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See W, Morin C, Sage M, Stowe S, Gohier C, Nault S, Micheau P, Adler A, Fortin-Pellerin É. Air distribution within the lungs after total liquid ventilation in a neonatal ovine model. Respir Physiol Neurobiol 2021; 290:103666. [PMID: 33798788 DOI: 10.1016/j.resp.2021.103666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To gain insight into the total and regional lung aeration dynamics at the transition from total liquid ventilation (TLV) to conventional mechanical ventilation (GV). METHODS Neonatal lambs received either TLV for 4 h followed by GV (n = 15) or GV only (n = 11, controls). Monitoring was performed in the prone position with both videofluoroscopy and electrical impedance tomography (EIT) for the first 10 min of the transition. RESULTS Total and regional end-expiratory lung volumes were stable throughout the transition (p < 0.05). The percentage of tidal volume, liquid and/or gaseous, distributed to the different regions was stable (p < 0.05). Radiopacity of the nondependent regions markedly decreased at end-expiration (p < 0.01), reflecting the progressive transition to a gaseous end-expiratory lung volume. CONCLUSION Weaning to GV did not increase total or regional lung volumes, suggesting that the risk of overdistention was not increased. Residual perfluorocarbon in the dependent lung regions might account for the high O2 needs we observed in the first minutes of GV after TLV.
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Affiliation(s)
- Wendy See
- Department of Pharmacology-Physiology, Université de Sherbrooke, 3001, 12(e)Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada.
| | - Christophe Morin
- Department of Pharmacology-Physiology, Université de Sherbrooke, 3001, 12(e)Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada.
| | - Michaël Sage
- Department of Pharmacology-Physiology, Université de Sherbrooke, 3001, 12(e)Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada.
| | - Symon Stowe
- Department of Computer Engineering, Carleton University, 1125 Colonel By Dr, Ottawa, K1S 5B6, ON, Canada.
| | - Catherine Gohier
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke. 3001, 12(e)Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada.
| | - Stéphanie Nault
- Department of Pharmacology-Physiology, Université de Sherbrooke, 3001, 12(e)Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada.
| | - Philippe Micheau
- Department of Mechanical Engineering, Université de Sherbrooke. 2500 Boulevard de l'Université, Sherbrooke, QC, J1K 2R1, Canada.
| | - Andy Adler
- Department of Computer Engineering, Carleton University, 1125 Colonel By Dr, Ottawa, K1S 5B6, ON, Canada.
| | - Étienne Fortin-Pellerin
- Department of Pharmacology-Physiology, Université de Sherbrooke, 3001, 12(e)Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada; Department of Pediatrics, Université de Sherbrooke. 3001, 12(e)Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada.
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Klinkhamhom A, Glaharn S, Srisook C, Ampawong S, Krudsood S, Ward SA, Viriyavejakul P. M1 macrophage features in severe Plasmodium falciparum malaria patients with pulmonary oedema. Malar J 2020; 19:182. [PMID: 32414377 PMCID: PMC7226720 DOI: 10.1186/s12936-020-03254-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/08/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pulmonary oedema (PE) is a serious complication of Plasmodium falciparum malaria which can lead to acute lung injury in severe cases. Lung macrophages are activated during malaria infection due to a complex host-immune response. The molecular basis for macrophage polarization is still unclear but understanding the predominant subtypes could lead to new therapeutic strategies where the diseases present with lung involvement. The present study was designed to study the polarization of lung macrophages, as M1 or M2 macrophages, in the lungs of severe P. falciparum malaria patients, with and without evidence of PE. METHODS Lung tissue samples, taken from patients who died from severe P. falciparum malaria, were categorized into severe malaria with PE and without PE (non-PE). Expression of surface markers (CD68+, all macrophages; CD40+, M1 macrophage; and CD163+, M2 macrophage) on activated lung macrophages was used to quantify M1/M2 macrophage subtypes. RESULTS Lung injury was demonstrated in malaria patients with PE. The expression of CD40 (M1 macrophage) was prominent in the group of severe P. falciparum malaria patients with PE (63.44 ± 1.98%), compared to non-PE group (53.22 ± 3.85%, p < 0.05), whereas there was no difference observed for CD163 (M2 macrophage) between PE and non-PE groups. CONCLUSIONS The study demonstrates M1 polarization in lung tissues from severe P. falciparum malaria infections with PE. Understanding the nature of macrophage characterization in malaria infection may provide new insights into therapeutic approaches that could be deployed to reduce lung damage in severe P. falciparum malaria.
