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Nocentini G, MacLaren G, Bartlett R, De Luca D, Perdichizzi S, Stoppa F, Marano M, Cecchetti C, Biasucci DG, Polito A, AlGhobaishi A, Guner Y, Gowda SH, Hirschl RB, Di Nardo M. Perfluorocarbons in Research and Clinical Practice: A Narrative Review. ASAIO J 2023; 69:1039-1048. [PMID: 37549675 DOI: 10.1097/mat.0000000000002017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Perfluorocarbons (PFCs) are organic liquids derived from hydrocarbons in which some of the hydrogen atoms have been replaced by fluorine atoms. They are chemically and biologically inert substances with a good safety profile. They are stable at room temperature, easy to store, and immiscible in water. Perfluorocarbons have been studied in biomedical research since 1960 for their unique properties as oxygen carriers. In particular, PFCs have been used for liquid ventilation in unusual environments such as deep-sea diving and simulations of zero gravity, and more recently for drug delivery and diagnostic imaging. Additionally, when delivered as emulsions, PFCs have been used as red blood cell substitutes. This narrative review will discuss the multifaceted utilization of PFCs in therapeutics, diagnostics, and research. We will specifically emphasize the potential role of PFCs as red blood cell substitutes, as airway mechanotransducers during artificial placenta procedures, as a means to improve donor organ perfusion during the ex vivo assessment, and as an adjunct in cancer therapies because of their ability to reduce local tissue hypoxia.
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Affiliation(s)
- Giulia Nocentini
- From the Academic Department of Pediatrics (DPUO), Immune and Infectious Diseases Division, Research Unit of Primary Immunodeficiencies, IRCCS Bmbino Gesù Children's Hospital, Rome, Italy
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, National University Health System, Singapore
| | - Robert Bartlett
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
| | | | - Francesca Stoppa
- Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Marco Marano
- Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Daniele G Biasucci
- Department of Clinical Science and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - Angelo Polito
- Pediatric Intensive Care Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Abdullah AlGhobaishi
- Pediatric Critical Care Unit, Department of Pediatrics, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Yit Guner
- Department of Pediatric Surgery, Children's Hospital of Orange County and University of California Irvine, Orange, California
| | - Sharada H Gowda
- Departments of Surgery and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
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Huang X, Liu Z, Quan ZS, Guo HY, Shen QK. Synthesis and structure-activity relationship studies of fusidic acid derivatives as anti-inflammatory agents for acute lung injury. Bioorg Chem 2023; 141:106885. [PMID: 37804700 DOI: 10.1016/j.bioorg.2023.106885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/09/2023]
Abstract
Acute lung injury (ALI) are severe forms of diffuse lung disease that impose a substantial health burden all over the world. In the United States, approximately 190,000 cases per year of ALI each year, with an associated 74,500 deaths per year. Anti-inflammatory therapy has become a reasonable approach for the treatment of patients with ALI. In this study, fusidic acid derivatives were used to design new anti-inflammatory compounds with high pharmacological activity and low toxicity. A total of 30 new fusidic acid derivatives were discovered, synthesized, and screened for their anti-inflammatory activity against lipopolysaccharide (LPS)-treated RAW264.7 cells. Of them, b2 was found to be the most active, with a higher efficiency compared with fusidic acid and celecoxib in 10 μM. In vitro, we further measured b2 inhibited inflammatory factor NO (IC50 = 5.382 ± 0.655 μM), IL-6 (IC50 = 7.767 ± 0.871 μM), and TNF-α (IC50 = 7.089 ± 0.775 μM) and b2 inhibited inflammatory cytokines COX-2 and iNOS, ROS production, NF-κB/MAPK and Bax/Bcl-2 signaling pathway pathway. In vivo,b2 attenuated ALI pathological changes and inhibited inflammatory cytokines COX-2 and iNOS in lung tissue and NF-κB/MAPK and Bax/Bcl-2 signaling pathway. In conclusion, b2 may be a promising anti-inflammatory lead compound.
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Affiliation(s)
- Xing Huang
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji, Jilin 133002, China
| | - Zheng Liu
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji, Jilin 133002, China
| | - Zhe-Shan Quan
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji, Jilin 133002, China.
| | - Hong-Yan Guo
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji, Jilin 133002, China.
| | - Qing-Kun Shen
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji, Jilin 133002, China.
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3
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Li G, Xu X, Zuo YY. Biophysical function of pulmonary surfactant in liquid ventilation. Biophys J 2023; 122:3099-3107. [PMID: 37353933 PMCID: PMC10432212 DOI: 10.1016/j.bpj.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/18/2023] [Accepted: 06/20/2023] [Indexed: 06/25/2023] Open
Abstract
Liquid ventilation is a mechanical ventilation technique in which the entire or part of the lung is filled with oxygenated perfluorocarbon (PFC) liquids rather than air in conventional mechanical ventilation. Despite its many ideal biophysicochemical properties for assisting liquid breathing, a general misconception about PFC is to use it as a replacement for pulmonary surfactant. Because of the high PFC-water interfacial tension (59 mN/m), pulmonary surfactant is indispensable in liquid ventilation to increase lung compliance. However, the biophysical function of pulmonary surfactant in liquid ventilation is still unknown. Here, we have studied the adsorption and dynamic surface activity of a natural surfactant preparation, Infasurf, at the PFC-water interface using constrained drop surfactometry. The constrained drop surfactometry is capable of simulating the intra-alveolar microenvironment of liquid ventilation under physiologically relevant conditions. It was found that Infasurf adsorbed to the PFC-water interface reduces the PFC-water interfacial tension from 59 mN/m to an equilibrium value of 9 mN/m within seconds. Atomic force microscopy revealed that after de novo adsorption, Infasurf forms multilayered structures at the PFC-water interface with an average thickness of 10-20 nm, depending on the adsorbing surfactant concentration. It was found that the adsorbed Infasurf film is capable of regulating the interfacial tension of the PFC-water interface within a narrow range, between ∼12 and ∼1 mN/m, during dynamic compression-expansion cycles that mimic liquid ventilation. These findings have novel implications in understanding the physiological and biophysical functions of the pulmonary surfactant film at the PFC-water interface, and may offer new translational insights into the development of liquid ventilation and liquid breathing techniques.
