Document Detail


Twenty-five percent albumin prevents lung injury following shock/resuscitation.
MedLine Citation:
PMID:  14501967     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate novel indications for the use of human albumin solutions in the prevention and treatment of acute lung injury following shock/resuscitation and to test the hypothesis that 25% human albumin is an effective resuscitation fluid as well as an immunomodulatory agent protective against lung injury in our model. DESIGN: A previously developed rodent model of acute lung injury in which resuscitated shock primes for increased lung injury in response to a small dose of intratracheal lipopolysaccharide. SETTING: University-affiliated hospital. SUBJECTS: Sprague Dawley rats weighing 300-350 g. INTERVENTIONS: Animals were bled to a mean arterial pressure of 40 mm Hg and maintained in a shock phase for 1 hr. Animals then were resuscitated by transfusion of the shed blood plus an equal volume of Ringer's lactate or their shed blood plus 3 mL/kg volume of 25% albumin or their shed blood plus 15 mL/kg of 5% human albumin over a period of 2 hrs. To test for the possible role of 25% albumin as an antioxidant, we also performed resuscitation with Ringer's lactate supplemented with N-acetylcysteine or 25% albumin depleted of its antioxidant properties by N-ethylmaleimide. Mean arterial pressure was monitored continuously. One hour after resuscitation, 100 microg of lipopolysaccharide in 200 microL of saline was administered intratracheally. MEASUREMENTS AND MAIN RESULTS: Resuscitation with 25% albumin significantly reduced transpulmonary protein flux, bronchoalveolar lavage fluid neutrophil counts, and the degree of histopathological injury compared with resuscitation with Ringer's lactate or 5% albumin. To delineate the underlying mechanism of this beneficial effect, the production of cytokine-induced neutrophil chemoattractant as well as nuclear translocation of its critical transcription factor nuclear factor-kappaB was measured. Both cytokine-induced neutrophil chemoattractant messenger RNA concentrations and nuclear factor-kappaB translocation were diminished following 25% albumin resuscitation. Furthermore, 25% albumin significantly decreased lipid peroxidation in plasma as measured by 8-isoprostane concentrations. N-ethylmaleimide modified 25% albumin, possessing lesser antioxidant activity, exhibited an attenuated protection from lung injury. CONCLUSIONS: Resuscitation with 25% albumin attenuates lung injury in this rat model. The beneficial effect was due to reduced neutrophil sequestration. The antioxidant properties of the 25% albumin preparation appeared to be partially responsible for the effects observed. These studies suggest a novel role for 25% albumin as an anti-inflammatory agent in neutrophil-mediated diseases, such as acute respiratory distress syndrome.
Authors:
Kinga A Powers; Andras Kapus; Rachel G Khadaroo; Ruijuan He; John C Marshall; Thomas F Lindsay; Ori D Rotstein
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  31     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-09-22     Completed Date:  2003-11-17     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2355-63     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University Health Network, Toronto, Canada.
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MeSH Terms
Descriptor/Qualifier:
Albumins / pharmacology*
Analysis of Variance
Animals
Base Sequence
Blotting, Northern
Bronchoalveolar Lavage Fluid / chemistry
Disease Models, Animal
Dose-Response Relationship, Drug
Male
Molecular Sequence Data
Oxidative Stress
Polymerase Chain Reaction
Rats
Rats, Sprague-Dawley
Respiratory Distress Syndrome, Adult / mortality,  prevention & control*
Resuscitation / methods*
Sensitivity and Specificity
Shock, Hemorrhagic / mortality,  therapy*
Chemical
Reg. No./Substance:
0/Albumins

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


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