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Affiliation(s)
- Aekkarin Klinkhamhom
- Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Supattra Glaharn
- Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Charit Srisook
- Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Sumate Ampawong
- Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Srivicha Krudsood
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Stephen A Ward
- Research Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Parnpen Viriyavejakul
- Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand.
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Spengler D, Rintz N, Krause MF. An Unsettled Promise: The Newborn Piglet Model of Neonatal Acute Respiratory Distress Syndrome (NARDS). Physiologic Data and Systematic Review. Front Physiol 2019; 10:1345. [PMID: 31736777 PMCID: PMC6831728 DOI: 10.3389/fphys.2019.01345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/10/2019] [Indexed: 12/12/2022] Open
Abstract
Despite great advances in mechanical ventilation and surfactant administration for the newborn infant with life-threatening respiratory failure no specific therapies are currently established to tackle major pro-inflammatory pathways. The susceptibility of the newborn infant with neonatal acute respiratory distress syndrome (NARDS) to exogenous surfactant is linked with a suppression of most of the immunologic responses by the innate immune system, however, additional corticosteroids applied in any severe pediatric lung disease with inflammatory background do not reduce morbidity or mortality and may even cause harm. Thus, the neonatal piglet model of acute lung injury serves as an excellent model to study respiratory failure and is the preferred animal model for reasons of availability, body size, similarities of porcine and human lung, robustness, and costs. In addition, similarities to the human toll-like receptor 4, the existence of intraalveolar macrophages, the sensitivity to lipopolysaccharide, and the production of nitric oxide make the piglet indispensable in anti-inflammatory research. Here we present the physiologic and immunologic data of newborn piglets from three trials involving acute lung injury secondary to repeated airway lavage (and others), mechanical ventilation, and a specific anti-inflammatory intervention via the intratracheal route using surfactant as a carrier substance. The physiologic data from many organ systems of the newborn piglet—but with preference on the lung—are presented here differentiating between baseline data from the uninjured piglet, the impact of acute lung injury on various parameters (24 h), and the follow up data after 72 h of mechanical ventilation. Data from the control group and the intervention groups are listed separately or combined. A systematic review of the newborn piglet meconium aspiration model and the repeated airway lavage model is finally presented. While many studies assessed lung injury scores, leukocyte infiltration, and protein/cytokine concentrations in bronchoalveolar fluid, a systematic approach to tackle major upstream pro-inflammatory pathways of the innate immune system is still in the fledgling stages. For the sake of newborn infants with life-threatening NARDS the newborn piglet model still is an unsettled promise offering many options to conquer neonatal physiology/immunology and to establish potent treatment modalities.
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Affiliation(s)
- Dietmar Spengler
- Department of Pediatrics, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Nele Rintz
- Department of Pediatrics, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Martin F Krause
- Department of Pediatrics, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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Ozdinc S, Oz G, Ozdemir C, Kilic I, Karakaya Z, Bal A, Koken T, Solak O. Melatonin: is it an effective antioxidant for pulmonary contusion? J Surg Res 2016; 204:445-451. [DOI: 10.1016/j.jss.2016.05.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/31/2016] [Accepted: 05/11/2016] [Indexed: 12/21/2022]
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Yao Y, Liu X, Liu T, Zhou J, Zhu J, Sun G, He D. Preparation of inclusion complex of perfluorocarbon compound with β-cyclodextrin for ultrasound contrast agent. RSC Adv 2015. [DOI: 10.1039/c4ra12205d] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A novel FC-77/β-CD inclusion complex was prepared and used as a ultrasound imaging contract to enhance the ultrasonic echo signal.
