Rationale: The pathophysiological relationship between fluid administration, fluid balance, and mechanical ventilation in the development of lung injury is unclear. Objectives: To quantify the relative contribution of mechanical power and fluid balance in the development of lung injury. Methods: Thirty-nine healthy female pigs, divided into four groups, were ventilated for 48 hours with high (~18J/min) or low (~6J/min) mechanical power; and high (~4L) or low (~1L) targeted fluid balance. Measurements and Main Results: We measured physiological variables e.g., end-expiratory lung gas volume, respiratory-system mechanics, gas-exchange and 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 weight (i.e., lung edema), lung wet-to-dry ratio and pathological variables. Animals with higher fluid balance developed more ascites, which was associated with a decrease in end-expiratory lung gas volume. Conclusions: In conclusion, 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 Medicine
Impact of Fluid Balance on the Development of Lung Injury
Simone Gattarello
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; Tommaso Pozzi Simone Gattarello
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IRCCS Ospedale San Raffaele, Department of Anesthesia and Intensive Care Medicine; IRCCS San Raffaele Scientific Institute, Milano, Italy
University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany; [email protected]
IRCCS Ospedale San Raffaele, Department of Anesthesia and Intensive Care Medicine; IRCCS San Raffaele Scientific Institute, Milano, Italy
University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany; [email protected]
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; Mauro Galizia Tommaso Pozzi
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University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
University of Milan, Department of Health Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milano, Lombardia, Italy
University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
University of Milan, Department of Health Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milano, Lombardia, Italy
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; Mattia Busana Mauro Galizia
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University of Milan, Department of Health Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Germany
University of Milan, Department of Health Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
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, Valentina Ghidoni Mattia Busana
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University Medical Center Göttingen, Department for Anesthesiology, Intensive Care and Emergency Medicine, Gottingen, Niedersachsen, Germany
University Medical Center Göttingen, Department for Anesthesiology, Intensive Care and Emergency Medicine, Gottingen, Niedersachsen, Germany
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; Giulia Catozzi Valentina Ghidoni
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University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
University of Florence, Department of Health Science, Department of Anesthesia and Intensive Care, AOU Careggi, Largo Brambilla 3, 50139, Firenze, Italy
University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
University of Florence, Department of Health Science, Department of Anesthesia and Intensive Care, AOU Careggi, Largo Brambilla 3, 50139, Firenze, Italy
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; Beatrice Donati Giulia Catozzi
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University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
University of Milan, Department of Health Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
University of Milan, Department of Health Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
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; Domenico Nocera Beatrice Donati
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University of Milan, Department of Health Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
University of Milan, Department of Health Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
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; Stefano Giovanazzi Domenico Nocera
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Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Emilia-Romagna, Italy
University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Emilia-Romagna, Italy
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; Rosanna D'Albo Stefano Giovanazzi
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University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
University of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25121, Brescia, Italy
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; Antonio Fioccola Rosanna D'Albo
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Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Emilia-Romagna, Italy
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Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Emilia-Romagna, Italy
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; Antonio Fioccola
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University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
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Mara Velati
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; Rosmery Nicolardi Mara Velati
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; Isabella Fratti Rosmery Nicolardi
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; Federica Romitti Isabella Fratti
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University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
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, Alessandro Gatta Federica Romitti
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, Peter Herrmann Francesca Collino
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, Michael Quintel Peter Herrmann
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, Konrad Meissner Michael Quintel
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, Aurelio Sonzogni Konrad Meissner
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, John J. Marini Aurelio Sonzogni
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, Luigi Camporota John J. Marini
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Department of Pulmonary and Critical Care Medicine, Regions Hospital, St. Paul, Minnesota, United States
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, Onnen Moerer Luigi Camporota
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King's College London, Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences. King’s College London, London, UK. Guy’s & St Thomas’ NHS foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
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, and Luciano Gattinoni Onnen Moerer
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University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
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Luciano Gattinoni
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University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Germany
University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Germany
- Simone Gattarello IRCCS Ospedale San Raffaele, Department of Anesthesia and Intensive Care Medicine; IRCCS San Raffaele Scientific Institute, Milano, Italy; University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
- Tommaso Pozzi University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany; University of Milan, Department of Health Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milano, Lombardia, Italy
- Mauro Galizia University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Germany; University of Milan, Department of Health Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
- Mattia Busana University Medical Center Göttingen, Department for Anesthesiology, Intensive Care and Emergency Medicine, Gottingen, Niedersachsen, Germany
- Valentina Ghidoni University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany; University of Florence, Department of Health Science, Department of Anesthesia and Intensive Care, AOU Careggi, Largo Brambilla 3, 50139, Firenze, Italy
- Giulia Catozzi University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany; University of Milan, Department of Health Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
- Beatrice Donati University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany; University of Milan, Department of Health Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
- Domenico Nocera University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany; Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Emilia-Romagna, Italy
- Stefano Giovanazzi University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany; University of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25121, Brescia, Italy
- Rosanna D'Albo University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany; Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Emilia-Romagna, Italy
- Antonio Fioccola University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany; ASST Santi Paolo e Carlo, Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milano, Lombardia, Italy
- Mara Velati IRCCS Ospedale San Raffaele, Department of Anesthesia and Intensive Care Medicine; IRCCS San Raffaele Scientific Institute, Milano, Italy; University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
- Rosmery Nicolardi IRCCS Ospedale San Raffaele, Department of Anesthesia and Intensive Care Medicine; IRCCS San Raffaele Scientific Institute, Milano, Italy; University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
- Isabella Fratti University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany; University of Milan, Department of Health Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
- Federica Romitti University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
- Alessandro Gatta AUSL della Romagna Rimini, Department of Anesthesia and Intensive Care, "Ceccarini" Hospital, AUSL della Romagna, Rimini, Emilia-Romagna, Italy
- Francesca Collino University Hospital City of Science and Health Turin, Department of Anesthesia, Intensive Care and Emergency, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Torino, Piemonte, Italy
- Peter Herrmann University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
- Michael Quintel University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
- Konrad Meissner University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
- Aurelio Sonzogni ASST Bergamo Est, Department of Pathology, ASST Bergamo Est, Seriate, Lombardia, Italy
- John J. Marini Department of Pulmonary and Critical Care Medicine, Regions Hospital, St. Paul, Minnesota, United States
- Luigi Camporota King's College London, Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences. King’s College London, London, UK. Guy’s & St Thomas’ NHS foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
- Onnen Moerer University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Niedersachsen, Germany
- Luciano Gattinoni University Medical Center Göttingen, Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075, Gottingen, Germany
Received: June 25, 2024
Accepted: November 21, 2024