| Maintaining end-expiratory transpulmonary pressure prevents worsening of ventilator-induced lung injury caused by chest wall constriction in surfactant-depleted rats. | |
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MedLine Citation:
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PMID: 20890197 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To see whether in acute lung injury 1) compression of the lungs caused by thoracoabdominal constriction degrades lung function and worsens ventilator-induced lung injury; and 2) maintaining end-expiratory transpulmonary pressure by increasing positive end-expiratory pressure reduces the deleterious effects of chest wall constriction. DESIGN: Experimental study in rats. SETTING: Physiology laboratory. INTERVENTIONS: Acute lung injury was induced in three groups of nine rats by saline lavage. Nine animals immediately killed served as a control group. Group L had lavage only, group LC had the chest wall constricted with an elastic binder, and group LCP had the same chest constriction but with positive end-expiratory pressure raised to maintain end-expiratory transpulmonary pressure. After lavage, all groups were ventilated with the same pattern for 1½ hrs. MEASUREMENTS AND MAIN RESULTS: Transpulmonary pressure, measured with an esophageal balloon catheter, lung volume changes, arterial blood gasses, and pH were assessed during mechanical ventilation. Lung wet-to-dry ratio, albumin, tumor necrosis factor-α, interleukin-1β, interleukin-6, interleukin-10, and macrophage inflammatory protein-2 in serum and bronchoalveolar lavage fluid and serum E-selectin and von Willebrand Factor were measured at the end of mechanical ventilation. Lavage caused hypoxemia and acidemia, increased lung resistance and elastance, and decreased end-expiratory lung volume. With prolonged mechanical ventilation, lung mechanics, hypoxemia, and wet-to-dry ratio were significantly worse in group LC. Proinflammatory cytokines except E-selectin were elevated in serum and bronchoalveolar lavage fluid in all groups with significantly greater levels of tumor necrosis factor-α, interleukin-1β, and interleukin-6 in group LC, which also exhibited significantly worse bronchiolar injury and greater heterogeneity of airspace expansion at a fixed transpulmonary pressure than other groups. CONCLUSIONS: Chest wall constriction in acute lung injury reduces lung volume, worsens hypoxemia, and increases pulmonary edema, mechanical abnormalities, proinflammatory mediator release, and histologic signs of ventilator-induced lung injury. Maintaining end-expiratory transpulmonary pressure at preconstriction levels by adding positive end-expiratory pressure prevents these deleterious effects. |
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Authors:
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Stephen H Loring; Matteo Pecchiari; Patrizia Della Valle; Ario Monaco; Guendalina Gentile; Edgardo D'Angelo |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Critical care medicine Volume: 38 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-11-22 Completed Date: 2010-12-21 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 2358-64 Citation Subset: AIM; IM |
Affiliation:
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Dipartimento di Fisiologia Umana, Università degli Studi di Milano, and Servizio di Coagulazione, IRCCS Ospedale San Raffaele, Milan, Italy. sloring@bidmc.harvard.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Analysis of Variance Animals Bronchoalveolar Lavage Fluid / chemistry Constriction, Pathologic Disease Models, Animal Disease Progression Male Positive-Pressure Respiration / methods* Primary Prevention / methods Pulmonary Gas Exchange Pulmonary Surfactants / metabolism* Random Allocation Rats Reference Values Respiratory Mechanics Statistics, Nonparametric Thoracic Wall Tidal Volume Ventilator-Induced Lung Injury / physiopathology*, therapy* |
| Grant Support | |
ID/Acronym/Agency:
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HL52586/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Pulmonary Surfactants |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2010 Dec;38(12):2418-9
[PMID:
21088512
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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