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Smeding L, Kuiper JW, Plötz FB, Kneyber MC, Groeneveld AJ. Aggravation of myocardial dysfunction by injurious mechanical ventilation in LPS-induced pneumonia in rats. Respir Res 2013; 14:92. [PMID: 24047433 PMCID: PMC3848739 DOI: 10.1186/1465-9921-14-92] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 09/09/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Mechanical ventilation (MV) may cause ventilator-induced lung injury (VILI) and may thereby contribute to fatal multiple organ failure. We tested the hypothesis that injurious MV of lipopolysaccharide (LPS) pre-injured lungs induces myocardial inflammation and further dysfunction ex vivo, through calcium (Ca2+)-dependent mechanism. MATERIALS AND METHODS N = 35 male anesthetized and paralyzed male Wistar rats were randomized to intratracheal instillation of 2 mg/kg LPS or nothing and subsequent MV with lung-protective settings (low tidal volume (Vt) of 6 mL/kg and 5 cmH2O positive end-expiratory pressure (PEEP)) or injurious ventilation (high Vt of 19 mL/kg and 1 cmH2O PEEP) for 4 hours. Myocardial function ex vivo was evaluated in a Langendorff setup and Ca2+ exposure. Key mediators were determined in lung and heart at the mRNA level. RESULTS Instillation of LPS and high Vt MV impaired gas exchange and, particularly when combined, increased pulmonary wet/dry ratio; heat shock protein (HSP)70 mRNA expression also increased by the interaction between LPS and high Vt MV. For the heart, C-X-C motif ligand (CXCL)1 and Toll-like receptor (TLR)2 mRNA expression increased, and ventricular (LV) systolic pressure, LV developed pressure, LV +dP/dtmax and contractile responses to increasing Ca2+ exposure ex vivo decreased by LPS. High Vt ventilation aggravated the effects of LPS on myocardial inflammation and dysfunction but not on Ca2+ responses. CONCLUSIONS Injurious MV by high Vt aggravates the effects of intratracheal instillation of LPS on myocardial dysfunction, possibly through enhancing myocardial inflammation via pulmonary release of HSP70 stimulating cardiac TLR2, not involving Ca2+ handling and sensitivity.
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Affiliation(s)
- Lonneke Smeding
- Institute for Cardiovascular Research ICaR-VU, VU University Medical Center, Amsterdam, Netherlands.
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Hoegl S, Bachmann M, Scheiermann P, Goren I, Hofstetter C, Pfeilschifter J, Zwissler B, Muhl H. Protective properties of inhaled IL-22 in a model of ventilator-induced lung injury. Am J Respir Cell Mol Biol 2011; 44:369-76. [PMID: 20463292 DOI: 10.1165/rcmb.2009-0440oc] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
High-pressure ventilation induces barotrauma and pulmonary inflammation, thus leading to ventilator-induced lung injury (VILI). IL-22 has both immunoregulatory and tissue-protective properties. Functional IL-22 receptor expression is restricted to nonleukocytic cells, such as alveolar epithelial cells. When applied via inhalation, IL-22 reaches the pulmonary system directly and in high concentrations, and may protect alveolar epithelial cells against cellular stress and biotrauma associated with VILI. In A549 lung epithelial cells, IL-22 was able to induce rapid signal transducer and activator of transcription (STAT)-3 phosphorylation/activation, and hereon mediated stable suppressor of cytokine signaling (SOCS) 3 expression detectable even 24 hours after onset of stimulation. In a rat model of VILI, the prophylactic inhalation of IL-22 before induction of VILI (peak airway pressure = 45 cm H(2)O) protected the lung against pulmonary disintegration and edema. IL-22 reduced VILI-associated biotrauma (i.e., pulmonary concentrations of macrophage inflammatory protein-2, IL-6, and matrix metalloproteinase 9) and mediated pulmonary STAT3/SOCS3 activation. In addition, despite a short observation period of 4 hours, inhaled IL-22 resulted in an improved survival of the rats. These data support the hypothesis that IL-22, likely via activation of STAT3 and downstream genes (e.g., SOCS3), is able to protect against cell stretch and pulmonary baro-/biotrauma by enhancing epithelial cell resistibility.
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Affiliation(s)
- Sandra Hoegl
- Clinic for Anesthesiology, University Hospital of Ludwig-Maximilians-University, Munich, Germany.