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Affiliation(s)
- Guangle Li
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Xiaojie Xu
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Yi Y Zuo
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii; Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.
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Renard Triché L, Futier E, De Carvalho M, Piñol-Domenech N, Bodet-Contentin L, Jabaudon M, Pereira B. Sample size estimation in clinical trials using ventilator-free days as the primary outcome: a systematic review. Crit Care 2023; 27:303. [PMID: 37528425 PMCID: PMC10394791 DOI: 10.1186/s13054-023-04562-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/04/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Ventilator-free days (VFDs) are a composite endpoint increasingly used as the primary outcome in critical care trials. However, because of the skewed distribution and competitive risk between components, sample size estimation remains challenging. This systematic review was conducted to systematically assess whether the sample size was congruent, as calculated to evaluate VFDs in trials, with VFDs' distribution and the impact of alternative methods on sample size estimation. METHODS A systematic literature search was conducted within the PubMed and Embase databases for randomized clinical trials in adults with VFDs as the primary outcome until December 2021. We focused on peer-reviewed journals with 2021 impact factors greater than five. After reviewing definitions of VFDs, we extracted the sample size and methods used for its estimation. The data were collected by two independent investigators and recorded in a standardized, pilot-tested forms tool. Sample sizes were calculated using alternative statistical approaches, and risks of bias were assessed with the Cochrane risk-of-bias tool. RESULTS Of the 26 clinical trials included, 19 (73%) raised "some concerns" when assessing risks of bias. Twenty-four (92%) trials were two-arm superiority trials, and 23 (89%) were conducted at multiple sites. Almost all the trials (96%) were unable to consider the unique distribution of VFDs and death as a competitive risk. Moreover, significant heterogeneity was found in the definitions of VFDs, especially regarding varying start time and type of respiratory support. Methods for sample size estimation were also heterogeneous, and simple models, such as the Mann-Whitney-Wilcoxon rank-sum test, were used in 14 (54%) trials. Finally, the sample sizes calculated varied by a factor of 1.6 to 17.4. CONCLUSIONS A standardized definition and methodology for VFDs, including the use of a core outcome set, seems to be required. Indeed, this could facilitate the interpretation of findings in clinical trials, as well as their construction, especially the sample size estimation which is a trade-off between cost, ethics, and statistical power. Systematic review registration PROSPERO ID: CRD42021282304. Registered 15 December 2021 ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021282304 ).
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Affiliation(s)
- Laurent Renard Triché
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France. lrenard--
| | - Emmanuel Futier
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
- iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | | | | | - Laëtitia Bodet-Contentin
- Medical Intensive Care Unit, CHRU de Tours, Tours, France
- INSERM, SPHERE, UMR1246, Université de Tours et Nantes, Tours et Nantes, France
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
- iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit, Department of Clinical Research, and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
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Tsagogiorgas C, Otto M. Semifluorinated Alkanes as New Drug Carriers-An Overview of Potential Medical and Clinical Applications. Pharmaceutics 2023; 15:pharmaceutics15041211. [PMID: 37111696 PMCID: PMC10146824 DOI: 10.3390/pharmaceutics15041211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
Fluorinated compounds have been used in clinical and biomedical applications for years. The newer class of semifluorinated alkanes (SFAs) has very interesting physicochemical properties including high gas solubility (e.g., for oxygen) and low surface tensions, such as the well-known perfluorocarbons (PFC). Due to their high propensity to assemble to interfaces, they can be used to formulate a variety of multiphase colloidal systems, including direct and reverse fluorocarbon emulsions, microbubbles and nanoemulsions, gels, dispersions, suspensions and aerosols. In addition, SFAs can dissolve lipophilic drugs and thus be used as new drug carriers or in new formulations. In vitreoretinal surgery and as eye drops, SFAs have become part of daily clinical practice. This review provides brief background information on the fluorinated compounds used in medicine and discusses the physicochemical properties and biocompatibility of SFAs. The clinically established use in vitreoretinal surgery and new developments in drug delivery as eye drops are described. The potential clinical applications for oxygen transport by SFAs as pure fluids into the lungs or as intravenous applications of SFA emulsions are presented. Finally, aspects of drug delivery with SFAs as topical, oral, intravenous (systemic) and pulmonary applications as well as protein delivery are covered. This manuscript provides an overview of the (potential) medical applications of semifluorinated alkanes. The databases of PubMed and Medline were searched until January 2023.