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Affiliation(s)
- Yanjie Yao
- School of Materials Science and Engineering
- Shanghai Jiao Tong University
- Shanghai 200240
- P. R. China
| | - Xunwei Liu
- Department of Medical Imaging
- Jinan Military General Hospital
- Jinan
- P. R. China
| | - Tian Liu
- School of Materials Science and Engineering
- Shanghai Jiao Tong University
- Shanghai 200240
- P. R. China
| | - Juan Zhou
- National Engineering Research Center for Nanotechnology
- Shanghai 200241
- P. R. China
| | - Jun Zhu
- National Engineering Research Center for Nanotechnology
- Shanghai 200241
- P. R. China
| | - Gang Sun
- Department of Medical Imaging
- Jinan Military General Hospital
- Jinan
- P. R. China
| | - Dannong He
- School of Materials Science and Engineering
- Shanghai Jiao Tong University
- Shanghai 200240
- P. R. China
- National Engineering Research Center for Nanotechnology
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Orizondo RA, Babcock CI, Fabiilli ML, Pavlovsky L, Fowlkes JB, Younger JG, Cook KE. Characterization of a reverse-phase perfluorocarbon emulsion for the pulmonary delivery of tobramycin. J Aerosol Med Pulm Drug Deliv 2014; 27:392-9. [PMID: 24476046 DOI: 10.1089/jamp.2013.1058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Aerosolized delivery of antibiotics is hindered by poor penetration within distal and plugged airways. Antibacterial perfluorocarbon ventilation (APV) is a proposed solution in which the lungs are partially or totally filled with perfluorocarbon (PFC) containing emulsified antibiotics. The purpose of this study was to evaluate emulsion stability and rheological, antibacterial, and pharmacokinetic characteristics. METHODS This study examined emulsion aqueous droplet diameter and number density over 24 hr and emulsion and neat PFC viscosity and surface tension. Additionally, Pseudomonas aeruginosa biofilm growth was measured after 2-hr exposure to emulsion with variable aqueous volume percentages (0.25, 1, and 2.5%) and aqueous tobramycin concentrations (Ca=0.4, 4, and 40 mg/mL). Lastly, the time course of serum and pulmonary tobramycin concentrations was evaluated following APV and conventional aerosolized delivery of tobramycin in rats. RESULTS The initial aqueous droplet diameter averaged 1.9±0.2 μm with little change over time. Initial aqueous droplet number density averaged 3.5±1.7×10(9) droplets/mL with a significant (p<0.01) decrease over time. Emulsion and PFC viscosity were not significantly different, averaging 1.22±0.03×10(-3) Pa·sec. The surface tensions of PFC and emulsion were 15.0±0.1×10(-3) and 14.6±0.6×10(-3) N/m, respectively, and the aqueous interfacial tensions were 46.7±0.3×10(-3) and 26.9±11.0×10(-3) N/m (p<0.01), respectively. Biofilm growth decreased markedly with increasing Ca and, to a lesser extent, aqueous volume percentage. Tobramycin delivered via APV yielded 2.5 and 10 times larger pulmonary concentrations at 1 and 4 hr post delivery, respectively, and significantly (p<0.05) lower serum concentrations compared with aerosolized delivery. CONCLUSIONS The emulsion is bactericidal, retains the rheology necessary for pulmonary delivery, is sufficiently stable for this application, and results in increased pulmonary retention of the antibiotic.