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Toll-like receptor 4 mediates neutrophil sequestration and lung injury induced by endotoxin and hyperinflation. Crit Care Med 2010; 38:194-201. [PMID: 19789446 DOI: 10.1097/ccm.0b013e3181bc7c17] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To address the role of Toll-like receptor 4 signaling in mediating neutrophil recruitment and lung injury induced by lipopolysaccharide challenge coupled to lung hyperinflation, using Toll-like receptor 4 knockout (tlr4) mice. Infiltration of polymorphonuclear neutrophils into the lung is an important feature of ventilator-induced lung injury associated with pneumonia, but the mechanisms involved in neutrophil recruitment are poorly understood. DESIGN Experimental animal model. SETTING University laboratory. SUBJECTS tlr4 and wild-type C57BL/6 mice. INTERVENTIONS Wild-type or tlr4 mice were challenged by intratracheal instillation of lipopolysaccharide (0.3 mg/kg) for 2 hrs and then subjected to normal (7 mL/kg) or high (28 mL/kg) tidal volume ventilation for another 2 hrs. In other studies, neutrophils from wild-type or tlr4 mice were pretreated with lipopolysaccharide for 30 mins and then infused into the isolated lung preparation for 30 mins as the lungs were ventilated with 25 cm H2O peak inspiratory pressure. MEASUREMENTS AND MAIN RESULTS Lipopolysaccharide-challenged wild-type mice ventilated with a 28 mL/kg tidal volume exhibited 12-fold increase in neutrophil sequestration, 6-fold increase in bronchoalveolar lavage albumin concentration, and 1.6-fold increase in lung water content compared with unchallenged mice exposed to normal tidal volume ventilation. However, tlr4 mice showed negligible neutrophil sequestration, microvascular barrier breakdown, or edema formation. Mechanical ventilation alone or combined with lipopolysaccharide caused activation of circulating neutrophils and pulmonary endothelium in wild-type mice, whereas this was prevented in tlr4 mice. CONCLUSIONS High tidal volume ventilation during pneumonia/sepsis induces lung neutrophil sequestration and injury via the Toll-like receptor 4-dependent signaling pathway. The results suggest an important role of Toll-like receptor 4 in the mechanism of lung neutrophil sequestration and acute lung injury when pneumonia/sepsis is coupled to lung hyperinflation.
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Chong E, Dysart KC, Chidekel A, Locke R, Shaffer TH, Miller TL. Heat shock protein 70 secretion by neonatal tracheal tissue during mechanical ventilation: association with indices of tissue function and modeling. Pediatr Res 2009; 65:387-91. [PMID: 19127221 PMCID: PMC2676716 DOI: 10.1203/pdr.0b013e31819913f5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Mechanical ventilation (MV) of the neonatal airway alters mechanical properties and activates tissue-modeling pathways. Heat shock protein (HSP70) is a marker of tissue injury and modulates inflammation, which may influence subsequent pulmonary tissue modeling by matrix metalloproteinases (MMPs). HSP70 secretion is up-regulated in MV airway tissues and associated with changes in airway elasticity and secretion of MMPs. Proximal tracheal segments were isolated in 13 newborn lambs and were either MV for 4 h or SHAM. At baseline and hourly, tracheal segments were flushed and tracheal elasticity was determined. Tracheal wash fluid was assayed for HSP70 by ELISA and for MMPs by substrate zymography. HSP70 secretion increased from baseline to a peak at 1 h in both groups (p < 0.01), greater in the MV group (p < 0.05), and returned to baseline values by 2 h. This response was in contrast to the progressive decrease in tracheal elasticity (p < 0.05). The HSP70 elevation pattern was noted in MMP-2, but beyond 1 h, MMP-2 returned to baseline values in MV group but remained elevated in SHAM (p < 0.05). HSP70 secretion is associated with the degree of biophysical tracheal injury as well as the time course of MMP-2 secretion by tracheal tissues.
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Affiliation(s)
- Euming Chong
- Department of Pediatrics, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
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Haitsma JJ, Lachmann B, Papadakos PJ. Additives in intravenous anesthesia modulate pulmonary inflammation in a model of LPS-induced respiratory distress. Acta Anaesthesiol Scand 2009; 53:176-82. [PMID: 19175577 DOI: 10.1111/j.1399-6576.2008.01844.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND It has been suggested that propofol with ethylenediaminetetraacetic acid (EDTA) can modulate the systemic inflammatory response. Prolonged higher levels of pulmonary inflammation are associated with poor outcome of patients with acute lung injury. In the present study, we hypothesized that pulmonary inflammation could be modulated by propofol with EDTA compared with propofol with sulfite. METHODS Respiratory distress was induced in rats (n=25) by intratracheal nebulization of lipopolysaccharide (LPS). After 24 h, animals were randomized to either propofol with EDTA (Propofol(EDTA)), propofol with sulfite (Propofol(sulfite)) or ketamine/midazolam (Ket/Mid); control animals received saline (n=30). Animals were ventilated for 4 h and blood gases were measured hourly. Bronchoalveolar lavage (BAL) was performed for cytokine analysis of: tumor necrosis factor (TNF), interleukin (IL)-6 and macrophage inflammatory protein (MIP)-2. RESULTS LPS led to increased pulmonary inflammation in all groups compared with the control groups. Gas exchange deteriorated over time only in the LPS Propofol(sulfite) group and was significantly lower than the Ket/Mid group. Only IL-6 was significantly higher in the LPS Propofol(sulfite) group compared with both the Ket/Mid group and the Propofol(EDTA) group. CONCLUSION Pulmonary IL-6 can be modulated by additives in systemic anesthesia. IMPLICATION STATEMENT This study demonstrates that pulmonary inflammation caused by direct lung injury can be modulated by intravenous anesthesia used in critically ill patients.
