Document Detail


Mechanical ventilation aggravates transfusion-related acute lung injury induced by MHC-I class antibodies.
MedLine Citation:
PMID:  20221752     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Transfusion-related acute lung injury (TRALI) occurs more often in critically ill patients than in a general hospital population, possibly due to the presence of underlying inflammatory conditions that may prime pulmonary neutrophils. Mechanical ventilation may be a risk factor for developing TRALI. We examined the influence of mechanical ventilation (MV) on the development of TRALI, combining a murine MV model causing ventilator-induced lung injury with a model of antibody-induced TRALl. METHODS: BALB/c mice (n = 84) were ventilated for 5 h with low (7.5 ml/kg) or high (15 ml/kg) tidal volume, a positive end-expiratory pressure of 2 cm H(2)O and a fraction of inspired oxygen of 50%. After 3 h of MV, TRALI was induced by infusion of MHC-I antibodies (4.5 mg/kg); controls received vehicle. Non-ventilated animals receiving vehicle, isotype or MHC-I antibodies served as additional controls. RESULTS: All animals receiving MHC-I antibodies developed TRALI within 2 h. In mice in which TRALI was induced, MV with low tidal volumes aggravated pulmonary injury, as evidenced by an increase in neutrophil influx, pulmonary and systemic levels of cytokines and lung histopathological changes compared to unventilated controls. The use of high tidal volume ventilation resulted in a further increase in protein leakage and pulmonary edema. CONCLUSIONS: Mechanical ventilation (MV) synergistically augmented lung injury during TRALI, which was even further enhanced by the use of injurious ventilator settings. Results suggest that MV may be a risk factor for the onset of TRALI and may aggravate the course of disease.
Authors:
A P J Vlaar; E K Wolthuis; J J Hofstra; J J T H Roelofs; L Boon; M J Schultz; R Lutter; N P Juffermans
Publication Detail:
Type:  Journal Article     Date:  2010-03-11
Journal Detail:
Title:  Intensive care medicine     Volume:  36     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-07     Completed Date:  2010-07-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  879-87     Citation Subset:  IM    
Affiliation:
Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands. a.p.vlaar@amc.uva.nl
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MeSH Terms
Descriptor/Qualifier:
Acute Lung Injury / etiology*,  immunology
Animals
Antibodies / immunology
Blood Gas Analysis
Blood Transfusion / adverse effects*
Bronchoalveolar Lavage Fluid / chemistry,  immunology
Critical Illness
Disease Models, Animal
Histocompatibility Antigens Class II / immunology*
Leukocytes / immunology
Male
Mice
Mice, Inbred BALB C
Neutrophils / immunology*
Risk Factors
Ventilator-Induced Lung Injury / immunology*
Ventilators, Mechanical / adverse effects*
Chemical
Reg. No./Substance:
0/Antibodies; 0/Histocompatibility Antigens Class II

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


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