Document Detail


Ventilator-induced coagulopathy in experimental Streptococcus pneumoniae pneumonia.
MedLine Citation:
PMID:  18768578     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Pneumonia, the main cause of acute lung injury, is characterised by a local pro-inflammatory response and coagulopathy. Mechanical ventilation (MV) is often required. However, MV can lead to additional injury: so-called ventilator-induced lung injury (VILI). Therefore, the current authors investigated the effect of VILI on alveolar fibrin turnover in Streptococcus pneumoniae pneumonia. Pneumonia was induced in rats, followed 48 h later by either lung-protective MV (lower tidal volumes (LV(T)) and positive end-expiratory pressure (PEEP)) or MV causing VILI (high tidal volumes (HV(T)) and zero end-expiratory pressure (ZEEP)) for 3 h. Nonventilated pneumonia rats and healthy rats served as controls. Thrombin-antithrombin complexes (TATc), as a measure for coagulation, and plasminogen activator activity, as a measure of fibrinolysis, were determined in bronchoalveolar lavage fluid (BALF) and serum. Pneumonia was characterised by local (BALF) activation of coagulation, resulting in elevated TATc levels and attenuation of fibrinolysis compared with healthy controls. LV(T)-PEEP did not influence alveolar coagulation or fibrinolysis. HV(T)-ZEEP did intensify the local procoagulant response: TATc levels rose significantly and levels of the main inhibitor of fibrinolysis, plasminogen activator inhibitor-1, increased significantly. HV(T)-ZEEP also resulted in systemic elevation of TATc compared with LV(T)-PEEP. Mechanical ventilation causing ventilator-induced lung injury increases pulmonary coagulopathy in an animal model of Streptococcus pneumoniae pneumonia and results in systemic coagulopathy.
Authors:
J J Haitsma; M J Schultz; J-J H Hofstra; J W Kuiper; J Juco; R Vaschetto; M Levi; H Zhang; A S Slutsky
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-09-03
Journal Detail:
Title:  The European respiratory journal     Volume:  32     ISSN:  1399-3003     ISO Abbreviation:  Eur. Respir. J.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-01     Completed Date:  2009-05-08     Revised Date:  2013-05-23    
Medline Journal Info:
Nlm Unique ID:  8803460     Medline TA:  Eur Respir J     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  1599-606     Citation Subset:  IM    
Affiliation:
Interdepartmental Division of Critical Care Medicine, University of Toronto, Keenan Research Center, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond Street, Queen Wing 4-042, Toronto, ON, M5B 1W8 Canada. jack.haitsma@utoronto.ca
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MeSH Terms
Descriptor/Qualifier:
Animals
Antithrombins / chemistry
Blood Coagulation Disorders / complications,  diagnosis*
Bronchoalveolar Lavage Fluid
Disease Models, Animal
Fibrinolysis
Lipopolysaccharides / metabolism
Male
Pneumonia, Bacterial / complications,  therapy*
Pulmonary Gas Exchange
Rats
Rats, Sprague-Dawley
Streptococcus pneumoniae / metabolism*
Thrombin / chemistry
Ventilator-Induced Lung Injury / diagnosis*,  etiology
Chemical
Reg. No./Substance:
0/Antithrombins; 0/Lipopolysaccharides; EC 3.4.21.5/Thrombin

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