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Seitz T, Bergmayr F, Kitzberger R, Holbik J, Grieb A, Hind J, Lucny F, Tyercha A, Neuhold S, Krenn C, Wenisch C, Zoufaly A, Kaniusas E, Széles JC. Randomized controlled study to evaluate the safety and clinical impact of percutaneous auricular vagus nerve stimulation in patients with severe COVID-19. Front Physiol 2023; 14:1223347. [PMID: 37614753 PMCID: PMC10442574 DOI: 10.3389/fphys.2023.1223347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction: A severe course of COVID-19 is characterized by a hyperinflammatory state resulting in acute respiratory distress syndrome or even multi-organ failure along a derailed sympatho-vagal balance. Methods: In this prospective, randomized study, we evaluate the hypothesis that percutaneous minimally invasive auricular vagus nerve stimulation (aVNS) is a safe procedure and might reduce the rate of clinical complications in patients with severe course of COVID-19. In our study, patients with SARS-CoV-2 infection admitted to the intensive care unit with moderate-to-severe acute respiratory distress syndrome, however without invasive ventilation yet, were included and following randomization assigned to a group receiving aVNS four times per 24 h for 3 h and a group receiving standard of care (SOC). Results: A total of 12 patients were included (six in the aVNS and six in the SOC group). No side effects in aVNS were reported, especially no significant pain at device placement or during stimulation at the stimulation site or significant headache or bleeding after or during device placement or lasting skin irritation. There was no significant difference in the aVNS and SOC groups between the length of stay in the intensive care unit and at the hospital, bradycardia, delirium, or 90-day mortality. In the SOC group, five of six patients required invasive mechanical ventilation during their stay at hospital and 60% of them venovenous extracorporeal membrane oxygenation, compared to three of six patients and 0% in the aVNS group (p = 0.545 and p = 0.061). Discussion: Vagus nerve stimulation in patients with severe COVID-19 is a safe and feasible method. Our data showed a trend to a reduction of progression to the need of invasive ventilation and venovenous extracorporeal membrane oxygenation which encourages further research with larger patient samples.
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Affiliation(s)
- Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Franziska Bergmayr
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria
- Department of General Surgery, Division of Vascular Surgery, Center for Wound Surgery and Special Pain Therapy, Health Service Center of Vienna Privat Clinics, Medical University of Vienna, Vienna, Austria
- Department of Anesthesiology and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Reinhard Kitzberger
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Johannes Holbik
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Alexander Grieb
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Julian Hind
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Felix Lucny
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexander Tyercha
- Department of General Surgery, Division of Vascular Surgery, Center for Wound Surgery and Special Pain Therapy, Health Service Center of Vienna Privat Clinics, Medical University of Vienna, Vienna, Austria
| | - Stephanie Neuhold
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Claus Krenn
- Department of Anesthesiology and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph Wenisch
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Alexander Zoufaly
- Department of Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Eugenijus Kaniusas
- Faculty of Electrical Engineering and Information Technology, Institute of Biomedical Electronics, Vienna University of Technology (TU Wien), Vienna, Austria
| | - József Constantin Széles
- Department of General Surgery, Division of Vascular Surgery, Center for Wound Surgery and Special Pain Therapy, Health Service Center of Vienna Privat Clinics, Medical University of Vienna, Vienna, Austria
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Yang A, Liu B, Inoue T. Role of autonomic system imbalance in neurogenic pulmonary oedema. Eur J Neurosci 2022; 55:1645-1657. [PMID: 35277906 DOI: 10.1111/ejn.15648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/09/2022] [Accepted: 03/04/2022] [Indexed: 02/05/2023]
Abstract
Neurogenic pulmonary oedema (NPE) is a life-threatening complication that develops rapidly and dramatically after an injury to the central nervous system (CNS). The autonomic system imbalance produced by severe brain damage may play an important role in the development of NPE. Activation of the sympathetic nervous system and inhibition of the vagus nerve system are essential prerequisites for autonomic system imbalance. The more severe the damage, the more pronounced the phenomenon. Sympathetic hyperactivity is associated with increased release of catecholamines from peripheral sympathetic nerve endings, which can cause dramatic changes in haemodynamics and cause pulmonary oedema. On the other hand, the abnormal inflammatory response caused by vagus nerve inhibition may also play an important role in the pathogenesis of NPE. The perspective of autonomic system imbalance seems to perfectly integrate the existing pathogenesis of NPE and can explain the entire development progression of NPE.
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Affiliation(s)
- Aobing Yang
- Department of Neurosurgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Physiology of Visceral Function and Body Fluid, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Bin Liu
- Department of Neurosurgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Tsuyoshi Inoue
- Department of Physiology of Visceral Function and Body Fluid, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Sadi L, Sjölin G, Ahl Hulme R. Beta-blockade is not associated with improved outcomes in isolated severe extracranial injury: an observational cohort study. Scand J Trauma Resusc Emerg Med 2021; 29:132. [PMID: 34496923 PMCID: PMC8425052 DOI: 10.1186/s13049-021-00947-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/30/2021] [Indexed: 11/21/2022] Open
Abstract
Background There is evidence supporting the use of beta-blockade in patients with traumatic brain injury. The reduction in sympathetic drive is thought to underlie the relationship between beta-blockade and increased survival. There is little evidence for similar effects in extracranial injuries. This study aimed to assess the association between beta-blockade and survival in patients suffering isolated severe extracranial injuries. Methods Patients treated at an academic urban trauma centre during a 5-year period were retrospectively identified. Adults suffering isolated severe extracranial injury [Injury Severity Score (ISS) ≥ 16 with Abbreviated Injury Score of ≤ 2 for any intracranial injury] were included. Patient characteristics and outcomes were collected from the trauma registry and hospital medical records. Patients were subdivided into beta-blocker exposed and unexposed groups. Patients were matched using propensity score matching. Differences were assessed using McNemar’s or paired Student’s t test. The primary outcome of interest was 90-day mortality and secondary outcome was in-hospital complications. Results 698 patients were included of whom 10.5% were on a beta-blocker. Most patients suffered blunt force trauma (88.5%) with a mean [standard deviation] ISS of 24.6 [10.6]. Unadjusted mortality was higher in patients receiving beta-blockers (34.2% vs. 9.1%, p < 0.001) as were cardiac complications (8.2% vs. 1.4%, p = 0.002). Patients on beta-blockers were significantly older (69.5 [14.1] vs. 43.2 [18.0] years) and of higher comorbidity. After matching, no statistically significant differences were seen in 90-day mortality (34.2% vs. 30.1%, p = 0.690) or in-hospital complications. Conclusions Beta-blocker therapy does not appear to be associated with improved survival in patients with isolated severe extracranial injuries.