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Affiliation(s)
- J J Haitsma
- Departments of Anesthesiology, Surgery and Neurosurgery, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
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Inhaled IL-10 reduces biotrauma and mortality in a model of ventilator-induced lung injury. Respir Med 2008; 103:463-70. [PMID: 19006658 DOI: 10.1016/j.rmed.2008.09.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Revised: 09/08/2008] [Accepted: 09/15/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND High-pressure ventilation induces barotrauma and pulmonary inflammation, thus leading to ventilator-induced lung injury (VILI). By limiting the pulmonal inflammation cascade the anti-inflammatory cytokine interleukin (IL)-10 may have protective effects. Via inhalation, IL-10 reaches the pulmonary system directly and in high concentrations. METHODS Thirty six male, anesthetized and mechanically ventilated Sprague-Dawley rats were randomly assigned to the following groups (n=9, each): SHAM: pressure controlled ventilation with p(max)=20cmH(2)O, PEEP=4; VILI: ventilator settings were changed for 20min to p(max)=45cmH(2)O, PEEP=0; IL-10(high): inhalation of 10microg/kg IL-10 prior to induction of VILI; and IL-10(low): inhalation of 1microg/kg IL-10 prior to induction of VILI. All groups were ventilated and observed for 4h. RESULTS High-pressure ventilation increased the concentrations of macrophage inflammatory protein (MIP)-2 and IL-1beta in bronchoalveolar lavage fluid (BALF) and plasma. This effect was reduced by the inhalation of IL-10 (10microg/kg). Additionally, IL-10 increased the animal survival time (78% vs. 22% 4-h mortality rate) and reduced NO-release from ex vivo cultured alveolar macrophages. Moreover, VILI-induced pulmonary heat shock protein-70 expression was reduced by IL-10 aerosol in a dose-dependent manner. Similarly, the activation of matrix metalloproteinase (MMP)-9 in BALF was reduced dose-dependently by IL-10. IL-10-treated animals showed a lower macroscopic lung injury score and less impairment of lung integrity and gas exchange. CONCLUSIONS Prophylactic inhalation of IL-10 improved survival and reduced lung injury in experimental VILI. Results indicate that this effect may be mediated by the inhibition of stress-induced inflammation and pulmonary biotrauma.
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Kuiper JW, Versteilen AMG, Niessen HWM, Vaschetto RR, Sipkema P, Heijnen CJ, Groeneveld ABJ, Plötz FB. Production of endothelin-1 and reduced blood flow in the rat kidney during lung-injurious mechanical ventilation. Anesth Analg 2008; 107:1276-83. [PMID: 18806040 DOI: 10.1213/ane.0b013e31818067a2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The mechanisms by which mechanical ventilation (MV) can injure remote organs, such as the kidney, remain poorly understood. We hypothesized that upregulation of systemic inflammation, as reflected by plasma interleukin-6 (IL-6) levels, in response to a lung-injurious ventilatory strategy, ultimately results in kidney dysfunction mediated by local endothelin-1 (ET-1) production and renal vasoconstriction. METHODS Healthy, male Wistar rats were randomized to 1 of 2 MV settings (n=9 per group) and ventilated for 4 h. One group had a lung-protective setting using peak inspiratory pressure of 14 cm H2O and a positive end-expiratory pressure of 5 cm H2O; the other had a lung-injurious strategy using a peak inspiratory pressure of 20 cm H2O and positive end-expiratory pressure of 2 cm H2O. Nine randomly assigned rats served as nonventilated controls. We measured venous and arterial blood pressure and cardiac output (thermodilution method), renal blood flow (RBF) using fluorescent microspheres, and calculated creatinine clearance, urine flow, and fractional sodium excretion. Histological lung damage was assessed using hematoxylin-eosin staining. Renal ET-1 and plasma ET-1 and IL-6 concentrations were measured using enzyme-linked immunosorbent assays. RESULTS Lung injury scores were higher after lung-injurious MV than after lung-protective ventilation or in sham controls. Lung-injurious MV resulted in significant production of renal ET-1 compared with the lung-protective and control groups. Simultaneously, RBF in the lung-injurious MV group was approximately 40% lower (P<0.05) than in the control group and 28% lower (P<0.05) than in the lung-protective group. Plasma ET-1 and IL-6 levels did not differ among the groups and systemic hemodynamics, such as cardiac output, were comparable. There was no effect on creatinine clearance, fractional sodium excretion, urine output, or kidney histology. CONCLUSIONS Lung-injurious MV for 4 h in healthy rats results in significant production of renal ET-1 and in decreased RBF, independent of IL-6. Decreased RBF has no observable effect on kidney function or histology.
