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. 2020 Mar 19;11:227. doi: 10.3389/fphys.2020.00227

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Copyright © 2020 Nieman, Al-Khalisy, Kollisch-Singule, Satalin, Blair, Trikha, Andrews, Madden, Gatto and Habashi.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Left – Subpleural alveoli seen using in vivo microscopy in a rat hemorrhagic shock-induced ARDS model ventilated with volume cycled ventilation (VC; A,B) or airway pressure release ventilation (APRV) using the time controlled adaptive ventilation (TCAV) method (APRV; C,D). Individual alveoli are shown by arrows. Inflated alveoli were color coded yellow, and alveolar number, size, and surface area were measured by computer image analysis in each group. TCAV significantly improved alveolar patency and stability as compared with the VC group. Right – The APRV group delivered using the TCAV method stabilized alveoli that was associated with a significant reduction in lung histopathology as evidenced by open alveoli and reduced intra-alveolar edema (purple areas) as compared with the collapsed and edema-filled alveoli (stars), fibrinous deposits in the air compartment (arrowheads), and white cell infiltration (between arrows) in the VC group (Roy S.K. et al., 2013). Permissions obtained from Wolters Kluwer Health, Inc. License 4699411295724.