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Affiliation(s)
- Lin Sadi
- Department of Surgery, Capio St Görans Hospital, Stockholm, Sweden
| | - Gabriel Sjölin
- Department of Surgery, Örebro University Hospital, Örebro, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Rebecka Ahl Hulme
- School of Medical Sciences, Örebro University, Örebro, Sweden. .,Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
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Kaniusas E, Szeles JC, Kampusch S, Alfageme-Lopez N, Yucuma-Conde D, Li X, Mayol J, Neumayer C, Papa M, Panetsos F. Non-invasive Auricular Vagus Nerve Stimulation as a Potential Treatment for Covid19-Originated Acute Respiratory Distress Syndrome. Front Physiol 2020; 11:890. [PMID: 32848845 PMCID: PMC7399203 DOI: 10.3389/fphys.2020.00890] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/30/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Covid-19 is an infectious disease caused by an invasion of the alveolar epithelial cells by coronavirus 19. The most severe outcome of the disease is the Acute Respiratory Distress Syndrome (ARDS) combined with hypoxemia and cardiovascular damage. ARDS and co-morbidities are associated with inflammatory cytokine storms, sympathetic hyperactivity, and respiratory dysfunction. Hypothesis: In the present paper, we present and justify a novel potential treatment for Covid19-originated ARDS and associated co-morbidities, based on the non-invasive stimulation of the auricular branch of the vagus nerve. Methods: Auricular vagus nerve stimulation activates the parasympathetic system including anti-inflammatory pathways (the cholinergic anti-inflammatory pathway and the hypothalamic pituitary adrenal axis) while regulating the abnormal sympatho-vagal balance and improving respiratory control. Results: Along the paper (1) we expose the role of the parasympathetic system and the vagus nerve in the control of inflammatory processes (2) we formulate our physiological and methodological hypotheses (3) we provide a large body of clinical and preclinical data that support the favorable effects of auricular vagus nerve stimulation in inflammation, sympatho-vagal balance as well as in respiratory and cardiac ailments, and (4) we list the (few) possible collateral effects of the treatment. Finally, we discuss auricular vagus nerve stimulation protective potential, especially in the elderly and co-morbid population with already reduced parasympathetic response. Conclusions: Auricular vagus nerve stimulation is a safe clinical procedure and it could be either an effective treatment for ARDS originated by Covid-19 and similar viruses or a supplementary treatment to actual ARDS therapeutic approaches.
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Affiliation(s)
- Eugenijus Kaniusas
- Faculty of Electrical Engineering and Information Technology, Institute of Electrodynamics, Microwave and Circuit Engineering, Vienna University of Technology, Vienna, Austria
- SzeleSTIM GmbH, Vienna, Austria
| | - Jozsef C. Szeles
- General Hospital of the City of Vienna, Vienna, Austria
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Nuria Alfageme-Lopez
- Faculty of Biology and Faculty of Optics, Complutense University of Madrid, Madrid, Spain
| | - Daniela Yucuma-Conde
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Xie Li
- The Pediatric Department, Women and Children's Hospital of Hunan, Changsha, China
| | - Julio Mayol
- San Carlos Clinical Hospital, Madrid, Spain
- Institute for Health Research, San Carlos Clinical Hospital (IdISSC), Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Christoph Neumayer
- General Hospital of the City of Vienna, Vienna, Austria
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Michele Papa
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Fivos Panetsos
- Faculty of Biology and Faculty of Optics, Complutense University of Madrid, Madrid, Spain
- Institute for Health Research, San Carlos Clinical Hospital (IdISSC), Madrid, Spain
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Ahl R, Matthiessen P, Fang X, Cao Y, Sjolin G, Lindgren R, Ljungqvist O, Mohseni S. Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery. Br J Surg 2018; 106:477-483. [DOI: 10.1002/bjs.10988] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/18/2018] [Accepted: 07/28/2018] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Emergency colorectal cancer surgery is associated with significant mortality. Induced adrenergic hyperactivity is thought to be an important contributor. Downregulating the effects of circulating catecholamines may reduce the risk of adverse outcomes. This study assessed whether regular preoperative beta-blockade reduced mortality after emergency colonic cancer surgery.
Methods
This cohort study used the prospectively collected Swedish Colorectal Cancer Registry to recruit all adult patients requiring emergency colonic cancer surgery between 2011 and 2016. Patients were subdivided into those receiving regular beta-blocker therapy before surgery and those who were not (control). Demographics and clinical outcomes were compared. Risk factors for 30-day mortality were evaluated using Poisson regression analysis.
