Ectasis and pallor of peripheral airways during mechanical ventilation

Study Objective: To evaluate morphologic changes in peripheral airways associated with positive-pressure ventilation (PPV). Design: Single-blind study. Setting: Intensive care unit of a university hospital. Patients: Ten patients who required mechanical ventilation due to acute respiratory failure but had no history of prior pulmonary disease. Interventions: Seventeen fiberoptic bronchoscopy procedures were performed using a fine fiberoptic bronchoscope of 1.8 mm outside diameter. Measurements and Main Results: The main morphologic findings were pallor and ectasts. Increased secretions, pigmentation, and stenosis or collapse in peripheral airways also were observed. Patients with ectasis were more likely to have had prolonged mechanical ventilation (17 ± 9 days) as compared with those patients without ectasis (9 ±5 days). Conclusion: The structural alterations in peripheral airways noted in patients on prolonged PPV suggest that barotrauma may be more widespread than previously recognized.