Document Detail


Mild endotoxemia during mechanical ventilation produces spatially heterogeneous pulmonary neutrophilic inflammation in sheep.
MedLine Citation:
PMID:  20179503     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There is limited information on the regional inflammatory effects of mechanical ventilation and endotoxemia on the production of acute lung injury. Measurement of F-fluorodeoxyglucose (F-FDG) uptake with positron emission tomography allows for the regional, in vivo and noninvasive, assessment of neutrophilic inflammation. The authors tested whether mild endotoxemia combined with large tidal volume mechanical ventilation bounded by pressures within clinically acceptable limits could yield measurable and anatomically localized neutrophilic inflammation.
METHODS: Sheep were mechanically ventilated with plateau pressures = 30-32 cm H2O and positive end-expiratory pressure = 0 for 2 h. Six sheep received intravenous endotoxin (10 ng x kg x min), whereas six did not (controls), in sequentially performed studies. The authors imaged with positron emission tomography the intrapulmonary kinetics of infused N-nitrogen and F-FDG to compute regional perfusion and F-FDG uptake. Transmission scans were used to assess aeration.
RESULTS: Mean gas fraction and perfusion distribution were similar between groups. In contrast, a significant increase in F-FDG uptake was observed in all lung regions of the endotoxin group. In this group, F-FDG uptake in the middle and dorsal regions was significantly larger than that in the ventral regions. Multivariate analysis showed that the F-FDG uptake was associated with regional aeration (P < 0.01) and perfusion (P < 0.01).
CONCLUSIONS: Mild short-term endotoxemia in the presence of heterogeneous lung aeration and mechanical ventilation with pressures within clinically acceptable limits produces marked spatially heterogeneous increases in pulmonary neutrophilic inflammation. The dependence of inflammation on aeration and perfusion suggests a multifactorial basis for that finding. F-FDG uptake may be a sensitive marker of pulmonary neutrophilic inflammation in the studied conditions.
Authors:
Eduardo L V Costa; Guido Musch; Tilo Winkler; Tobias Schroeder; R Scott Harris; Hazel A Jones; Jose G Venegas; Marcos F Vidal Melo
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Anesthesiology     Volume:  112     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-24     Completed Date:  2010-03-30     Revised Date:  2011-07-25    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  658-69     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Blood Gas Analysis
Endotoxemia / pathology*,  radionuclide imaging
Fluorodeoxyglucose F18 / diagnostic use
Inflammation / etiology,  pathology*,  radionuclide imaging
Leukocyte Count
Lung / pathology*,  radionuclide imaging
Neutrophils / pathology*
Nitrogen Radioisotopes / diagnostic use
Perfusion
Pneumonia / etiology,  pathology,  radionuclide imaging
Positive-Pressure Respiration
Positron-Emission Tomography
Pulmonary Circulation / physiology
Radiopharmaceuticals / diagnostic use
Respiration, Artificial / adverse effects*
Sheep
Grant Support
ID/Acronym/Agency:
HL 5R01HL086827/HL/NHLBI NIH HHS; K08HL076464/HL/NHLBI NIH HHS; R01 HL086717-04/HL/NHLBI NIH HHS; R01 HL086827-03/HL/NHLBI NIH HHS; R01 HL086827-05/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Nitrogen Radioisotopes; 0/Radiopharmaceuticals; 63503-12-8/Fluorodeoxyglucose F18
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