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Maximizing survival: lung protective ventilation

Lab Animal volume 46, pages 213–216 (2017)Cite this article

The ability to safely and successful anesthetize a model is a staple in research. One of the most powerful tools available is the mechanical ventilator, especially for large animal models during the anesthetic period. While mechanical ventilation has undoubtedly elevated the practice of anesthesia and critical care, it does not come without potential harm to subjects, whether animals or human patients. Adverse effects of mechanical ventilation include abnormal distribution of ventilation, redistribution of blood flow, mismatching of ventilation and perfusion, increased anatomic dead space, and altered pulmonary vascular resistance1. The complex physiological effects of mechanical ventilation, especially when administered inappropriately, can also result in direct cellular injury to the lungs, termed ventilator-induced lung injury (VILI)1. Laboratory animal studies show that ventilation of “healthy” lungs with inappropriate tidal volumes can produce fulminant lung injury that is histologically identical to acute respiratory distress syndrome (ARDS) in a matter of minutes, which has undoubtedly added a research variable we may not have been aware of2. ARDS is a condition of severe lung inflammation and dysfunction that can occur independently of ventilation injury and which can have multifactorial intra- or extra-pulmonary causes.

In a clinical setting, the clinician will rarely be able to determine whether a mechanically ventilated subject's deteriorating respiratory status is due to mechanical ventilation, project intervention, or disease1. In situations when mechanically ventilated subjects with significant respiratory disease are deteriorating and showing clinical signs of developing ARDS, the term ventilator-associated lung injury (VALI) is more appropriate than VILI2. However, many clinicians continue to use the terms VILI and VALI interchangeably. While mechanical ventilation is likely not the sole contributor to a patient's demise, there is significant evidence that ventilatory strategy plays a role in the development of ARDS and affects mortality in human patients3. As recently as the 1970's, these patients had mortality rates up to 90 percent4. After decades of research, we now have a better idea of how and why some ventilatory strategies exacerbate lung injury, and why some attenuate it. Despite our advances, current mortality estimates for human ARDS patients remain as high as 30 to 60 percent, and research into alternative ventilation methods is ongoing4.

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  1. Foundation Veterinary Solutions, Asheville, North Carolina

    Noah Jones

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  1. Noah Jones
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Correspondence to Noah Jones.

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Jones, N. Maximizing survival: lung protective ventilation. Lab Anim 46, 213–216 (2017). https://doi.org/10.1038/laban.1254

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