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Affiliation(s)
- Charalambos Tsagogiorgas
- Department of Anaesthesiology and Critical Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
- Department of Anaesthesiology and Critical Care Medicine, St. Elisabethen-Krankenhaus, Teaching Hospital of the University of Frankfurt, 60487 Frankfurt, Germany
| | - Matthias Otto
- Department of Anaesthesiology and Critical Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
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Spin and fragility in anaesthesia studies: when sirens sing into anaesthetists' ears. Br J Anaesth 2023; 130:507-510. [PMID: 36931963 DOI: 10.1016/j.bja.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
Spin and fragility are common in randomised controlled trials published in anaesthesia journals. Staying with the facts and addressing only the primary endpoint in the conclusion of clinical research reports might help reduce spin. Routinely reporting the fragility index, in turn, could deliver information about robustness, enhancing the transparency of positive dichotomous results. It is in the best interest of clinical research that authors, reviewers, and journals come together to reduce spin and address the fragility of randomised controlled trials.
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Saha R, Assouline B, Mason G, Douiri A, Summers C, Shankar-Har M. The Impact of Sample Size Misestimations on the Interpretation of ARDS Trials: Systematic Review and Meta-analysis. Chest 2022; 162:1048-1062. [PMID: 35643115 DOI: 10.1016/j.chest.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/06/2022] [Accepted: 05/04/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Indeterminate randomized controlled trials (RCTs) in ARDS may arise from sample size misspecification, leading to abandonment of efficacious therapies. RESEARCH QUESTIONS If evidence exists for sample size misspecification in ARDS RCTs, has this led to rejection of potentially beneficial therapies? Does evidence exist for prognostic enrichment in RCTs using mortality as a primary outcome? STUDY DESIGN AND METHODS We identified 150 ARDS RCTs commencing recruitment after the 1994 American European Consensus Conference ARDS definition and published before October 31, 2020. We examined predicted-observed sample size, predicted-observed control event rate (CER), predicted-observed average treatment effect (ATE), and the relationship between observed CER and observed ATE for RCTs with mortality and nonmortality primary outcome measures. To quantify the strength of evidence, we used Bayesian-averaged meta-analysis, trial sequential analysis, and Bayes factors. RESULTS Only 84 of 150 RCTs (56.0%) reported sample size estimations. In RCTs with mortality as the primary outcome, CER was overestimated in 16 of 28 RCTs (57.1%). To achieve predicted ATE, interventions needed to prevent 40.8% of all deaths, compared with the original prediction of 29.3%. Absolute reduction in mortality ≥ 10% was observed in 5 of 28 RCTs (17.9%), but predicted in 21 of 28 RCTs (75%). For RCTs with mortality as the primary outcome, no association was found between observed CER and observed ATE (pooled OR: β = -0.04; 95% credible interval, -0.18 to 0.09). We identified three interventions that are not currently standard of care with a Bayesian-averaged effect size of > 0.20 and moderate strength of existing evidence: corticosteroids, airway pressure release ventilation, and noninvasive ventilation. INTERPRETATION Reporting of sample size estimations was inconsistent in ARDS RCTs, and misspecification of CER and ATE was common. Prognostic enrichment strategies in ARDS RCTs based on all-cause mortality are unlikely to be successful. Bayesian methods can be used to prioritize interventions for future effectiveness RCTs.
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Affiliation(s)
- Rohit Saha
- Critical Care Centre, King's College London, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Benjamin Assouline
- Service de Médecine Intensive Réanimation, Faculté de Médecine Sorbonne Université, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Georgina Mason
- Critical Care Centre, King's College London, London, United Kingdom
| | - Abdel Douiri
- School of Population Health & Environmental Sciences, King's College London, London, United Kingdom; National Institute for Health Research Comprehensive Biomedical Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Charlotte Summers
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Manu Shankar-Har
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom.
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Alapati D, Shaffer TH. Administration of Drugs/Gene Products to the Respiratory System: A Historical Perspective of the Use of Inert Liquids. Front Physiol 2022; 13:871893. [PMID: 35620598 PMCID: PMC9127416 DOI: 10.3389/fphys.2022.871893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/31/2022] [Indexed: 11/20/2022] Open
Abstract
The present review is a historical perspective of methodology and applications using inert liquids for respiratory support and as a vehicle to deliver biological agents to the respiratory system. As such, the background of using oxygenated inert liquids (considered a drug when used in the lungs) opposed to an oxygen-nitrogen gas mixture for respiratory support is presented. The properties of these inert liquids and the mechanisms of gas exchange and lung function alterations using this technology are described. In addition, published preclinical and clinical trial results are discussed with respect to treatment modalities for respiratory diseases. Finally, this forward-looking review provides a comprehensive overview of potential methods for administration of drugs/gene products to the respiratory system and potential biomedical applications.