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Affiliation(s)
- Jan Willem Kuiper
- VU Medical Center, Department of Pediatric Intensive Care, P.O. Box 7057, 1007, Ambsterdam, The Netherlands
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Inflammatory consequences of lung ischemia-reperfusion injury and low-pressure ventilation. J Surg Res 2008; 153:295-301. [PMID: 18952232 DOI: 10.1016/j.jss.2008.04.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 04/09/2008] [Accepted: 04/11/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lung ischemia-reperfusion injury (LIRI) is a clinical problem observed during thoracic surgery, and adversely affects patient recovery. A better understanding of the mechanisms of LIRI could be helpful to develop new therapeutic strategies. The objective was to assess the inflammatory and apoptotic consequences of LIRI using an in vivo rat model. MATERIALS AND METHODS The left lung of Sprague-Dawley rats was subjected to ischemia for 120 min and reperfusion for up to 4 h. Ventilated controls underwent sham surgery and low-pressure mechanical ventilation for the above mentioned time points. Lung tissue was analyzed for histopathology and for the expression of inflammatory and apoptotic mediators. RESULTS Low-pressure ventilated controls showed a clear increase in myeloperoxidase activity, macrophage inflammatory protein-2, interleukin-6, and caspase-3 expression compared with naïve animals. However, LIRI animals showed faster kinetics of pulmonal myeloperoxidase activity and caspase-3 expression. Moreover, only LIRI animals showed increased inducible nitric oxide synthase and interleukin-6 expression and had a decreased interleukin-10 expression in the lung compared to ventilated controls. Furthermore, lungs of LIRI animals contained much more cellular infiltrates compared with ventilated controls. CONCLUSIONS Low-pressure mechanical ventilation induces an inflammatory response in the lung, but LIRI accelerates the kinetics of granulocyte infiltration and apoptosis. Moreover, LIRI skews the cytokine balance to a pro-inflammatory profile. Finally, LIRI deteriorates lung histology much more than ventilation only.
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Edelman DA, Jiang Y, Tyburski JG, Wilson RF, Steffes CP. Lipopolysaccharide up-regulates heat shock protein expression in rat lung pericytes. J Surg Res 2007; 140:171-6. [PMID: 17509261 DOI: 10.1016/j.jss.2006.12.560] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 11/30/2006] [Accepted: 12/26/2006] [Indexed: 11/15/2022]
Abstract
BACKGROUND Heat shock proteins (HSP) function as molecular chaperones, participating in protein folding and maturation throughout the cell. Serum HSPs may correlate with acute lung injury. Pericytes are perivascular cells located abluminally from endothelial cells, and play a regulatory role in capillary leak. It is our hypothesis that pericytes express HSP 60 and HSP 70, and these HSPs are up-regulated in response to lipopolysaccharide (LPS). METHODS Rat microvascular lung pericytes were isolated and cultured. Cells from passages three to five were used and treated with LPS (control, 10 ng/mL, and 100 ng/mL) for either 4 or 18 h. Immunoblotting and real-time PCR were used to analyze the presence and quantity of HSP 60 and HSP 70. RESULTS Immunoblotting revealed the presence of HSP 60 and HSP 70 in control pericytes. After 4 h of treatment with LPS (10 ng/mL and 100 ng/mL), no increase in protein expression of HSP 60 or HSP 70 was seen. However, after 18 h an increase in protein expression of HSP 60 and HSP 70 was seen. Real-time PCR demonstrated the presence of HSP 60 mRNA and HSP 70 mRNA in control pericytes. An increase in mRNA was seen after 18 h of LPS treatment, but not after 4 h. CONCLUSIONS This study provides the first in vitro evidence that rat lung pericytes express HSP 60 and HSP 70. HSP 60 and HSP 70 are up-regulated after 18 h of LPS exposure. Pericyte heat shock protein expression may contribute to the lung's response seen in sepsis.
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Affiliation(s)
- David A Edelman
- Wayne State University, Detroit Medical Center, Detroit, Michigan, USA
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Nonas SA, Moreno-Vinasco L, Vinasco LM, Ma SF, Jacobson JR, Desai AA, Dudek SM, Flores C, Hassoun PM, Sam L, Ye SQ, Moitra J, Barnard J, Grigoryev DN, Lussier YA, Garcia JGN. Use of consomic rats for genomic insights into ventilator-associated lung injury. Am J Physiol Lung Cell Mol Physiol 2007; 293:L292-302. [PMID: 17468131 PMCID: PMC3616407 DOI: 10.1152/ajplung.00481.2006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Increasing evidence supports the contribution of genetic influences on susceptibility/severity in acute lung injury (ALI), a devastating syndrome requiring mechanical ventilation with subsequent risk for ventilator-associated lung injury (VALI). To identify VALI candidate genes, we determined that Brown Norway (BN) and Dahl salt-sensitive (SS) rat strains were differentially sensitive to VALI (tidal volume of 20 ml/kg, 85 breaths/min, 2 h) defined by bronchoalveolar lavage (BAL) protein and leukocytes. We next exploited differential sensitivities and phenotyped both the VALI-sensitive BN and the VALI-resistant SS rat strains by expression profiling coupled to a bioinformatic-intense candidate gene approach (Significance Analysis of Microarrays, i.e., SAM). We identified 106 differentially expressed VALI genes representing gene ontologies such as "transcription" and "chemotaxis/cell motility." We mapped the chromosomal location of the differentially expressed probe sets and selected consomic SS rats with single BN introgressions of chromosomes 2, 13, and 16 (based on the highest density of probe sets) while also choosing chromosome 20 (low probe sets density). VALI exposure of consomic rats with introgressions of BN chromosomes 13 and 16 resulted in significant increases in both BAL cells and protein (compared to parental SS strain), whereas introgression of BN chromosome 2 displayed a large increase only in BAL protein. Introgression of BN chromosome 20 had a minimal effect. These results suggest that genes residing on BN chromosomes 2, 13, and 16 confer increased sensitivity to high tidal volume ventilation. We speculate that the consomic-microarray-SAM approach is a time- and resource-efficient tool for the genetic dissection of complex diseases including VALI.