Results
A total of 3187 patients were included, of whom 685 (21·5 per cent) used regular beta-blocker therapy before surgery. The overall 30-day mortality rate was significantly reduced in the beta-blocker group compared with controls: 3·1 (95 per cent c.i. 1·9 to 4·7) versus 8·6 (7·6 to 9·8) per cent respectively (P < 0·001). Beta-blocker therapy was the only modifiable protective factor identified in multivariable analysis of 30-day all-cause mortality (incidence rate ratio 0·31, 95 per cent c.i. 0·20 to 0·47; P < 0·001) and was associated with a significant reduction in death of cardiovascular, respiratory, sepsis and multiple organ failure origin.
Conclusion
Preoperative beta-blocker therapy may be associated with a reduction in 30-day mortality following emergency colonic cancer surgery.
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Affiliation(s)
- R Ahl
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - P Matthiessen
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Department of Surgery, Orebro University Hospital, Orebro, Sweden
| | - X Fang
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Y Cao
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden
| | - G Sjolin
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Department of Surgery, Orebro University Hospital, Orebro, Sweden
| | - R Lindgren
- Department of Surgery, Orebro University Hospital, Orebro, Sweden
| | - O Ljungqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - S Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Department of Surgery, Orebro University Hospital, Orebro, Sweden
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Postictal neurogenic pulmonary edema: Case report and brief literature review. EPILEPSY & BEHAVIOR CASE REPORTS 2017; 9:49-50. [PMID: 29692972 PMCID: PMC5913356 DOI: 10.1016/j.ebcr.2017.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/13/2017] [Accepted: 09/20/2017] [Indexed: 12/03/2022]
Abstract
Cardiopulmonary complications associated with epilepsy are generally associated with generalized tonic–clonic seizures, as a consequence of systemic adrenergic discharge and release of inflammatory mediators. We present a case of a 34-year-old woman with a history of Focal epilepsy since adolescence, who presented self-limited pulmonary edema following a focal to bilateral tonic–clonic seizure with subsequent resolution of the symptoms. We also made a brief review of neurogenic pulmonary edema, its proposed pathophysiology, treatment and its relation with sudden unexpected death in epilepsy (SUDEP). Neurogenic pulmonary edema can be fatal and its early identification allows the initiation of medical surveillance and management. Seizures are a rare cause of pulmonary edema and may be recurrent. NPE is associated with recurrent seizures and longer epileptic seizure. Treatment of NPE centers on resolution of CNS injury and ventilation support.
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Yan Z, Shang Y, Li F, Xie F, Qian H, Zhang Y, Yue B. Therapeutic efficacy of phentolamine in the management of severe hand, foot and mouth disease combined with pulmonary edema. Exp Ther Med 2017; 13:1403-1407. [PMID: 28413485 PMCID: PMC5377404 DOI: 10.3892/etm.2017.4104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/18/2016] [Indexed: 01/28/2023] Open
Abstract
The aim of this study was to examine the effects of phentolamine on severe hand, foot and mouth disease (HFMD) combined with pulmonary edema (PE). From May 2008 to December 2012, 53 children with severe HFMD plus PE were enrolled in the treatment group, receiving phentolamine intravenously at a loading dose of 5 µg/kg/min. The control group comprised 52 children with the same disease who did not receive phentolamine infusion. Data concerning creatine kinase (CK), CK-MB, cardiac troponin I (cTnI), heart rate, systolic blood pressure (SBP) and the duration of ventilation dependence and hospitalization were collected. Adverse events were also recorded. It was found that the phentolamine-treated patients exhibited significantly lower CK, CK-MB and cTnI levels, heart rate and SBP than the controls (P<0.01 for all parameters). The average duration of ventilator dependence and hospitalization was significantly shorter (P<0.01) in the phentolamine group than in the control group. It was also found that the overall mortality rate was lower in the phentolamine group (5.8%) than in the control group (11.5%). No adverse events were observed in either group. Thus, these results offer preliminary evidence that phentolamine reduces mortality and relieves the symptoms of EV71-induced PE. Phentolamine is a potential therapeutic agent for this highly lethal disorder.
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Affiliation(s)
- Zhixin Yan
- Department of First Pediatric Internal Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Yaokai Shang
- Department of Pediatrics, Yanshan Fude Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Fengxian Li
- Department of Internal Medicine, Yanshan Fude Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Fei Xie
- Department of First Pediatric Internal Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Huili Qian
- Department of Second Pediatric Internal Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Youqi Zhang
- Department of Fourth Pediatric Internal Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Bin Yue
- Department of First Pediatric Internal Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P.R. China
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Abstract
Neurogenic pulmonary edema (NPE) is a life-threatening complication of central nervous system (CNS) injuries. This review summarizes current knowledge about NPE etiology and pathophysiology with an emphasis on its experimental models, including our spinal cord compression model. NPE may develop as a result of activation of specific CNS trigger zones located in the brainstem, leading to a rapid sympathetic discharge, rise in systemic blood pressure, baroreflex-induced bradycardia, and enhanced venous return resulting in pulmonary vascular congestion characterized by interstitial edema, intra-alveolar accumulation of transudate, and intra-alveolar hemorrhages. The potential etiological role of neurotransmitter changes in NPE trigger zones leading to enhanced sympathetic nerve activity is discussed. Degree of anesthesia is a crucial determinant for the extent of NPE development in experimental models because of its influence on sympathetic nervous system activity. Sympathetic hyperactivity is based on the major activation of either ascending spinal pathways by spinal cord injury or NPE trigger zones by increased intracranial pressure. Attenuation of sympathetic nerve activity or abolition of reflex bradycardia completely prevent NPE development in our experimental model. Suggestions for future research into NPE pathogenesis as well as therapeutic potential of particular drugs and interventions are discussed.