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Affiliation(s)
- Deepthi Alapati
- Nemours Children’s Health, Wilmington, DE, United States
- Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA, United States
- *Correspondence: Deepthi Alapati, ; Thomas H. Shaffer,
| | - Thomas H. Shaffer
- Nemours Children’s Health, Wilmington, DE, United States
- Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA, United States
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
- *Correspondence: Deepthi Alapati, ; Thomas H. Shaffer,
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Liquid Ventilation in the Management of Preterm Infants. CURRENT STEM CELL REPORTS 2021. [DOI: 10.1007/s40778-021-00192-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Saha R, Assouline B, Mason G, Douiri A, Summers C, Shankar-Hari M. Impact of differences in acute respiratory distress syndrome randomised controlled trial inclusion and exclusion criteria: systematic review and meta-analysis. Br J Anaesth 2021; 127:85-101. [PMID: 33812666 PMCID: PMC9768208 DOI: 10.1016/j.bja.2021.02.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/31/2021] [Accepted: 02/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Control-arm mortality varies between acute respiratory distress syndrome (ARDS) RCTs. METHODS We systematically reviewed ARDS RCTs that commenced recruitment after publication of the American-European Consensus (AECC) definition (MEDLINE, Embase, and Cochrane central register of controlled trials; January 1994 to October 2020). We assessed concordance of RCT inclusion criteria to ARDS consensus definitions and whether exclusion criteria are strongly or poorly justified. We estimated the proportion of between-trial difference in control-arm 28-day mortality explained by the inclusion criteria and RCT design characteristics using meta-regression. RESULTS A literature search identified 43 709 records. One hundred and fifty ARDS RCTs were included; 146/150 (97.3%) RCTs defined ARDS inclusion criteria using AECC/Berlin definitions. Deviations from consensus definitions, primarily aimed at improving ARDS diagnostic certainty, frequently related to duration of hypoxaemia (117/146; 80.1%). Exclusion criteria could be grouped by rationale for selection into strongly or poorly justified criteria. Common poorly justified exclusions included pregnancy related, age, and comorbidities (infectious/immunosuppression, hepatic, renal, and human immunodeficiency virus/acquired immunodeficiency syndrome). Control-arm 28-day mortality varied between ARDS RCTs (mean: 29.8% [95% confidence interval: 27.0-32.7%; I2=88.8%; τ2=0.02; P<0.01]), and differed significantly between RCTs with different Pao2:FiO2 ratio inclusion thresholds (26.6-39.9 kPa vs <26.6 kPa; P<0.01). In a meta-regression model, inclusion criteria and RCT design characteristics accounted for 30.6% of between-trial difference (P<0.01). CONCLUSIONS In most ARDS RCTs, consensus definitions are modified to use as inclusion criteria. Between-RCT mortality differences are mostly explained by the Pao2:FiO2 ratio threshold within the consensus definitions. An exclusion criteria framework can be applied when designing and reporting exclusion criteria in future ARDS RCTs.
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Affiliation(s)
- Rohit Saha
- Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Georgina Mason
- Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Abdel Douiri
- School of Population Health & Environmental Sciences, King's College London, London, UK,National Institute for Health Research Comprehensive Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Manu Shankar-Hari
- Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK,School of Immunology & Microbial Sciences, King's College London, London, UK,Corresponding author
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11
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Eichenwald C, Dysart K, Zhang H, Fox W. Neonatal Partial Liquid Ventilation for the Treatment and Prevention of Bronchopulmonary Dysplasia. Neoreviews 2020; 21:e238-e248. [PMID: 32238486 DOI: 10.1542/neo.21-4-e238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Connor Eichenwald
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kevin Dysart
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Huayan Zhang
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - William Fox
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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12
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Rieger-Fackeldey E, Jonzon A, Schulze A, Sedin G, Sindelar R. Pulmonary stretch receptor activity during partial liquid ventilation with different pressure waveforms. Respir Physiol Neurobiol 2020; 276:103413. [PMID: 32044447 DOI: 10.1016/j.resp.2020.103413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of the present study was to investigate pulmonary stretch receptor activity (PSR) under different peak inspiratory pressures (PIPs) and inspiratory pressure waveforms during partial liquid (PLV) and gas ventilation (GV). METHODS PSR instantaneous impulse frequency (PSRfimp) was recorded from single fibers in the vagal nerve during PLV and GV in young cats. PIPs were set at 1.2/1.8/2.2/2.7 kPa, and square and sinusoidal pressure waveforms were applied. RESULTS PSRfimp at the start of inspiration increased with increasing PIPs, and was steeper and higher with square than with sinusoidal waveforms (p < 0.05). Total number of impulses, peak and mean PSRfimp were lower during PLV than GV at the lowest and highest PIPs (p < 0.025). Time to peak PSRfimp was shorter with square than with sinusoidal waveforms at all pressures and ventilations (p < 0.005). Irrespective of waveform, lower PIPs yielded lower ventilation during PLV. CONCLUSION As assessed by PSRfimp, increased PIPs do not expose the lungs to more stretching during PLV than during GV, with only minor differences between square and sinusoidal waveforms.
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Affiliation(s)
- Esther Rieger-Fackeldey
- Department of Women´s and Children´s Health, Section for Pediatrics, Uppsala University, Uppsala, Sweden; Perinatal Center, Neonatology, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Pediatrics, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Anders Jonzon
- Department of Women´s and Children´s Health, Section for Pediatrics, Uppsala University, Uppsala, Sweden.
| | - Andreas Schulze
- Perinatal Center, Neonatology, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany.
| | - Gunnar Sedin
- Department of Women´s and Children´s Health, Section for Pediatrics, Uppsala University, Uppsala, Sweden
| | - Richard Sindelar
- Department of Women´s and Children´s Health, Section for Pediatrics, Uppsala University, Uppsala, Sweden.
