but the decline in Pao₂ reached statistical significance in only the HP1/2 group. The bacterial translocation rate was greater in group HPP2/1 than group HPP1/2 (P = 0.01).

CONCLUSIONS: We found that high PIP, with or without prolonged inspiratory time, increased the rate of bacterial dissemination. PEEP prevented bacterial translocation in the high PIP group. However, the protective effect of PEEP was lost when inspiratory time was prolonged.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999