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Affiliation(s)
- Ryan A Orizondo
- 1 Department of Biomedical Engineering, University of Michigan , Ann Arbor, MI
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Yang CF, Jeng MJ, Soong WJ, Lee YS, Tsao PC, Tang RB. Acute pathophysiological effects of intratracheal instillation of budesonide and exogenous surfactant in a neonatal surfactant-depleted piglet model. Pediatr Neonatol 2010; 51:219-226. [PMID: 20713286 DOI: 10.1016/s1875-9572(10)60042-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 10/28/2009] [Accepted: 11/16/2009] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chronic lung disease continues to be a major complication in premature infants with severe respiratory distress syndrome (RDS). This is despite having advanced ventilatory care, prenatal corticosteroids, and postnatal surfactant therapies. The combined use of intratracheal corticosteroids and surfactant may not only recruit the lungs, but also alleviate pulmonary inflammation in severe RDS. METHODS Fifteen newborn piglets received repeated pulmonary saline lavage to induce surfactant-depleted lungs, mimicking neonatal RDS. They were randomly divided into three groups: control group receiving no treatment; surfactant (Surf) group, treated with standard intratracheally instilled surfactant (100 mg/kg); and Budesonide plus surfactant (Bude + Surf) group, treated with intratracheally administered mixed suspension of budesonide (0.5 mg/kg) and surfactant (100 mg/kg). Blood samples were taken every 30 minutes for 4 hours. Lung tissue was examined after the experiment. RESULTS Significantly better oxygenation with higher PaO(2) and alveolar-arterial oxygen difference was noted in the Surf and Bude + Surf groups, compared with the control group (p < 0.05), but there were no significant differences between the Surf and Bude + Surf groups. Pulmonary histologic damage was also markedly alleviated in both the Surf and Bude + Surf groups, compared with the control group, and lung injury scores were significantly decreased in the Surf and Bude + Surf groups, compared with the control group (p < 0.05). CONCLUSIONS Intratracheal instillation of surfactant or surfactant plus budesonide can improve oxygenation and pulmonary histologic outcome in neonatal surfactant-depleted lungs. The additional use of budesonide does not disturb the function of the exogenous surfactant. Intratracheal administration of a corticosteroid combined with surfactant may be an effective method for alleviating local pulmonary inflammation in severe RDS.
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Affiliation(s)
- Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Jy Jeng
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Wen-Jue Soong
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Sheng Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pen-Chen Tsao
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ren-Bin Tang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
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Chang LP, Lai YS, Wu CJ, Chou TC. Liquid perfluorochemical inhibits inducible nitric oxide synthase expression and nitric oxide formation in lipopolysaccharide-treated RAW 264.7 macrophages. J Pharmacol Sci 2010; 111:147-54. [PMID: 19834286 DOI: 10.1254/jphs.09043fp] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Partial liquid ventilation with various types of perfluorocarbon (PFC) has been shown to be beneficial in treating acute lung injury, a clinical outcome that may involve the anti-inflammatory activity of PFC. FC-77 is a type of PFC with relatively higher vapor pressure and evaporative loss than other PFCs during partial liquid ventilation. Overproduction of nitric oxide (NO) by inducible nitric oxide synthase (iNOS) has been proposed to play a crucial role in the pathogenesis of inflammatory diseases. However, whether the iNOS/NO pathway is affected by FC-77 is unknown. Thus, the aim of this study was to investigate whether FC-77 inhibits iNOS expression and NO production in lipopolysaccharide (LPS)-treated RAW 264.7 macrophages. We found that treatment with FC-77 significantly attenuated LPS-induced iNOS expression/activity and production of NO and reactive oxygen species (ROS). FC-77 also attenuated LPS-induced pro-inflammatory cytokine formation, but enhanced interleukin-10 production. Furthermore, the LPS-induced degradation of cytosolic IkappaB-alpha and activation of nuclear transcription factor-kappaB (NF-kappaB) were also inhibited by FC-77. In conclusion, the present study is the first to demonstrate that FC-77 decreases LPS-induced NO production in macrophages, which may be associated with the suppression of pro-inflammatory cytokines, and ROS production, as well as NF-kappaB activation. These results also provide a novel explanation for its anti-inflammatory activity.