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13
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Zhang Z, Li H, Liang Z, Li C, Yang Z, Li Y, Cao L, She Y, Wang W, Liu C, Chen L. Vaporized perfluorocarbon inhalation attenuates primary blast lung injury in canines by inhibiting mitogen-activated protein kinase/nuclear factor-κB activation and inducing nuclear factor, erythroid 2 like 2 pathway. Toxicol Lett 2020; 319:49-57. [DOI: 10.1016/j.toxlet.2019.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/19/2019] [Accepted: 10/22/2019] [Indexed: 02/07/2023]
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14
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Guo B, Bai Y, Ma Y, Liu C, Wang S, Zhao R, Dong J, Ji HL. Preclinical and clinical studies of smoke-inhalation-induced acute lung injury: update on both pathogenesis and innovative therapy. Ther Adv Respir Dis 2019; 13:1753466619847901. [PMID: 31068086 PMCID: PMC6515845 DOI: 10.1177/1753466619847901] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Smoke-inhalation-induced acute lung injury (SI-ALI) is a leading cause of morbidity and mortality in victims of fire tragedies. SI-ALI contributes to an estimated 30% of burn-caused patient deaths, and recently, more attention has been paid to the specific interventions for this devastating respiratory illness. In the last decade, much progress has been made in the understanding of SI-ALI patho-mechanisms and in the development of new therapeutic strategies in both preclinical and clinical studies. This article reviews the recent progress in the treatment of SI-ALI, based on pathophysiology, thermal damage, airway obstruction, the nuclear-factor kappa-B signaling pathway, and oxidative stress. Preclinical therapeutic strategies include use of mesenchymal stem cells, hydrogen sulfide, peroxynitrite decomposition catalysts, and proton-pump inhibitors. Clinical interventions include high-frequency percussive ventilation, perfluorohexane, inhaled anticoagulants, and nebulized epinephrine. The animal model, dose, clinical application, and pharmacology of these medications are summarized. Future directions and further needs for developing innovative therapies are discussed.
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Affiliation(s)
- Bingxin Guo
- Institute of Lung and Molecular Therapy, Xinxiang Medical University, Xinxiang Henan, China
| | - Yichun Bai
- Institute of Lung and Molecular Therapy, Xinxiang Medical University, Xinxiang Henan, China
| | - Yana Ma
- Institute of Lung and Molecular Therapy, Xinxiang Medical University, Xinxiang Henan, China
| | - Cong Liu
- Institute of Lung and Molecular Therapy, Xinxiang Medical University, Xinxiang Henan, China
| | - Song Wang
- Institute of Lung and Molecular Therapy, Xinxiang Medical University, Xinxiang Henan, China
| | - Runzhen Zhao
- Department of Cellular and Molecular Biology, University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - Jiaxing Dong
- Institute of Lung and Molecular Therapy, Xinxiang Medical University, Xinxiang Henan, China
| | - Hong-Long Ji
- Texas Lung Injury Institute, University of Texas Health Science Center at Tyler, Tyler, TX, USA
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16
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Degnan AJ, Fox WW, Zhang H, Saul D. Partial liquid ventilation for bronchopulmonary dysplasia: Visualizing ventilation patterns on chest radiographs. Pediatr Neonatol 2019; 60:587-588. [PMID: 30448214 DOI: 10.1016/j.pedneo.2018.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/09/2018] [Accepted: 10/25/2018] [Indexed: 12/01/2022] Open
Affiliation(s)
- Andrew J Degnan
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - William W Fox
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Division of Neonatology and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Huayan Zhang
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Division of Neonatology and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David Saul
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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17
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A new paradigm for lung-conservative total liquid ventilation. EBioMedicine 2019; 52:102365. [PMID: 31447395 PMCID: PMC7033528 DOI: 10.1016/j.ebiom.2019.08.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 12/23/2022] Open
Abstract
Background Total liquid ventilation (TLV) of the lungs could provide radically new benefits in critically ill patients requiring lung lavage or ultra-fast cooling after cardiac arrest. It consists in an initial filling of the lungs with perfluorocarbons and subsequent tidal ventilation using a dedicated liquid ventilator. Here, we propose a new paradigm for a lung-conservative TLV using pulmonary volumes of perfluorocarbons below functional residual capacity (FRC). Methods and findings Using a dedicated technology, we showed that perfluorocarbon end-expiratory volumes could be maintained below expected FRC and lead to better respiratory recovery, preserved lung structure and accelerated evaporation of liquid residues as compared to complete lung filling in piglets. Such TLV below FRC prevented volutrauma through preservation of alveolar recruitment reserve. When used with temperature-controlled perfluorocarbons, this lung-conservative approach provided neuroprotective ultra-fast cooling in a model of hypoxic-ischemic encephalopathy. The scale-up and automating of the technology confirmed that incomplete initial lung filling during TLV was beneficial in human adult-sized pigs, despite larger size and maturity of the lungs. Our results were confirmed in aged non-human primates, confirming the safety of this lung-conservative approach. Interpretation This study demonstrated that TLV with an accurate control of perfluorocarbon volume below FRC could provide the full potential of TLV in an innovative and safe manner. This constitutes a new paradigm through the tidal liquid ventilation of incompletely filled lungs, which strongly differs from the previously known TLV approach, opening promising perspectives for a safer clinical translation. Fund ANR (COOLIVENT), FRM (DBS20140930781), SATT IdfInnov (project 273).
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Experimental Evaluation of Perfluorocarbon Aerosol Generation with Two Novel Nebulizer Prototypes. Pharmaceutics 2019; 11:pharmaceutics11010019. [PMID: 30621300 PMCID: PMC6358822 DOI: 10.3390/pharmaceutics11010019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/22/2018] [Accepted: 12/30/2018] [Indexed: 12/13/2022] Open
Abstract
The potential of non-invasive ventilation procedures and new minimally invasive techniques has resulted in the research of alternative approaches as the aerosolization for the treatment of respiratory distress syndrome (RDS). The aim of this work was to design two nebulizer prototypes and to evaluate them studying the particle size distribution of the inhaled droplets generated with distilled water and two perfluorocarbons (PFCs). Different experiments were performed with driving pressures of 1–3 bar for each compound. An Aerodynamic Particle Sizer was used to measure the aerodynamic diameter (Da), the mass median aerodynamic diameter (MMAD) and the geometric standard deviation (GSD). The results showed that both prototypes produced heterodisperse aerosols with Da mean values in all cases below 5 µm. The initial experiments with distilled water showed MMAD values lower than 9 µm and up to 15 µm with prototype 1 and prototype 2, respectively. Regarding the PFCs, relatively uniform MMAD values close to 12 µm were achieved. The air delivery with outer lumens of prototype 1 presented more suitable mass distribution for the generation and delivery of a uniform aerosol than the two half-circular ring geometry proposed in the prototype 2.