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Affiliation(s)
- Jiří Šedý
- Institute of Physiology , Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Jaroslav Kuneš
- Institute of Physiology , Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Josef Zicha
- Institute of Physiology , Academy of Sciences of the Czech Republic, Prague, Czech Republic
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Tu YF, Lin CH, Lee HT, Yan JJ, Sze CI, Chou YP, Ho CJ, Huang CC. Elevated cerebrospinal fluid endothelin 1 associated with neurogenic pulmonary edema in children with enterovirus 71 encephalitis. Int J Infect Dis 2015; 34:105-11. [PMID: 25820093 DOI: 10.1016/j.ijid.2015.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/04/2015] [Accepted: 03/21/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Neurogenic pulmonary edema (NPE) is a fatal complication in children with enterovirus 71 (EV71) encephalitis. Endothelin 1 (ET-1), a potent vasoconstrictor, can induce pulmonary edema in rats via intrathecal injections. Thus, it was hypothesized that ET-1 in the central nervous system may correlate with NPE in children with EV71 encephalitis. METHODS Clinical data and ET-1 in the cerebrospinal fluid (CSF) were compared between three groups: (1) EV71 encephalitis with NPE; (2) EV71 encephalitis without NPE; and (3) non-EV71 aseptic meningitis. ET-1 immunostaining was performed on the brainstem of autopsy patients. RESULTS The EV71 with NPE group showed significantly increased CSF levels of ET-1 compared to the EV71 without NPE and the non-EV71 aseptic meningitis groups (both p<0.01). The optimum cut-off point of ET-1 to predict NPE in EV71 patients, based on the receiver operating characteristic curve, was 0.5 pg/ml (sensitivity 83%, specificity 100%). Immunostaining in the brainstem showed increased ET-1 expression, mainly in the oligodendrocytes, in EV71 with NPE patients compared with control patients. CONCLUSION ET-1 in the central nervous system may play a role in the development of NPE in children with EV71 infection and could be used as a biomarker or therapeutic target for NPE in EV71 encephalitis.
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Affiliation(s)
- Yi-Fang Tu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70403, Taiwan.
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsueh-Te Lee
- Institute of Anatomy and Cell Biology, National Yang Ming University, Taipei, Taiwan
| | - Jing-Jou Yan
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-I Sze
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ya-Ping Chou
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70403, Taiwan
| | - Chien-Jung Ho
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70403, Taiwan
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70403, Taiwan; Department of Pediatrics, Wan-Fang Hospital, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Preinjury β-blockade is protective in isolated severe traumatic brain injury. J Trauma Acute Care Surg 2014; 76:804-8. [DOI: 10.1097/ta.0000000000000139] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sympathetic Hyperactivity After Traumatic Brain Injury and the Role of Beta-Blocker Therapy. ACTA ACUST UNITED AC 2010; 69:1602-9. [DOI: 10.1097/ta.0b013e3181f2d3e8] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Faropoulos K, Apostolakis E. Brain death and its influence on the lungs of the donor: how is it prevented? Transplant Proc 2010; 41:4114-9. [PMID: 20005351 DOI: 10.1016/j.transproceed.2009.09.087] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Revised: 08/09/2009] [Accepted: 09/29/2009] [Indexed: 11/16/2022]
Abstract
The need for lung grafts is currently greater than ever. Unfortunately, the availability of grafts is insufficient for this demand. So we are forced to request organs for transplantation in the "waste bin." One possible solution to this problem may be the use of grafts from brain-dead patients. Sadly brain death is followed by devastating hemodynamic, inflammatory, and neurohumoral reactions in the potential donor which not only inflict direct damage, but also induce activation of the immune system which can cause rejection or even graft failure. Therefore, various groups have examined measures to prevent this outcome. In this review, we attempt to reconstruct the events that follow brain death, suggesting an algorithm to prevent a brain-dead patient's lungs from further damage. Finally, we are proposing potential measures of graft's protection of further investigation.
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Affiliation(s)
- K Faropoulos
- Neurosurgery Department, University Hospital of Patras, University Campus, Rio, Patras Achaia 26504, Greece.
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Sugita M, Berthiaume Y, VanSpall M, Dagenais A, Ferraro P. Pharmacologic Modulation of Alveolar Liquid Clearance in Transplanted Lungs by Phentolamine and FK506. Ann Thorac Surg 2009; 88:958-64. [DOI: 10.1016/j.athoracsur.2009.05.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 05/19/2009] [Accepted: 05/20/2009] [Indexed: 01/11/2023]
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Beta-blocker exposure in patients with severe traumatic brain injury (TBI) and cardiac uncoupling. ACTA ACUST UNITED AC 2008; 63:503-10; discussion 510-1. [PMID: 18073593 DOI: 10.1097/ta.0b013e3181271c34] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac uncoupling and reduced heart rate (HR) variability are associated with increased mortality after severe traumatic brain injury (TBI). Recent data has shown beta-blocker (betaB) exposure is associated with improved survival in this patient population. The purpose of the present study was to evaluate the effect of betaB exposure on the mortality risk of patients with severe TBI and early cardiac uncoupling. METHODS From December 2000 to October 2005, 4,116 patients were admitted to the trauma intensive care unit. Four hundred forty-six patients (12%) had head Abbreviated Injury Scale score >/= 5 without neck injury and had continuous HR data for the first 24 hours. One hundred forty-one patients (29%) received betaB. Cardiac uncoupling was calculated as the percent of time that 5-minute HR standard deviation was between 0.3 bpm and 0.6 bpm on postinjury day 1. RESULTS A relationship between betaB and survival was observed when the population was considered irrespective of length of stay or betaB start time (p < 0.001). Cardiac uncoupling appears to stratify patients into groups who might receive additional benefit from betaB, and identifies patients with increasing mortality. However, the association of betaB with survival was attenuated when analyses accounted for selection bias in betaB administration. CONCLUSIONS betaB exposure was associated with reduced mortality among patients with severe TBI. Though loss of HR variability has previously been associated with an increase in mortality, betaB exposure appears to be associated with increased survival across all stratifications of cardiac uncoupling.