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Affiliation(s)
- Li-Ping Chang
- Department of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
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Jeng MJ, Yang SS, Hwang B, Wolfson MR, Shaffer TH. Effects of perfluorochemical evaporative properties on oxygenation during partial liquid ventilation. Pediatr Int 2006; 48:608-15. [PMID: 17168983 DOI: 10.1111/j.1442-200x.2006.02287.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The physical-chemical properties of perfluorochemical (PFC) liquids have been shown to influence physiological and cellular responses during partial liquid ventilation (PLV). The aim of this study is to compare the relationship between patho-physiological endpoints and the physical properties of three PFC liquids used in treating acute lung injury. METHODS A total of 18 juvenile rabbits were randomized into conventional mechanical ventilation or PLV groups after lung saline lavages. Three PFC liquids, including Flutec perfluoro-1,3,5-trimethylcyclohexane (PP4; vapor pressure, 28.8 mmHg at 37 degrees C), Perfluorodecalin (PFD; vapor pressure, 13.6 mmHg at 37 degrees C), and Perflubron (PFB; vapor pressure, 10.4 mmHg at 37 degrees C) were used for PLV with no replacement for 4 h. A thermal detector was used to measure PFC loss rate. Physiological measurements and evaporative loss rate of PFC were done every 30 min, and lung histology was examined. RESULTS The mean evaporative loss rate was significantly higher in the PP4 group (4.75 +/- 0.24 mL/kg per h) than in either the PFD (1.43 +/- 0.11 mL/kg per h) or the PFB (1.18 +/- 0.05 mL/kg per h) group (P < 0.05). The oxygenation of PFD and PFB was maintained good for 4 h, however, the PP4 group showed a fast deterioration since 2 h post-treatment due to fast dropping of the residual PP4 amount in lungs. Histology showed good alveolar integrity in the PFD and PFB groups. CONCLUSIONS The effects of PLV are directly influenced by the evaporative property of the PFC liquid. With no replacement over 4 h, PLV effects could be maintained with utilizing a PFC liquid with low, rather than high, vapor pressure. PFC with high vapor pressure has a high loss rate and low residual volume that causes poor maintenance on oxygenation during PLV. Therefore, measuring PFC loss rate is important in future studies and clinical application of PLV.
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Affiliation(s)
- Mei-Jy Jeng
- Department of Pediatrics, Taipei Veterans General Hospital, Taichung, Taiwan.
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Jeng MJ, Soong WJ, Lee YS, Chang HL, Shen CM, Wang CH, Yang SS, Hwang B. Effects of therapeutic bronchoalveolar lavage and partial liquid ventilation on meconium-aspirated newborn piglets. Crit Care Med 2006; 34:1099-105. [PMID: 16484898 DOI: 10.1097/01.ccm.0000205662.60832.35] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the therapeutic effects of bronchoalveolar lavage (BAL) with either diluted surfactant (SBAL) or perfluorochemical liquid (PBAL), followed by either conventional mechanical ventilation (CMV) or partial liquid ventilation (PLV), on lung injury and proinflammatory cytokine production induced by meconium aspiration in newborn piglets. DESIGN A prospective, randomized, experimental study. SETTING An animal research laboratory at a medical center. SUBJECTS Anesthetized and mechanically ventilated newborn piglets (n = 27). INTERVENTIONS The animals were instilled with 3-5 mL/kg 25% human meconium via an endotracheal tube to induce meconium aspiration syndrome (MAS). After stabilization, animals were randomly assigned to either CMV group (no BAL) or one of the treatment groups (SBAL-CMV, SBAL-PLV, PBAL-CMV, and PBAL-PLV). MEASUREMENTS AND MAIN RESULTS Cardiopulmonary variables were monitored, and interleukin-1beta and interleukin-6 content of the serum and lung tissue was measured. The animals without any treatment (CMV group) displayed the worst outcome; the animals in the PBAL-PLV group had the best gas exchange, lung compliance, and least pulmonary damage; and the SBAL-CMV, PBAL-CMV, and SBAL-PLV groups had intermediate effects. The serum interleukin-1beta concentration of the CMV group was significantly higher than all other groups over time (p < .05), and interleukin-6 concentration was significantly higher than the PBAL-PLV group (p < .05). The tissue interleukin-1beta and interleukin-6 contents were also highest in the CMV group and lowest in the PBAL-PLV group. CONCLUSIONS Initial therapeutic BAL and therapeutic BAL followed by PLV with the same perfluorochemical liquid provided significant therapeutic effects in treating an animal model with severe MAS and therefore warrant consideration in cases that are intractable to other therapies.
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Affiliation(s)
- Mei-Jy Jeng
- School of Medicine, National Yang-Ming University, Taipei Taiwan.