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19
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Design, synthesis and biological evaluation of novel 2-sulfonylindoles as potential anti-inflammatory therapeutic agents for treatment of acute lung injury. Eur J Med Chem 2018; 160:120-132. [DOI: 10.1016/j.ejmech.2018.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/11/2018] [Accepted: 10/07/2018] [Indexed: 01/10/2023]
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Xu X, Zhang R, Liu F, Ping J, Wen X, Wang H, Wang K, Sun X, Zou H, Shen B, Wu L. 19F MRI in orthotopic cancer model via intratracheal administration of ανβ3-targeted perfluorocarbon nanoparticles. Nanomedicine (Lond) 2018; 13:2551-2562. [PMID: 30338723 DOI: 10.2217/nnm-2018-0051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Aim: To demonstrate the feasibility of intratracheal administration in orthotopic lung cancer model with 19F MRI. Materials & methods: αvβ3-integrin targeting ability of the perfluorocarbon (PFC) nanoparticles was tested. Orthotopic lung cancer model was established in rabbits under computed tomography guidance. αvβ3-targeted PFC nanoparticles were administrated intratracheally or intravenously, and 19F MRI was performed before and up to 24 h after administration. Results: The targeted PFC nanoparticles could bind with αvβ3-integrin. PFC concentrations in the tumors of intratracheal group after administration were significantly higher than intravenous group. Conclusion: Intratracheal administration of PFC nanoparticles was shown to be feasible and efficacious. 19F MRI with αvβ3-targeted PFC nanoparticles provided quantitative assessment of nanoparticles distribution and tumor angiogenesis.
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Affiliation(s)
- Xiuan Xu
- Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, Heilongjiang, PR China
- TOF-PET/CT/MR center, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
- Department of Medical Imaging, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Ruixin Zhang
- Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Fang Liu
- Department of Medical Imaging, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Jiaqi Ping
- Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, Heilongjiang, PR China
- TOF-PET/CT/MR center, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Xiaofei Wen
- Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, Heilongjiang, PR China
- TOF-PET/CT/MR center, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Hongbin Wang
- Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Kai Wang
- Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, Heilongjiang, PR China
- TOF-PET/CT/MR center, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Xilin Sun
- Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, Heilongjiang, PR China
- TOF-PET/CT/MR center, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Hongyan Zou
- Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, Heilongjiang, PR China
- TOF-PET/CT/MR center, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Baozhong Shen
- Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, Heilongjiang, PR China
- TOF-PET/CT/MR center, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Lina Wu
- Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, Heilongjiang, PR China
- TOF-PET/CT/MR center, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
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21
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Nelson DL, Zhao Y, Fabiilli ML, Cook KE. In vitro evaluation of lysophosphatidic acid delivery via reverse perfluorocarbon emulsions to enhance alveolar epithelial repair. Colloids Surf B Biointerfaces 2018; 169:411-417. [PMID: 29807339 DOI: 10.1016/j.colsurfb.2018.05.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Alveolar drug delivery is needed to enhance alveolar repair during acute respiratory distress syndrome. However, delivery of inhaled drugs is poor in this setting. Drug delivery via liquid perfluorocarbon emulsions could address this problem through better alveolar penetration and improved spatial distribution. Therefore, this study investigated the efficacy of the delivery of lysophosphatidic acid (LPA) growth factor to cultured alveolar epithelial cells via a perfluorocarbon emulsion. METHODS Murine alveolar epithelial cells were treated for 2 h with varying concentrations (0-10 μM) of LPA delivered via aqueous solution or PFC emulsion. Cell migration was evaluated 18 h post-treatment using a scratch assay. Barrier function was evaluated 1 h post-treatment using a permeability assay. Proliferation was evaluated 72 h post-treatment using a viability assay. RESULTS Partially due to emulsion creaming and stability, the effects of LPA were either diminished or completely hindered when delivered via emulsion versus aqueous. Migration increased significantly following treatment with the 10 μM emulsion (p < 10-3), but required twice the concentration to achieve an increase similar to aqueous LPA. Both barrier function and proliferation increased following aqueous treatment, but neither were significantly affected by the emulsion. CONCLUSIONS The availability and thus the biological effect of LPA is significantly blunted during emulsified delivery in vitro, and this attenuation depends on the specific cellular function examined. Thus, the cellular level effects of drug delivery to the lungs via PFC emulsion are likely to vary based on the drug and the effect it is intended to create.
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Affiliation(s)
- Diane L Nelson
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Scott Hall 4th Floor, Pittsburgh, PA, 15213, USA.
| | - Yutong Zhao
- Department of Medicine, University of Pittsburgh, Division of Pulmonary, Allergy and Critical Care Medicine, East 1200A Biomedical Science Tower, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| | - Mario L Fabiilli
- Department of Radiology, University of Michigan, 3226A Medical Sciences Building I, 1301 Catherine Street, Ann Arbor, MI, 48109, USA.
| | - Keith E Cook
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Scott Hall 4th Floor, Pittsburgh, PA, 15213, USA.