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Sedý J, Likavcanová K, Urdziková L, Zicha J, Kunes J, Hejcl A, Jendelová P, Syková E. Low degree of anesthesia increases the risk of neurogenic pulmonary edema development. Med Hypotheses 2008; 70:308-13. [PMID: 17693037 DOI: 10.1016/j.mehy.2007.05.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 05/22/2007] [Indexed: 02/07/2023]
Abstract
Neurogenic pulmonary edema is an acute life-threatening complication following central nervous system injury. The exact pathogenic mechanism leading to its development is still unclear. We introduce a new hypothesis that high levels of anesthesia might protect the organism against the development of neurogenic pulmonary edema due to a more pronounced inhibition of the hypothalamic, brainstem and spinal vasoactive sympathetic centers. On the basis of a more pronounced neuronal inhibition of the vasoactive centers, a severe sympathetic discharge does not occur and neurogenic pulmonary edema does not develop. In contrast, an insufficient anesthesia level is not able to inhibit the sympathetic nervous system during an injury of the central nervous system and thus neurogenic pulmonary edema develops. During experiments with central nervous system injury, low-anesthesia-induced neurogenic pulmonary edema might negatively influence the overall recovery of the animal. More importantly, during a neurosurgical intervention, insufficient anesthesia might similarly lead to neurogenic pulmonary edema development in operated patients. Our hypothesis indicates the necessity of precisely monitoring of the level anesthesia during experimental manipulations of the central nervous system in animals or neurosurgical interventions in humans.
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Affiliation(s)
- J Sedý
- Institute of Experimental Medicine, ASCR, Prague, Czech Republic
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Abstract
Neurogenic pulmonary edema (NPE) is usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. It has been reported regularly for a long time in numerous and various injuries of the central nervous system in both adults and children, but remains poorly understood because of the complexity of its pathophysiologic mechanisms involving hemodynamic and inflammatory aspects. NPE seems to be under-diagnosed in acute neurologic injuries, partly because the prevention and detection of non-neurologic complications of acute cerebral insults are not at the forefront of the strategy of physicians. The presence of NPE should be high on the list of diagnoses when patients with central neurologic injury suddenly become dyspneic or present with a decreased P(a)o(2)/F(i)o(2) ratio. The associated mortality rate is high, but recovery is usually rapid with early and appropriate management. The treatment of NPE should aim to meet the oxygenation needs without impairing cerebral hemodynamics, to avoid pulmonary worsening and to treat possible associated myocardial dysfunction. During brain death, NPE may worsen myocardial dysfunction, preventing heart harvesting.
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Affiliation(s)
- A Baumann
- Département d'Anesthésie - Réanimation, Centre Hospitalier Universitaire de Nancy, Hôpital Central, Nancy, France
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Toung TJK, Chen CH, Lin C, Bhardwaj A. Osmotherapy with hypertonic saline attenuates water content in brain and extracerebral organs. Crit Care Med 2007; 35:526-31. [PMID: 17205030 DOI: 10.1097/01.ccm.0000253309.44567.a6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Because of their beneficial effects in patients with hemorrhagic shock and multiple-system trauma, hypertonic saline solutions are increasingly being used perioperatively for volume resuscitation. Although the anti-edema effects of hypertonic saline on brain are well documented in a variety of brain injury paradigms, its effects on the water content on other organs has not been studied rigorously. In this study, we tested the hypothesis that a) hypertonic saline when given as an intravenous bolus and continuous infusion attenuates water content of small bowel, lung, and brain in rats without neuro-injury; and b) attenuation of stroke-associated increases in lung water is dependent on achieving a target serum osmolality. DESIGN Prospective laboratory animal study. SETTING Research laboratory in a teaching hospital. SUBJECTS Adult male Wistar rats. INTERVENTIONS In the first series of experiments, under controlled conditions of normoxia, normocarbia, and normothermia, spontaneously breathing, halothane-anesthetized (1.0-1.5%) adult male Wistar rats (280-320 g) were treated in a blinded randomized fashion with 7.5% hypertonic saline or 0.9% normal saline in a 8-mL/kg intravenous infusion for 3 hrs followed by a continuous intravenous infusion (1 mL/kg/hr) of 5% hypertonic saline or normal saline, respectively (n=10 each), for 48 hrs. A second group of rats were treated with continuous infusion only for 48 hrs of either 7.5% hypertonic saline or normal saline (1 mL/kg/hr) (n=10 each) without an intravenous bolus. Naïve rats served as controls (n=10). Tissue water content of small bowel, lung, and brain was determined by comparing the wet-to-dry ratios at the end of the experiment. In a second series of experiments, rats (n=94) were subjected to 2 hrs of transient middle cerebral artery occlusion by the intraluminal occlusion technique. At 6 hrs following middle cerebral artery occlusion, rats were treated in a blinded randomized fashion with a continuous intravenous infusion of normal saline, 3% hypertonic saline, or 7.5% hypertonic saline for 24, 48, 72, and 96 hrs. Surgical shams served as controls (n=7). Hypertonic saline was instituted as chloride/acetate mixture (50:50) in all experiments. Serum osmolality was determined at the end of the experiment in all animals. MEASUREMENTS AND MAIN RESULTS In rats without neuro-injury that received intravenous bolus followed by a continuous infusion, lung water content was significantly reduced with hypertonic saline (73.9+/-1.1%; 359+/-10 mOsm/L) (mean+/-sd) compared with normal saline treatment (76.1+/-0.53%; 298+/-4 mOsm/L) as was water content of small bowel (hypertonic saline, 69.1+/-5.8%; normal saline, 74.7+/-0.71%) and brain (hypertonic saline, 78.1+/-0.87%; normal saline, 79.2+/-0.38%) at 48 hrs. Stroke-associated increases in lung water content were attenuated with 7.5% hypertonic saline at all time points. There was a strong correlation between serum osmolality and attenuation of stroke-associated increases in lung water content (r=-.647) CONCLUSIONS Bowel, lung, and brain water content is attenuated with hypertonic saline when serum osmolality is >350 mOsm/L without adverse effect on mortality in animals with and without neuro-injury. Attenuation of water content of extracerebral organs with hypertonic saline treatment may have therapeutic implications in perioperative fluid management in patients with and without brain injury.