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Chang H, Kuo FC, Lai YS, Chou TC. Inhibition of inflammatory responses by FC-77, a perfluorochemical, in lipopolysaccharide-treated RAW 264.7 macrophages. Intensive Care Med 2005; 31:977-84. [PMID: 15931525 DOI: 10.1007/s00134-005-2652-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2004] [Accepted: 04/13/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study tested whether FC-77, a perfluorochemical, inhibits inflammatory responses in lipopolysaccharide (LPS) stimulated RAW 264.7 macrophages. The possible anti-inflammatory mechanisms involved were also investigated. METHODS RAW 264.7 macrophages were simultaneously incubated with pure FC-77 at final volume of 10% or 30% (v/v) and LPS (1 microg/ml) for 12 or 24 h on a mechanical shaker. In some tests FC-77 was added after cells stimulated by LPS for 12 h. Then the levels of prostaglandin E2(PGE2), tumor necrosis factor alpha (TNF-alpha), and interleukins (IL)-1beta, -6), and -10 were measured in medium. Alterations in cyclooxygenase (COX) 2 expression and nuclear transcription factor (NF) kappaB activation in cells were also evaluated. RESULTS Pre- or posttreatment with FC-77 dose-dependently reduced the LPS-induced TNF-alpha, IL-1beta, and IL-6 formation and enhanced IL-10 production compared to LPS-stimulated alone cells. FC-77 also attenuated the LPS-induced PGE2 formation accompanied by suppressing COX-2 expression, the degradation of cytosolic inhibitor of kappaB-alpha and NF-kappaB activation. CONCLUSIONS FC-77 inhibits inflammatory responses in LPS-stimulated macrophages by a mechanism that involves the attenuation of NF-kappaB dependent induction of COX-2/PGE2 pathway and the pro- /anti-inflammatory cytokine ratio.
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Affiliation(s)
- Hung Chang
- Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan, R.O.C
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Su X, Bai C, Hong Q, Zhu D, He L, Wu J, Ding F, Fang X, Matthay MA. Effect of continuous hemofiltration on hemodynamics, lung inflammation and pulmonary edema in a canine model of acute lung injury. Intensive Care Med 2003; 29:2034-42. [PMID: 14557856 DOI: 10.1007/s00134-003-2017-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2003] [Accepted: 08/18/2003] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study examined whether continuous hemofiltration favorably affects cardiopulmonary variables, lung inflammation, and lung fluid balance in a canine model of oleic acid induced acute lung injury. METHODS Eleven pentobarbital-anesthetized dogs were randomly divided into a control (mechanical ventilation, MV) group (n=6) and a MV plus hemofiltration (HF) group (n=5). All animals received an intravenous injection of oleic acid (0.09 ml/kg) to induce acute lung injury. Continuous arterial-venous hemofiltration (blood flow 100 ml/min, ultrafiltration rate at 50-65 ml kg(-1) h(-1)) was started after establishment of oleic acid induced acute lung injury and continued for 4 h. Hemodynamics, lung mechanics, gas exchange, lung fluid balance, lung histology, and the level of plasma cytokines were assessed. RESULTS After 240 min of HF treatment there was a significant increase in cardiac output, reduction in pulmonary arterial pressure, and improvement in both oxygenation and lung mechanics. Also, in the HF group the lung wet-to-dry weight ratio was significantly reduced. Histologically, HF reduced edema and inflammatory cell infiltration in the lung. There was also a significantly greater decrease in plasma IL-6 and IL-8 levels in the HF group than in group receiving MV alone. CONCLUSIONS In a canine model of acute lung injury continuous HF improved cardiopulmonary function, reduced pulmonary edema, decreased lung permeability and inflammation, and decreased the plasma concentration of proinflammatory cytokines.