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22
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Rambaud J, Lidouren F, Sage M, Kohlhauer M, Nadeau M, Fortin-Pellerin É, Micheau P, Zilberstein L, Mongardon N, Ricard JD, Terada M, Bruneval P, Berdeaux A, Ghaleh B, Walti H, Tissier R. Hypothermic total liquid ventilation after experimental aspiration-associated acute respiratory distress syndrome. Ann Intensive Care 2018; 8:57. [PMID: 29721820 PMCID: PMC5931951 DOI: 10.1186/s13613-018-0404-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 04/23/2018] [Indexed: 12/20/2022] Open
Abstract
Background Ultrafast cooling by total liquid ventilation (TLV) provides potent cardio- and neuroprotection after experimental cardiac arrest. However, this was evaluated in animals with no initial lung injury, whereas out-of-hospital cardiac arrest is frequently associated with early-onset pneumonia, which may lead to acute respiratory distress syndrome (ARDS). Here, our objective was to determine whether hypothermic TLV could be safe or even beneficial in an aspiration-associated ARDS animal model. Methods ARDS was induced in anesthetized rabbits through a two-hits model including the intra-tracheal administration of a pH = 1 solution mimicking gastric content and subsequent gaseous non-protective ventilation during 90 min (tidal volume [Vt] = 10 ml/kg with positive end-expiration pressure [PEEP] = 0 cmH2O). After this initial period, animals either received lung protective gas ventilation (LPV; Vt = 8 ml/kg and PEEP = 5 cmH2O) under normothermic conditions, or hypothermic TLV (TLV; Vt = 8 ml/kg and end-expiratory volume = 15 ml/kg). Both strategies were applied for 120 min with a continuous monitoring of respiratory and cardiovascular parameters. Animals were then euthanized for pulmonary histological analyses. Results Eight rabbits were included in each group. Before randomization, all animals elicited ARDS with arterial oxygen partial pressure over inhaled oxygen fraction ratios (PaO2/FiO2) below 100 mmHg, as well as decreased lung compliance. After randomization, body temperature rapidly decreased in TLV versus LPV group (32.6 ± 0.6 vs. 38.2 ± 0.4 °C after 15 min). Static lung compliance and gas exchanges were not significantly different in the TLV versus LPV group (PaO2/FiO2 = 62 ± 4 vs. 52 ± 8 mmHg at the end of the procedure, respectively). Mean arterial pressure and arterial bicarbonates levels were significantly higher in TLV versus LPV. Histological analysis also showed significantly lower inflammation in TLV versus LPV group (median histological score = 3 vs. 4.5/5, respectively; p = 0.03). Conclusion Hypothermic TLV can be safely induced in rabbits during aspiration-associated ARDS. It modified neither gas exchanges nor respiratory mechanics but reduced lung inflammation and hemodynamic failure in comparison with LPV. Since hypothermic TLV was previously shown to provide neuro- and cardio protective effects after cardiac arrest, these findings suggest a possible use of TLV in the settings of cardiac arrest-associated ARDS.
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Affiliation(s)
- Jérôme Rambaud
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France.,Paediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, UPMC, APHP, Paris, France
| | - Fanny Lidouren
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Michaël Sage
- Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Matthias Kohlhauer
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | | | | | | | - Luca Zilberstein
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Nicolas Mongardon
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France.,Service d'Anesthésie et des Réanimations Chirurgicales, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Jean-Damien Ricard
- UMR 1137, Inserm, Université Paris Diderot, Hôpital Louis Mourier, Réanimation Médico-chirurgicale, APHP, Colombes, France
| | - Megumi Terada
- UMR 970, Inserm, Paris Cardiovascular Research Center, Hôpital Européen Georges Pompidou, Paris, France
| | - Patrick Bruneval
- UMR 970, Inserm, Paris Cardiovascular Research Center, Hôpital Européen Georges Pompidou, Paris, France
| | - Alain Berdeaux
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Bijan Ghaleh
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Hervé Walti
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Renaud Tissier
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France.
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23
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Tak S, Barraclough M. 'Pseudo-calcifications': detection of perfluorocarbon residue on a computed tomography scan 15 years after liquid ventilation therapy at 3 months of age. BMJ Case Rep 2018; 2018:bcr-2017-223958. [PMID: 29507033 DOI: 10.1136/bcr-2017-223958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Partial liquid ventilation using perfluorocarbons is a therapy that was once frequently used in paediatric populations for patients with severe respiratory distress. Perfluorocarbon is a non-toxic, insoluble and radiopaque vector through which improved gas exchange can occur. Two previous cases have been reported of persistent perfluorocarbon residua, identified on imaging years after receiving liquid ventilation therapy. We report a case of perfluorocarbon detection on a CT scan 15 years after liquid ventilation at 3 months of age, and propose the probable mechanism of its appearance. The importance of considering the imaging appearances of 'pseudo-calcifications' as a long-term sequela to perfluorocarbon liquid ventilation is emphasised.
