Document Detail


Hepatic effects of an open lung strategy and cardiac output restoration in an experimental lung injury.
MedLine Citation:
PMID:  20055766     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Ventilation with high positive end-expiratory pressure (PEEP) can lead to liver dysfunction. We hypothesized that an open lung concept (OLC) using high PEEP impairs liver function and integrity dependent on the stabilization of cardiac output. METHODS: Juvenile female Pietrain pigs instrumented with flow probes around the common hepatic artery and portal vein, pulmonary and hepatic vein catheters underwent a lavage-induced lung injury. Ventilation was continued with a conventional approach (CON) using pre-defined combinations of PEEP and inspiratory oxygen fraction or with an OLC using PEEP set above the lower inflection point of the lung. Volume replacement with colloids was guided to maintain cardiac output in the CON(V+) and OLC(V+) groups or acceptable blood pressure and heart rate in the OLC(V-) group. Indocyanine green plasma disappearance rate (ICG-PDR), blood gases, liver-specific serum enzymes, bilirubin, hyaluronic acid and lactate were tested. Finally, liver tissue was examined for neutrophil accumulation, TUNEL staining, caspase-3 activity and heat shock protein 70 mRNA expression. RESULTS: Hepatic venous oxygen saturation was reduced to 18 + or - 16% in the OLC(V-) group, while portal venous blood flow decreased by 45%. ICG-PDR was not reduced and serum enzymes, bilirubin and lactate were not elevated. Liver cell apoptosis was negligible. Liver sinusoids in the OLC(V+) and OLC(V-) groups showed about two- and fourfold more granulocytes than the CON(V+) group. Heat shock protein 70 tended to be higher in the OLC(V-) group. CONCLUSIONS: Open lung ventilation elicited neutrophil infiltration, but no liver dysfunction even without the stabilization of cardiac output.
Authors:
M Kredel; R M Muellenbach; A Hornung; R Schmidt; J Laqua; J Brederlau; N Roewer; C Wunder
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Publication Detail:
Type:  Journal Article     Date:  2010-01-06
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  54     ISSN:  1399-6576     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-26     Completed Date:  2010-07-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  England    
Other Details:
Languages:  eng     Pagination:  632-42     Citation Subset:  IM    
Affiliation:
Department of Anaesthesia and Critical Care, University of Würzburg, Oberdürrbacherstrasse 6, 97080 Würzburg, Germany. kredel_m@klinik.uni-wuerzburg.de
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MeSH Terms
Descriptor/Qualifier:
Animals
Apoptosis / physiology
Blood Pressure / physiology
Cardiac Output / physiology*
Caspase 3 / analysis
Disease Models, Animal
Female
HSP70 Heat-Shock Proteins / metabolism
Hyaluronic Acid / analysis
Liver / metabolism,  pathology,  physiopathology*
Liver Function Tests
Lung Injury / complications,  physiopathology*
Neutrophil Infiltration / physiology
Oxygen / blood
Partial Pressure
Positive-Pressure Respiration / adverse effects*
Random Allocation
Respiration
Swine
Chemical
Reg. No./Substance:
0/HSP70 Heat-Shock Proteins; 7782-44-7/Oxygen; 9004-61-9/Hyaluronic Acid; EC 3.4.22.-/Caspase 3

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