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Affiliation(s)
- Xiao Su
- Research Institute of Respiratory Diseases, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
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Schmalisch G, Schmidt M, Proquitté H, Foitzik B, Rüdiger M, Wauer RR. Measurement of changes in respiratory mechanics during partial liquid ventilation using jet pulses. Crit Care Med 2003; 31:1435-41. [PMID: 12771615 DOI: 10.1097/01.ccm.0000063041.94690.76] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the changes in respiratory mechanics within the breathing cycle in healthy lungs between gas ventilation and partial liquid ventilation using a special forced-oscillation technique. DESIGN Prospective animal trial. SETTINGS Animal laboratory in a university setting. SUBJECTS A total of 12 newborn piglets (age, <12 hrs; mean weight, 725 g). INTERVENTIONS After intubation and instrumentation, lung mechanics of the anesthetized piglets were measured by forced-oscillation technique at the end of inspiration and the end of expiration. The measurements were performed during gas ventilation and 80 mins after instillation of 30 mL/kg perfluorocarbon PF 5080. MEASUREMENTS AND MAIN RESULTS Brief flow pulses (width, 10 msec; peak flow, 16 L/min) were generated by a jet generator to measure the end-inspiratory and the end-expiratory respiratory input impedance in the frequency range of 4-32 Hz. The mechanical variables resistance, inertance, and compliance were determined by model fitting, using the method of least squares. At least in the lower frequency range, respiratory mechanics could be described adequately by an RIC single-compartment model in all piglets. During gas ventilation, the respiratory variables resistance and inertance did not differ significantly between end-inspiratory and end-expiratory measurements (mean [sd]: 4.2 [0.7] vs. 4.1 [0.6] kPa x L(-1) x sec, 30.0 [3.2] vs. 30.7 [3.1] Pa x L(-1) x sec2, respectively), whereas compliance decreased during inspiration from 14.8 (2.0) to 10.2 (2.4) mL x kPa(-1) x kg(-1) due to a slight lung overdistension. During partial liquid ventilation, the end-inspiratory respiratory mechanics was not different from the end-inspiratory respiratory mechanics measured during gas ventilation. However, in contrast to gas ventilation during partial liquid ventilation, compliance rose from 8.2 (1.0) to 13.0 (3.0) mL x kPa(-1) x kg(-1) during inspiration. During expiration, when perfluorocarbon came into the upper airways, both resistance and inertance increased considerably (mean with 95% confidence interval) by 34.3% (23.1%-45.8%) and 104.1% (96.0%-112.1%), respectively. CONCLUSIONS The changes in the respiratory mechanics within the breathing cycle are considerably higher during partial liquid ventilation compared with gas ventilation. This dependence of lung mechanics from the pulmonary gas volume hampers the comparability of dynamic measurements during partial liquid ventilation, and the magnitude of these changes cannot be detected by conventional respiratory-mechanical analysis using time-averaged variables.
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Affiliation(s)
- Gerd Schmalisch
- Clinic of Neonatology (Charité), Humboldt-University Berlin, Germany
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Jeng MJ, Kou YR, Sheu CC, Hwang B. Effects of exogenous surfactant supplementation and partial liquid ventilation on acute lung injury induced by wood smoke inhalation in newborn piglets. Crit Care Med 2003; 31:1166-74. [PMID: 12682489 DOI: 10.1097/01.ccm.0000059312.90697.32] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the beneficial effects of exogenous surfactant supplementation (ESS) and partial liquid ventilation (PLV) in treating acute lung injury induced by wood smoke inhalation. DESIGN A prospective, randomized, controlled, multigroup study. SETTING An animal research laboratory at a medical center. SUBJECTS Newborn piglets (n = 29; 1.80 +/- 0.06 kg) of either sex. INTERVENTIONS Animals were ventilated with a tidal volume of 15 mL/kg, a rate of 30 breaths/min, a positive end-expiratory pressure of 5 cm H(2)O, and an Fio(2) of 1.0. After the induction of acute lung injury by wood smoke inhalation, animals were randomly assigned to receive either conventional mechanical ventilation (CMV) or PLV with or without ESS pretreatment. Animals were grouped as CMV, ESS-CMV, PLV, and ESS-PLV. MEASUREMENTS AND MAIN RESULTS Arterial blood gases, cardiovascular hemodynamics, dynamic lung compliance, and total lung injury scores were measured. After smoke inhalation, all four groups displayed similar high arterial carboxyhemoglobin levels, low Pao(2) (<150 mm Hg), and low dynamic lung compliance (<66% of its baseline). In the CMV group, these deleterious conditions remained during the 4-hr observation period, and severe lung injury was noted histologically. All treatment groups demonstrated a significant increase in Pao(2) compared with the CMV group. In addition, both the PLV and ESS-PLV groups displayed significant improvements in dynamic lung compliance and in their histologic outcomes. Nevertheless, none of the variables measured in the PLV group differed from those measured in the ESS-PLV group. CONCLUSIONS In a newborn piglet model of smoke inhalation injury, PLV or ESS improved oxygenation. PLV compared favorably with ESS in its greater improvements in lung compliance and lung pathology. However, the combined therapy of ESS and PLV was not clearly superior to PLV alone during the observation period.