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Affiliation(s)
- Stephanie A Nonas
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Abstract
Acute respiratory failure is manifested clinically as a patient with variable degrees of respiratory distress, but characteristically an abnormal arterial blood partial pressure of oxygen or carbon dioxide. The application of mechanical ventilation in this setting can be life-saving. An emerging body of clinical and basic research, however, has highlighted the potential adverse effects of positive pressure ventilation. Clinicians involved with the care of critically ill patients must recognize and seek to prevent these complications using lung-protective ventilation strategies. This article discusses the basic concepts of mechanical ventilation, reviews the categories of ventilator-associated lung injury, and discusses current strategies for the recognition and prevention of these adverse effects in the application of mechanical ventilation.
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Affiliation(s)
- Michael Donahoe
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, 628 NW, Pittsburgh, PA 15213, USA.
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Frank JA, Parsons PE, Matthay MA. Pathogenetic significance of biological markers of ventilator-associated lung injury in experimental and clinical studies. Chest 2007; 130:1906-14. [PMID: 17167015 PMCID: PMC2764530 DOI: 10.1378/chest.130.6.1906] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
For patients with acute lung injury, positive pressure mechanical ventilation is life saving. However, considerable experimental and clinical data have demonstrated that how clinicians set the tidal volume, positive end-expiratory pressure, and plateau airway pressure influences lung injury severity and patient outcomes including mortality. In order to better identify ventilator-associated lung injury (VALI), clinical investigators have sought to measure blood-borne and airspace biological markers of VALI. At the same time, several laboratory-based studies have focused on biological markers of inflammation and organ injury in experimental models in order to clarify the mechanisms of ventilator-induced lung injury (VILI) and VALI. This review summarizes data on biological markers of VALI and VILI from both clinical and experimental studies with an emphasis on markers identified in patients and in the experimental setting. This analysis suggests that measurement of some of these biological markers may be of value in diagnosing VALI and in understanding its pathogenesis.
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Affiliation(s)
- James A Frank
- Division of Pulmonary and Critical Care Medicine, University of California-San Francisco, 4150 Clement Street, Mail Stop 111D, San Francisco, CA 94121, USA.
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Garcia JGN, Moreno Vinasco L. Genomic insights into acute inflammatory lung injury. Am J Physiol Lung Cell Mol Physiol 2006; 291:L1113-7. [PMID: 16877634 DOI: 10.1152/ajplung.00266.2006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acute lung injury (ALI) is a devastating syndrome (usually associated with sepsis) that represents a major healthcare burden in the United States. We have focused our studies on unraveling the genetic underpinnings of this syndrome utilizing a candidate gene approach to identify novel genes for ALI susceptibility. Two novel genes identified by this approach include pre-B cell colony-enhancing factor (PBEF) and the gene for myosin light chain kinase (MLCK). PBEF protein levels were elevated in human bronchoalveolar lavage and serum samples from patients with ALI, and DNA sequencing identified two single nucleotide polymorphisms in the PBEF promoter (T-1001G, C-1543T) that were overrepresented in patients with sepsis-induced ALI. More recently, we found MLCK single polymorphisms and haplotypes to be associated with human ALI with unique variants observed in African-Americans with ALI. Thus genomic and genetic approaches represent powerful strategies in the identification of novel candidate genes and potential targets for ALI therapies.