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Affiliation(s)
- Thomas J K Toung
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Agrawal A, Timothy J, Pandit L, Kumar A, Singh G, Lakshmi R. NEUROGENIC PULMONARY OEDEMA. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2007. [DOI: 10.29333/ejgm/82417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cotton BA, Snodgrass KB, Fleming SB, Carpenter RO, Kemp CD, Arbogast PG, Morris JA. Beta-Blocker Exposure is Associated With Improved Survival After Severe Traumatic Brain Injury. ACTA ACUST UNITED AC 2007; 62:26-33; discussion 33-5. [PMID: 17215730 DOI: 10.1097/ta.0b013e31802d02d0] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Beta-blocker use in elective noncardiac surgery has been associated with a reduction in mortality and cardiovascular complications. Traumatic brain injury (TBI) is often associated with a hyperadrenergic state. We hypothesized that adrenergic blockade would confer improved survival among TBI patients. METHODS Retrospective review of the Trauma Registry of the American College of Surgeons database at a Level I trauma center was conducted. All trauma patients admitted from January 2004 to March 2005 with head Abbreviated Injury Scale score of 3 or greater were evaluated. Patients with length of stay <4 or >30 days were excluded. Beta-blocker exposure was defined as receiving beta-blockers for 2 or more consecutive days. RESULTS In all, 420 patients met inclusion criteria: 174 patients exposed to beta-blockers [BB(+)] and 246 not exposed [BB(-)]. Mean age in BB(+) group was 50 years and 36 years in BB(-) group (p < 0.001). Mean Injury Severity Score was 33.6 for BB(+) group and 30.8 for BB(-) group (p = 0.01). Predicted survival (by Trauma and Injury Severity Score) for BB(+) group was 59.1% compared with 70.3% for BB(-) group (p < 0.001). Observed mortality for BB(+) group was 5.1%, 10.8% for BB(-) group (p = 0.036). Adjusted incidence rate ratio of mortality among those exposed to beta-blockers compared with those not exposed was 0.29 (95% confidence interval). CONCLUSIONS Beta-blocker exposure was associated with a significant reduction in mortality in patients with severe TBI. This reduction in mortality is even more impressive, considering that the BB(+) group was older, more severely injured, and had lower predicted survival.
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Affiliation(s)
- Bryan A Cotton
- Departments of Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
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Benton RL, Woock JP, Gozal E, Hetman M, Whittemore SR. Intraspinal application of endothelin results in focal ischemic injury of spinal gray matter and restricts the differentiation of engrafted neural stem cells. Neurochem Res 2006; 30:809-23. [PMID: 16187216 DOI: 10.1007/s11064-005-6875-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2005] [Indexed: 10/25/2022]
Abstract
Previous data have shown that pluripotent stem cells engrafted into the contused spinal cord differentiate only along an astrocytic lineage. The unknown restrictive cues appear to be quite rigid as even neuronal-restricted precursors fail to differentiate to the mature potential they exhibit in vitro after similar grafting into the contused spinal cord. It has been hypothesized that this potent lineage restriction is, in part, the result of the significant loss of both gray and white matter observed following spinal contusion, which elicits a massive acute inflammatory response and is manifested chronically by dramatic cystic cavitation. To evaluate the gray matter component, we developed a clinically relevant model of focal gray matter ischemic injury using the potent vasoconstrictor endothelin (ET-1) and characterized the differentiation of pluripotent stem cells transplanted into this atraumatic vascular SCI. Results demonstrate that low dose ET-1 microinjection into cervical spinal gray matter results in an inflammatory response that is temporally comparable to that observed following traumatic SCI, as well as chronic gray matter loss, but without significant cystic cavitation or white matter degeneration. However, despite the preservation of host spinal parenchyma, no elaboration of neuronal phenotypes was observed from engrafted stem or precursor cells. These results suggest that a common pathologic component responsible for this lineage restriction exists between contusive SCI and ET-1 mediated focal ischemic SCI.
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Affiliation(s)
- Richard L Benton
- Kentucky Spinal Cord Injury Research Center (KSCIRC), 511 South Floyd Street, MDR 616, Louisville, KY 40292, USA
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Leal Filho MB, Morandin RC, de Almeida AR, Cambiucci EC, Metze K, Borges G, Gontijo JAR. Hemodynamic parameters and neurogenic pulmonary edema following spinal cord injury: an experimental model. ARQUIVOS DE NEURO-PSIQUIATRIA 2005; 63:990-6. [PMID: 16400418 DOI: 10.1590/s0004-282x2005000600016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Neurogenic pulmonary edema is a serious and always life-threatening complication following several lesions of the central nervous system. We report an experiment with 58 Wistar-Hanover adult male rats. Two groups were formed: control (n=4) and experimental (n=54). The experimental group sustained acute midthoracic spinal cord injury by Fogarty’s balloon-compression technique containing 20µL of saline for 5, 15, 30 or 60 seconds. The rats were anesthetized by intraperitoneal (i.p.) sodium pentobarbital (s.p.) 60 mg/Kg. The quantitative neurological outcome was presented at 4, 24 and 48 hours from compression to characterize the injury graduation in different groups. Poor outcome occurred with 60 seconds of compression. Six animals died suddenly with pulmonary edema. Using the procedure to investigate the pulmonary edema during 60 seconds of compression, followed by decompression and time-course of 60 seconds, 20 rats were randomly asigned to one of the following groups: control (1, n=4, anesthetized by i.p. s.p., 60 mg/Kg but without compression) and experimental (2, n=7, anesthetized by i.p. xylazine 10 mg/Kg and ketamine 75 mg/Kg) and (3, n=9, anesthetized by i.p. s.p., 60 mg/Kg). The pulmonary index (100 x wet lung weight / body weight) was 0.395 ± 0.018 in control group, rose to 0.499 ± 0.060 in group 2, and was 0.639 ± 0.14 in group 3. Histologic examination of the spinal cord showed parenchymal ruptures and acute hemorrhage. Comparison of the pulmonary index with morphometric evaluation of edema fluid-filled alveoli by light microscopy showed that relevant intra-alveolar edema occurred only for index values above 0.55. The results suggest that the pulmonary edema induced by spinal compression is of neurogenic nature and that the type of anesthesia used might be important for the genesis of lung edema.
