Document Detail

Adverse ventilatory strategy causes pulmonary-to-systemic translocation of endotoxin.
MedLine Citation:
PMID:  10903215     Owner:  NLM     Status:  MEDLINE    
Accumulating evidence strongly suggests that ventilatory strategy has an important impact on development of lung injury and patient outcome. Adverse ventilatory strategies have been shown to cause release of pulmonary-derived cytokines and may permit bacterial translocation from the lung to the systemic circulation. Because endotoxin is a potent and clinically important stimulant of cytokine-mediated systemic inflammatory responses that can lead to multiorgan failure, we investigated the effects of ventilatory strategy on lung-to-systemic translocation of endotoxin. We studied the effects of protective (tidal volume [VT] 5 ml. kg(-)(1), positive end-expiratory pressure [PEEP] 10 to 12.5 cm H(2)O) versus nonprotective (VT 12 ml. kg(-)(1), PEEP zero) ventilatory strategy on translocation of endotracheally instilled endotoxin. Anesthetized New Zealand White rabbits were subjected to saline lung lavage, and 32 were randomized to one of four groups: PS (protective ventilation + instilled saline); PE (protective ventilation + instilled endotoxin); NS (nonprotective ventilation + instilled saline); NE (nonprotective ventilation + instilled endotoxin), and ventilated for 3 h. Plasma endotoxin levels increased significantly in the NE group, and remained low and unchanged in the other groups. Peak levels of plasma tumor necrosis factor-alpha (TNF-alpha) were higher in NE versus other groups. Pa(O(2)) and mean arterial pressure (Pa) were lowest, and requirement for pressor and bicarbonate support greatest, in the NE group. Finally, plasma endotoxin levels were significantly greater in eventual nonsurvivors than survivors. These data provide convincing evidence for pulmonary translocation of lung-derived endotoxin. This translocation depends on ventilatory strategy, and suggests a pathophysiologic link between ventilatory strategy and outcome.
D B Murphy; N Cregg; L Tremblay; D Engelberts; J G Laffey; A S Slutsky; A Romaschin; B P Kavanagh
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  162     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2000-09-13     Completed Date:  2000-09-13     Revised Date:  2003-11-14    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  27-33     Citation Subset:  AIM; IM    
Medical Surgical I.C.U. and Department of Anaesthesia, Toronto General Hospital, University Health Network, Toronto, Canada.
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MeSH Terms
Bacterial Translocation*
Blood Gas Analysis
Endotoxins / blood*
Lung / microbiology
Positive-Pressure Respiration / adverse effects*
Random Allocation
Reg. No./Substance:
Erratum In:
Am J Respir Crit Care Med 2002 Dec 1;166(11):1517

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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