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Affiliation(s)
- Joe G N Garcia
- Pulmonary and Critical Care Medicine, Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
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Vreugdenhil HA, Lachmann B, Haitsma JJ, Zijlstra J, Heijnen CJ, Jansen NJ, van Vught AJ. Exogenous surfactant restores lung function but not peripheral immunosuppression in ventilated surfactant-deficient rats. Exp Lung Res 2006; 32:1-14. [PMID: 16809217 DOI: 10.1080/01902140600575006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The authors have previously shown that mechanical ventilation can result in increased pulmonary inflammation and suppressed peripheral leukocyte function. In the present study the effect of surfactant therapy on pulmonary inflammation and peripheral immune function in ventilated surfactant-deficient rats was assessed. Surfactant deficiency was induced by repeated lung lavage, treated rats with surfactant or left them untreated, and ventilated the rats during 2 hours. Nonventilated rats served as healthy control group. Expression of macrophage inflammatory protein (MIP)-2 was measured in bronchoalveolar lavage (BAL), interleukin (IL)-1beta, and heat shock protein 70 (HSP70) were measured in total lung homogenates. Outside the lung phytohemagglutinin (PHA)-induced lymphocyte proliferation, interferon (IFN)-gamma and IL-10 production, and natural killer activity were measured in splenocytes. After 2 hours of mechanical ventilation, expression of MIP-2, IL-1beta, and HSP70 increased significantly in the lungs of surfactant-deficient rats. Outside the lung, mitogen-induced proliferation and production of IFN-gamma and IL-10 reduced significantly. Only natural killer cell activity remained unaffected. Surfactant treatment significantly improved lung function, but could not prevent increased pulmonary expression of MIP-2, IL-1beta, and HSP70 and decreased peripheral mitogen-induced lymphocyte proliferation and IFN-gamma and IL-10 production in vitro. In conclusion, 2 hours of mechanical ventilation resulted in increased lung inflammation and partial peripheral leukocyte suppression in surfactant-deficient rats. Surfactant therapy ameliorated lung function but could not prevent or restore peripheral immunosuppression. The authors postulate that peripheral immunosuppression may occur in ventilated surfactant deficient patients, which may enhance susceptibility for infections.
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Affiliation(s)
- Harriet A Vreugdenhil
- Pediatric Intensive Care Unit, and Laboratory for Psycho-Neuroimmunology, University Medical Center Utrecht, Utrecht, The Netherlands
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Crimi E, Zhang H, Han RNN, Del Sorbo L, Ranieri VM, Slutsky AS. Ischemia and Reperfusion Increases Susceptibility to Ventilator-induced Lung Injury in Rats. Am J Respir Crit Care Med 2006; 174:178-86. [PMID: 16645175 DOI: 10.1164/rccm.200507-1178oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Hemorrhagic shock followed by resuscitation (HSR) commonly triggers an inflammatory response that leads to acute respiratory distress syndrome. HYPOTHESIS HSR exacerbates mechanical stress-induced lung injury by rendering the lung more susceptible to ventilator-induced lung injury. METHODS Rats were subjected to HSR, and were randomized into an HSR + high tidal volume and zero positive end-expiratory pressure (PEEP) or a HSR + low tidal volume with 5 cm H(2)O PEEP. A sham-operated rat + high tidal volume and zero PEEP served as a control. RESULTS HSR increased susceptibility to ventilator-induced lung injury as evidenced by an increase in lung elastance and the wet/dry ratio and a reduction in Pa(O(2)) as compared with the other groups. The lung injury observed in the HSR + high tidal volume group was associated with a higher level of interleukin 6 in the lung and blood, increased epithelial cell apoptosis in the kidney and small intestine villi, and a tendency toward high levels of alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and creatinine in plasma. CONCLUSIONS HSR priming renders the lung and kidney more susceptible to mechanical ventilation-induced organ injury.
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Affiliation(s)
- Ettore Crimi
- Division of Respiratory Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Simon BA, Easley RB, Grigoryev DN, Ma SF, Ye SQ, Lavoie T, Tuder RM, Garcia JGN. Microarray analysis of regional cellular responses to local mechanical stress in acute lung injury. Am J Physiol Lung Cell Mol Physiol 2006; 291:L851-61. [PMID: 16782753 DOI: 10.1152/ajplung.00463.2005] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Human acute lung injury is characterized by heterogeneous tissue involvement, leading to the potential for extremes of mechanical stress and tissue injury when mechanical ventilation, required to support critically ill patients, is employed. Our goal was to establish whether regional cellular responses to these disparate local mechanical conditions could be determined as a novel approach toward understanding the mechanism of development of ventilator-associated lung injury. We utilized cross-species genomic microarrays in a unilateral model of ventilator-associated lung injury in anesthetized dogs to assess regional cellular responses to local mechanical conditions that potentially contribute pathogenic mechanisms of injury. Highly significant regional differences in gene expression were observed between lung apex/base regions as well as between gravitationally dependent/nondependent regions of the base, with 367 and 1,544 genes differentially regulated between these regions, respectively. Major functional groupings of differentially regulated genes included inflammation and immune responses, cell proliferation, adhesion, signaling, and apoptosis. Expression of genes encoding both acute lung injury-associated inflammatory cytokines and protective acute response genes were markedly different in the nondependent compared with the dependent regions of the lung base. We conclude that there are significant differences in the local responses to stress within the lung, and consequently, insights into the cellular responses that contribute to ventilator-associated lung injury development must be sought in the context of the mechanical heterogeneity that characterizes this syndrome.
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Affiliation(s)
- Brett A Simon
- Department of Anesthesiology and Critical Medicine, Tower 711, Johns Hopkins Hospital, Baltimore, MD 21287-8711, USA.
