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Lung overinflation without positive end-expiratory pressure promotes bacteremia after experimental Klebsiella pneumoniae inoculation

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Abstract

Objective: To determine the effect of peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP) on the development of bacteremia with Klebsiella pneumoniae after mechanical ventilation of intratracheally inoculated rats.

Design: Prospective, randomized, animal study.

Setting: Experimental intensive care unit of a University.

Subjects: Eighty male Sprague Daw-ley rats.

Interventions: Intratracheal inoculation with 100 µl of saline containing 3.5−5.0×105 colony forming units (CFUs) K. pneumoniae/ml. Pressure-controlled ventilation (frequency 30 bpm; I/E ratio=1:2; FIO2=1.0) for 180 min at the following settings (PIP/PEEP in cmH2O): 13/3 (n=16); 13/0 (n=16); 30/10 (n=16) and 30/0 (n=16), starting 22 h after inoculation. Arterial blood samples were obtained and cultured before and 180 min after mechanical ventilation and immediately before sacrifice in two groups of non-ventilated control animals (n=8 per group). After sacrifice, the lungs were homogenized to determine the number of CFUs K. pneumoniae.

Measurements and results: The number of CFUs recovered from the lungs was comparable in all experimental groups. After 180 min, 11 animals had positive blood cultures for K. pneumoniae in group 30/0, whereas only 2,0 and 2 animals were positive in 13/3,13/0 and 30/10, respectively (p<0.05 group 30/0 versus all other groups).

Conclusions: These data show that 3 h of mechanical ventilation with a PIP of 30 cmH2O without PEEP in rats promotes bacteremia with K. pneumoniae. The use of 10 cmH2O PEEP at such PIP reduces ventilation-induced K. pneumoniae bacteremia.

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Authors and Affiliations

  1. Department of Anesthesiology, Erasmus University Rotterdam, Postbox 1738, 3000 DR, Rotterdam, The Netherlands

    S. J. C. Verbrugge, V. Šorm, A. van ’t Veen, D. Gommers & B. Lachmann

  2. Department of Medical Microbiology and Infectious Diseases, Erasmus University Rotterdam, 3000 DR, Rotterdam, The Netherlands

    J. W. Mouton

Authors
  1. S. J. C. Verbrugge
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  2. V. Šorm
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  3. A. van ’t Veen
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  4. D. Gommers
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  5. B. Lachmann
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  6. J. W. Mouton
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Supported by the International Foundation for Clinically Oriented Research (IFCOR).

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Verbrugge, S.J.C., Šorm, V., van ’t Veen, A. et al. Lung overinflation without positive end-expiratory pressure promotes bacteremia after experimental Klebsiella pneumoniae inoculation. Intensive Care Med 24, 172–177 (1998). https://doi.org/10.1007/s001340050541

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  • DOI: https://doi.org/10.1007/s001340050541

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