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de Chazal I, Parham WM, Liopyris P, Wijdicks EFM. Delayed cardiogenic shock and acute lung injury after aneurysmal subarachnoid hemorrhage. Anesth Analg 2005; 100:1147-1149. [PMID: 15781536 DOI: 10.1213/01.ane.0000147704.90285.2a] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Both cardiac and lung injury after aneurysmal subarachnoid hemorrhage has been attributed to an adrenergic surge. Cardiogenic shock is very uncommon. We describe a 55-yr-old woman with a delayed cardiogenic shock emerging within hours after aneurysmal rupture. Cardiac damage was documented by increased serum troponin T, CPK-mb fraction, and severe wall motion abnormality, which included an akinetic apex on echocardiography (ejection fraction of 33%). Her coronary angiogram was normal. Decreased cardiac index, increased systemic and pulmonary vascular resistance indices, and persistent oxygen desaturation despite improving ventricular contractility documented both cardiac and pulmonary injury. After treatment with dobutamine and milrinone all manifestations resolved.
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Affiliation(s)
- Ives de Chazal
- Division of Critical Care and Division of Critical Care Neurology, Mayo Medical Center, Saint Marys Hospital, Rochester, Minnesota
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Abstract
Pulmonary veins have been seen primarily as conduit vessels; however, over the past two decades, a large amount of evidence has accumulated to indicate that pulmonary veins can exhibit substantial vasoactivity. In this review, the role of veins in regulation of the pulmonary circulation, particularly during the perinatal period and under certain pathophysiological conditions, is discussed. In the fetus, pulmonary veins contribute a significant fraction to total pulmonary vascular resistance. At birth, the veins as well as the arteries relax in response to endothelium-derived nitric oxide and dilator prostaglandins, thereby assisting in the fall in pulmonary vascular resistance. These effects are oxygen dependent and modulated by cGMP-dependent protein kinase. Under chronic hypoxic conditions, pulmonary veins undergo remodeling and demonstrate substantial constriction and hypertrophy. In a number of species, including the human, pulmonary veins are also the primary sites of action of certain vasoconstrictors such as endothelin and thromboxane. In various pathological conditions, there is an increased synthesis of these vasoactive agents that may lead to pulmonary venous constriction, increased microvascular pressures for fluid filtration, and formation of pulmonary edema. In conclusion, the significant role of veins in regulation of the pulmonary circulation needs to be appreciated to better prevent, diagnose, and treat lung disease.
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Affiliation(s)
- Yuansheng Gao
- Division of Neonatology, Department of Pediatrics, Harbor-UCLA Research and Education Institute, 1124 W. Carson St., RB-1, Torrance, CA 90502, USA
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Toung TJK, Chang Y, Lin J, Bhardwaj A. Increases in lung and brain water following experimental stroke: Effect of mannitol and hypertonic saline*. Crit Care Med 2005; 33:203-8; discussion 259-60. [PMID: 15644670 DOI: 10.1097/01.ccm.0000150659.15558.23] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Pulmonary edema is a serious condition following brain injury of diverse etiologies, including large hemispheric infarctions. We have previously shown that treatment with hypertonic saline attenuates cerebral edema associated with experimental ischemic stroke. In a well-characterized animal model of large ischemic stroke, we tested the hypotheses that lung water increases following cerebral ischemia and determined the effects of osmotherapy with hypertonic saline and mannitol on total lung water, as well as on cerebral edema. DESIGN Prospective laboratory animal study. SETTING Research laboratory in a university teaching hospital. SUBJECTS Adult male Wistar rats (300-450 g, n = 103). INTERVENTIONS Under controlled conditions of normoxia, normocarbia, and normothermia, spontaneously breathing, halothane-anesthetized (1.0-1.5%) rats were subjected to permanent middle cerebral artery occlusion by the intraluminal occlusion technique. MEASUREMENTS AND MAIN RESULTS Cerebral perfusion was monitored by laser-Doppler flowmetry over ipsilateral parietal cortex to ensure adequate vascular occlusion. At 6 hrs following middle cerebral artery occlusion, rats were treated in a blinded randomized fashion with no intravenous fluids (n = 24), a continuous intravenous infusion (0.3 mL/hr) of 0.9% saline (n = 21), 20% mannitol (2 g/Kg) (n = 20), 5% hypertonic saline (n = 20), or 7.5% hypertonic saline (n = 18) as a chloride/acetate mixture (50:50) until the end of the experiment. Brains and lungs were harvested, and tissue water content was estimated by comparing wet-to-dry weight ratios of ipsilateral and contralateral cerebral hemispheres at 48 hrs postischemia. Sham-operated rats served as controls (n = 20). Serum osmolality was determined at the end of the experiment in all animals. Lung water content was increased significantly in rats subjected to middle cerebral artery occlusion and treated with no intravenous fluids (76.7 +/- 0.7%, 317 +/- 7 mOsm/L) (mean +/- sd) and saline (76.8 +/- 1.2%, 311 +/- 10 mOsm/L), compared with sham-operated controls (74.5 +/- 0.9%, 302 +/- 4 mOsm/L). Treatment with 20% mannitol (74.4 +/- 1.2%, 352 +/- 15 mOsm/L), 5% hypertonic saline (75.6 +/- 1.3%, 339 +/- 16 mOsm/L), and 7.5% hypertonic saline (74.9 +/- 0.7%, 360 +/- 23 mOsm/L) significantly attenuated lung water content. Hemispheric brain water content increased both in the ipsilateral ischemic and contralateral hemispheres treated with saline (ipsilateral, 85.1 +/- 1.7%; contralateral, 80.7 +/- 0.7%), compared with sham-operated controls (ipsilateral, 79.6 +/- 0.9%; contralateral, 79.5 +/- 0.9%), as well as in rats that received no fluids (ipsilateral, 84.6 +/- 1.8%; contralateral, 80.4 +/- 0.9%). Treatment with 5% hypertonic saline (ipsilateral, 83.8 +/- 1.0%; contralateral, 79.7 +/- 0.6%) and 7.5% hypertonic saline (ipsilateral, 82.3 +/- 1.3%; contralateral, 78.6 +/- 0.7%) resulted in attenuation of stroke-associated increases in brain water content to a greater extent than mannitol (ipsilateral, 83.6 +/- 1.6%; contralateral, 79.1 +/- 1.0%). CONCLUSIONS In a well-characterized animal model of large ischemic stroke, total lung water content increases, which is likely neurogenic in origin. Attenuation of stroke-associated increases in lung and brain water content with continuous infusion of hypertonic saline may have therapeutic implication in the treatment of cerebral and pulmonary edema following ischemic stroke.
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Affiliation(s)
- Thomas J K Toung
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lahlou S, Araújo Lima PF, Interaminense LFL, Duarte GP. Blunted central bromocriptine-induced tachycardia in conscious, malnourished rats. PHARMACOLOGY & TOXICOLOGY 2003; 92:189-94. [PMID: 12753422 DOI: 10.1034/j.1600-0773.2003.920409.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Bromocriptine-induced tachycardia, persisting after adrenalectomy, is mediated by central dopamine D2 receptor stimulation through activation of the sympathetic outflow to the heart. The present study investigated the effects of malnutrition during pregnancy on bromocriptine-induced tachycardia in adult conscious rats. Malnourished rats were obtained by feeding dams a multideficient diet (providing 8% protein) during mating and pregnancy. Birth weight was significantly reduced in malnourished rats when compared to control rats born to dams fed standard commercially diet (23% protein) during mating and pregnancy. Baseline mean aortic pressure and heart rate in malnourished rats were comparable to those of well-nourished rats. Tachycardia (33+/-9 beats/min.), but not the hypotensive response to intravenous bromocriptine (150 microg/kg) was significantly reduced in malnourished rats, compared with control rats (70+/-10 beats/min.). In malnourished rats, pretreatment with intravenous domperidone (500 microg/kg) blocked the bromocriptine-induced hypotension, without affecting the tachycardia. Neither cardiac vagal (40+/-6 beats/min.) nor sympathetic tone (76+/-6 beats/min.) was significantly altered by multideficient diet-induced malnutrition (51+/-6 and 67+/-10 beats/min., respectively). In isolated perfused heart preparations from malnourished rats, positive inotropic response to isoproterenol (10-8 to 10-4 M) was not significantly different compared to that in control rats. In summary, malnutrition during foetal life blunted the bromocriptine-induced tachycardia, an effect that could be related to central dopamine D2 receptor desensitization rather than to impairment of autonomic regulation of the heart or cardiac beta-adrenoceptor desensitization.
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Affiliation(s)
- Saad Lahlou
- Depart,ent of Physiology and Pharmacology, Center of Biological Sciences, Federal University of Pernambuco, 50670-901 Recife, PE, Brazil.
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Rehman HU. Neurogenic pulmonary oedema. Emerg Med Australas 2000. [DOI: 10.1046/j.1442-2026.2000.00082.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chapter VII Brain kallikrein–kinin system: from receptors to neuronal pathways and physiological functions. HANDBOOK OF CHEMICAL NEUROANATOMY 2000. [DOI: 10.1016/s0924-8196(00)80009-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Abstract
Since endothelins were discovered by Yanasigawa in 1988 it has been recognised that they may have an important role in lung pathophysiology. Despite their biological importance as vasoconstrictors the physiological role of endothelin has not yet been defined within the lungs. This review explores their role in acute and chronic disease. During acute inflammation and ischaemia-reperfusion injury cytokines may induce release of endothelin. This is important in the realm of acute lung injury and during surgical procedures such as cardiopulmonary operations including lung resections and transplantation. Complications of surgery including primary organ failure resulting in poor gas exchange as well as increased pulmonary vascular resistance have been linked to the presence of excessive endothelin. Endothelin may have an important role in transplantation biology. The complex process leading to successful lung transplantation includes optimising the donor with brain death, harvesting the lungs, managing acute and chronic rejection, and protecting the vital organs from toxic effects of immunosuppressants. During chronic disease processes, the mitotic action of endothelin may be important in vascular and airway remodelling by means of smooth muscle cell proliferation. We also explore recent advances in drug development, animal models and future directions for research.
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Affiliation(s)
- M J Boscoe
- Heart Science Centre, Royol Brompton and Harefield Hospital NHS Trust, Harefield, Middlesex, UK
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