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van den Tweel ERW, Kavelaars A, Lombardi MS, Nijboer CHA, Groenendaal F, van Bel F, Heijnen CJ. Bilateral molecular changes in a neonatal rat model of unilateral hypoxic-ischemic brain damage. Pediatr Res 2006; 59:434-9. [PMID: 16492985 DOI: 10.1203/01.pdr.0000200799.64038.19] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Perinatal hypoxia ischemia (HI) is a frequent cause of neonatal brain injury. This study aimed at describing molecular changes during the first 48 h after exposure of the neonatal rat brain to HI. Twelve-day-old rats were subjected to unilateral carotid artery occlusion and 90 min of 8% O2, leading to neuronal damage in the ipsilateral hemisphere only. Phosphorylated-Akt levels were decreased from 0.5 to 6 h post-HI, whereas the level of phosphorylated extracellular signal-related kinases (ERK)1/2 increased during this time frame. Hypoxia-inducible factor (HIF)-1alpha protein increased with a peak at 3 h after HI. mRNA expression for IL-beta and tumor necrosis factor-alpha and -beta started to increase at 6 h with a peak at 24 h post-HI. Expression of heat shock protein 70 was increased from 12 h after HI onwards in the ipsilateral hemisphere only. Surprisingly, HI changed the expression of cytokines, HIF1-alpha ,and P-Akt to the same extent in both the ipsi- as well as the contralateral hemisphere, although neuronal damage was unilateral. Exposure of animals to hypoxia without carotid artery occlusion induced similar changes in cytokines, HIF-1alpha, and P-Akt. We conclude that during HI, hypoxia is sufficient to regulate multiple molecular mediators that may contribute, but are not sufficient, to induce long-term neuronal damage.
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Wang XL, Li Y, Kuang JS, Zhao Y, Liu P. Increased heat shock protein 70 expression in the pancreas of rats with endotoxic shock. World J Gastroenterol 2006; 12:780-3. [PMID: 16521195 PMCID: PMC4066132 DOI: 10.3748/wjg.v12.i5.780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the ultra-structural changes and heat shock protein 70 (HSP70) expression in the pancreas of rats with endotoxic shock and to detect their possible relationship.
METHODS: A total of 33 Wistar rats were randomly divided into three groups: control group (given normal saline), small dose lipopolysaccharide (LPS) group (given LPS 5 mg/kg) and large dose LPS group (given LPS 10 mg/kg). Pancreas was explanted to detect the ultra-structural changes by TEM and the HSP70 expression by immunohistochemistry and Western blot.
RESULTS: Rats given small doses of LPS showed swelling and loss of mitochondrial cristae of acinar cells and increased number of autophagic vacuoles in the cytoplasm of acinar cells. Rats given large doses of LPS showed swelling, vacuolization, and obvious myeloid changes of mitochondrial cristae of acinar cells, increased number of autophagic vacuoles in the cytoplasm of acinar cells. HSP70 expression was increased compared to the control group (P<0.05).
CONCLUSION: Small doses of LPS may induce stronger expression of HSP70, promote autophagocytosis and ameliorate ultra-structural injuries.
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Affiliation(s)
- Xue-Lian Wang
- Department of Infectious Diseases, The Second Affiliated Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
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Charles PE, Martin L, Etienne M, Croisier D, Piroth L, Lequeu C, Pugin J, Portier H, Chavanet P. Influence of positive end-expiratory pressure (PEEP) on histopathological and bacteriological aspects of pneumonia during low tidal volume mechanical ventilation. Intensive Care Med 2004; 30:2263-70. [PMID: 15536527 PMCID: PMC7095170 DOI: 10.1007/s00134-004-2442-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2004] [Accepted: 08/24/2004] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Ventilatory strategies combining low tidal volume (V(T)) with positive end-expiratory pressure (PEEP) are considered to be lung protective. The influence of the PEEP level was investigated on bacteriology and histology in a model of ventilator-associated pneumonia. SUBJECTS Nineteen New Zealand rabbits. INTERVENTIONS The animals were mechanically ventilated with a positive inspiratory pressure of 15 cmH(2)O and received either a zero end-expiratory pressure (ZEEP, n=6), a 5 cmH(2)O PEEP (n=5) or a 10 cmH(2)O PEEP (n=4). An inoculum of Enterobacter aerogenes was then instilled intrabronchially. The non-ventilated pneumonia group (n=4) was composed of spontaneously breathing animals which received the same inoculum. Pneumonia was assessed 24 h later. MAIN RESULTS The lung bacterial burden was higher in mechanically ventilated animals compared with spontaneously breathing animals. All animals from the latter group had negative spleen cultures. The spleen bacterial concentration was found to be lower in the 5 cmH(2)O PEEP group when compared to the ZEEP and 10 cmH(2)O PEEP groups (3.1+/-1.5 vs 4.9+/-1.1 and 5.0+/-1.3 log(10) cfu/g, respectively; p<0.05). Lung weight and histological score values were lower in the spontaneously breathing animals as well as in the 5 cmH(2)O PEEP group compared with the ZEEP and 10 cmH(2)O groups. CONCLUSIONS Mechanical ventilation substantially increased the lung bacterial burden and worsened the histological aspects of pneumonia in this rabbit model. Variations in terms of lung injury and systemic spreading of infection were noted with respect to the ventilatory strategy.