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Affiliation(s)
- Mei-Jy Jeng
- Institutes of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
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15
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Abstract
PURPOSE OF REVIEW Disorders of the pulmonary circulation might develop as a primary disease process of the pulmonary vascular bed or, more often, as the acute or chronic consequence of pulmonary or cardiac pathologies. For the anaesthesiologist and intensivist it is particularly interesting to gain insight into the regulation of the pulmonary circulation since pulmonary hypertension and concomitant right heart failure contribute to high perioperative mortality rates in patients at risk, especially after cardiac surgery. Therefore, modulation of the pulmonary circulation may be a life-saving therapy in patients suffering from acute or chronic pulmonary circulatory disorders. Furthermore, routinely performed intra-operative interventions such as the use of volatile anaesthetics or cardiopulmonary bypass systems may have relevant side effects on the pulmonary circulation. RECENT FINDINGS This review focuses on new insights into the modulation of pulmonary circulation during general anaesthesia with volatile anaesthetics and anaesthesiological management during cardiopulmonary surgery. Recent publications in the field of cardiopulmonary bypass surgery, one-lung ventilation and heart and lung transplantation are discussed. Furthermore, the role of conventional and experimental therapeutic strategies to modulate pulmonary circulation in intensive care medicine is reviewed. SUMMARY Despite the performance of a large number of clinical and experimental studies, the pathophysiology of pulmonary circulatory disorders is not completely understood. Therefore, any new therapy has to be carefully evaluated as a therapeutic option. Several formerly experimental therapeutic interventions such as inhaled vasodilators, however, appear to have found their way into clinical practice for selected indications.
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Affiliation(s)
- Rolf Dembinski
- Department of Anaesthesiology, University Hospital Aachen, Germany.
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Jeng MJ, Yang SS, Wolfson MR, Shaffer TH. Perfluorochemical (PFC) combinations for acute lung injury: an in vitro and in vivo study in juvenile rabbits. Pediatr Res 2003; 53:81-8. [PMID: 12508085 DOI: 10.1203/00006450-200301000-00015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Perfluorochemical (PFC) fluids of different physical properties were titrated and tested in vitro for physical properties that are appropriate for respiratory application. Two PFC liquids were studied: perfluoromethylcyclohexane (PP2), a liquid with high vapor pressure and low viscosity, and perfluoromethyldecalin (PP9), a fluid with low vapor pressure and high viscosity. Eighteen rabbits (2.05 +/- 0.07 kg; mean +/- SEM) were lung-lavaged and randomized: group I, control group; group II, partial liquid ventilation with 75% PP2 and 25% PP9; group III, partial liquid ventilation with 50% PP2 and 50% PP9; and group IV, partial liquid ventilation with 25% PP2 and 75% PP9. Ventilator volumes were kept constant during the 4-h experiment. Cardiopulmonary measurements were performed every 30 min. The lung histology was examined. The in vitro study showed PFC [viscosity/vapor pressure (in cS and mm Hg, respectively)] as follows: 100% PP2 (0.88/141); 100% PP9 (3.32/2.9); 75% PP2 and 25% PP9 (1.26/107); 50% PP2 and 50% PP9 (1.63/13.7); and 25% PP2 and 75% PP9 (2.21/4.4). The in vivo experiments found that combinations of moderate vapor pressure (groups 3 and 4) demonstrated good gas exchange, compliance, and histologic findings. Thus, combinations of PFC liquids can be formulated to modulate the physiologic outcome in acutely injured lungs, and may prove useful for alternative PFC liquid applications.
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Affiliation(s)
- Mei-Jy Jeng
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, and Department of Pediatrics, Children's Medical Center, Veterans General Hospital-Taipei, Taipei 112, Taiwan.
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