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Affiliation(s)
- Pierre Emmanuel Charles
- Laboratoire des Maladies Infectieuses, EA562, Dijon University Hospital, Boulevard Mal de Lattre de Tassigny, 21033 Dijon, France.
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De Freitas I, Fernández-Somoza M, Essenfeld-Sekler E, Cardier JE. Serum levels of the apoptosis-associated molecules, tumor necrosis factor-alpha/tumor necrosis factor type-I receptor and Fas/FasL, in sepsis. Chest 2004; 125:2238-46. [PMID: 15189947 DOI: 10.1378/chest.125.6.2238] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE s: Numerous reports suggest that apoptosis may play an important role in the sepsis syndrome. The objective of the present study was to examine the levels of molecules associated with apoptosis belonging to the tumor necrosis factor (TNF)-alpha/TNF type-I receptor (TNFRI) and Fas ligand (FasL)/Fas receptor (Fas) pathways in patients with sepsis. PATIENTS AND METHODS Twenty-two patients with sepsis (14 patients with severe sepsis and 8 patients with sepsis), and 6 healthy volunteers were evaluated. Sequential analysis of the serum levels of TNF-alpha, TNFRI, FasL, and Fas were performed in these patients using enzyme-linked immunosorbent assays. RESULTS Detectable levels of TNF-alpha were found in only 8 of 14 patients with severe sepsis. Patients with severe sepsis and sepsis had similarly increased levels of FasL, compared with healthy individuals (p < 0.05). Higher levels of TNFRI and Fas were found in patients with severe sepsis than in patients with sepsis and healthy volunteers (p < 0.001 and p < 0.01, respectively). Fas levels were also higher in patients who died than in those who survived (p < 0.01). A direct relationship was found between serum levels of TNFRI and Fas, and multiorgan dysfunction (sequential organ failure assessment score) [p < 0.0001]. CONCLUSIONS These results suggest that the TNF-alpha/TNFRI and FasL/Fas systems may be involved in the pathogenesis of sepsis. Serum levels of the death-receptors, TNFRI and Fas, could serve as potential markers of the severity of human sepsis.
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Affiliation(s)
- Ivel De Freitas
- Department of Internal Medicine, Hospital General del Oeste, Caracas, Venezuela
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Abraham E, Andrews P, Antonelli M, Brochard L, Brun-Buisson C, Dobb G, Fagon JY, Groeneveld J, Mancebo J, Metnitz P, Nava S, Pinsky M, Radermacher P, Ranieri M, Richard C, Tasker R, Vallet B. Year in review in Intensive Care Medicine—2003. Intensive Care Med 2004; 30:1514-25. [PMID: 15292983 DOI: 10.1007/s00134-004-2358-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2004] [Indexed: 01/19/2023]
Affiliation(s)
- Edward Abraham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Colorado Health Sciences Center, Denver, USA
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Plötz FB, Slutsky AS, van Vught AJ, Heijnen CJ. Ventilator-induced lung injury and multiple system organ failure: a critical review of facts and hypotheses. Intensive Care Med 2004; 30:1865-72. [PMID: 15221129 DOI: 10.1007/s00134-004-2363-9] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2004] [Accepted: 06/01/2004] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To review how biotrauma leads to the development of multiple system organ failure (MSOF). DESIGN AND SETTING Published articles on experimental and clinical studies and review articles in the English language were collected and analyzed. RESULTS The concept that ventilation strategies using "large" tidal volumes and zero PEEP of injured lungs can enhance injury by the release of inflammatory mediators into the lungs and circulation, a mechanism that has been called biotrauma, is supported by evidence from experimental models ranging from mechanically stressed cell systems, to isolated lungs, intact animals, and humans. Biotrauma may lead to MSOF via spillover of lung-borne inflammatory mediators into the systemic circulation. However, spillover of other agents such as bacteria and soluble proapoptotic factors may also contribute to the onset of MSOF. Other less well studied mechanisms such as peripheral immunosuppression and translocation of bacteria and/or products from the gut may play an important role. Finally, genetic variability is a crucial factor. CONCLUSIONS The development of MSOF is a multifactorial process. Our proposed mechanisms linking mechanical ventilation and MSOF suggest several novel therapeutic approaches. However, it will first be necessary to study the mechanisms described above to delineate more precisely the contribution of each proposed factor, their interrelationships, and their time course. We suggest that scientific advances in immunology may offer novel approaches for prevention of MSOF secondary to ventilator-induced lung injury.
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Affiliation(s)
- Frans B Plötz
- Department of Pediatric Intensive Care, VU Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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