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Affiliation(s)
- Sameem Tak
- Department of Paediatrics, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Mary Barraclough
- Department of Paediatrics, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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24
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Zhang H, Barralet JE. Mimicking oxygen delivery and waste removal functions of blood. Adv Drug Deliv Rev 2017; 122:84-104. [PMID: 28214553 DOI: 10.1016/j.addr.2017.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 12/20/2022]
Abstract
In addition to immunological and wound healing cell and platelet delivery, ion stasis and nutrient supply, blood delivers oxygen to cells and tissues and removes metabolic wastes. For decades researchers have been trying to develop approaches that mimic these two immediately vital functions of blood. Oxygen is crucial for the long-term survival of tissues and cells in vertebrates. Hypoxia (oxygen deficiency) and even at times anoxia (absence of oxygen) can occur during organ preservation, organ and cell transplantation, wound healing, in tumors and engineering of tissues. Different approaches have been developed to deliver oxygen to tissues and cells, including hyperbaric oxygen therapy (HBOT), normobaric hyperoxia therapy (NBOT), using biochemical reactions and electrolysis, employing liquids with high oxygen solubility, administering hemoglobin, myoglobin and red blood cells (RBCs), introducing oxygen-generating agents, using oxygen-carrying microparticles, persufflation, and peritoneal oxygenation. Metabolic waste accumulation is another issue in biological systems when blood flow is insufficient. Metabolic wastes change the microenvironment of cells and tissues, influence the metabolic activities of cells, and ultimately cause cell death. This review examines advances in blood mimicking systems in the field of biomedical engineering in terms of oxygen delivery and metabolic waste removal.
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Villar J, Suárez-Sipmann F, Kacmarek RM. Should the ART trial change our practice? J Thorac Dis 2017; 9:4871-4877. [PMID: 29312680 DOI: 10.21037/jtd.2017.11.01] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Multidisciplinary Organ Dysfunction Evaluation Research Network (MODERN), Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain.,Adjunct Scientist, Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael Hospital, Toronto, Canada
| | - Fernando Suárez-Sipmann
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Intensive Care Unit, Hospital Universitario La Fé, Valencia, Spain.,Department of Surgical Sciences, Anesthesiology & Critical Care, Hedenstierna Laboratory, Uppsala University Hospital, Uppsala, Sweden
| | - Robert M Kacmarek
- Department of Respiratory Care, Massachusetts General Hospital, Boston, MA, USA.,Department of Anesthesia and Critical Care, Harvard University, Boston, MA, USA
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Intratracheal Instillation of Perfluorohexane Modulates the Pulmonary Immune Microenvironment by Attenuating Early Inflammatory Factors in Patients With Smoke Inhalation Injury. J Burn Care Res 2017; 38:251-259. [DOI: 10.1097/bcr.0000000000000496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Kacmarek RM, Villar J. Noninvasive ventilatory management of the acute respiratory distress syndrome: a new era or just another tease! ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:350. [PMID: 27761454 DOI: 10.21037/atm.2016.08.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Robert M Kacmarek
- Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts, USA;; Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jesús Villar
- CIBER de Enfermedades respiratorias, Instituto de Salud Carlos III, Madrid, Spain;; Multidisciplinary Organ Dysfunction Evaluation Research Network, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
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Kohlhauer M, Berdeaux A, Kerber RE, Micheau P, Ghaleh B, Tissier R. Liquid Ventilation for the Induction of Ultrafast Hypothermia in Resuscitation Sciences: A Review. Ther Hypothermia Temp Manag 2016; 6:63-70. [DOI: 10.1089/ther.2015.0024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthias Kohlhauer
- Inserm, Unité 955, Equipe 03, Créteil, France
- Université Paris Est, UMR_S955, DHU A-TVB, UPEC, Créteil, France
- Université Paris Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort Cedex, France
| | - Alain Berdeaux
- Inserm, Unité 955, Equipe 03, Créteil, France
- Université Paris Est, UMR_S955, DHU A-TVB, UPEC, Créteil, France
- Université Paris Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort Cedex, France
| | - Richard E. Kerber
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Philippe Micheau
- Department of Mechanical Engineering, Université de Sherbrooke, Sherbrooke, Canada
| | - Bijan Ghaleh
- Inserm, Unité 955, Equipe 03, Créteil, France
- Université Paris Est, UMR_S955, DHU A-TVB, UPEC, Créteil, France
- Université Paris Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort Cedex, France
| | - Renaud Tissier
- Inserm, Unité 955, Equipe 03, Créteil, France
- Université Paris Est, UMR_S955, DHU A-TVB, UPEC, Créteil, France
- Université Paris Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort Cedex, France
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29
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Open Lung Approach for the Acute Respiratory Distress Syndrome: A Pilot, Randomized Controlled Trial. Crit Care Med 2016; 44:32-42. [PMID: 26672923 DOI: 10.1097/ccm.0000000000001383] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The open lung approach is a mechanical ventilation strategy involving lung recruitment and a decremental positive end-expiratory pressure trial. We compared the Acute Respiratory Distress Syndrome network protocol using low levels of positive end-expiratory pressure with open lung approach resulting in moderate to high levels of positive end-expiratory pressure for the management of established moderate/severe acute respiratory distress syndrome. DESIGN A prospective, multicenter, pilot, randomized controlled trial. SETTING A network of 20 multidisciplinary ICUs. PATIENTS Patients meeting the American-European Consensus Conference definition for acute respiratory distress syndrome were considered for the study. INTERVENTIONS At 12-36 hours after acute respiratory distress syndrome onset, patients were assessed under standardized ventilator settings (FIO2≥0.5, positive end-expiratory pressure ≥10 cm H2O). If Pao2/FIO2 ratio remained less than or equal to 200 mm Hg, patients were randomized to open lung approach or Acute Respiratory Distress Syndrome network protocol. All patients were ventilated with a tidal volume of 4 to 8 ml/kg predicted body weight. MEASUREMENTS AND MAIN RESULTS From 1,874 screened patients with acute respiratory distress syndrome, 200 were randomized: 99 to open lung approach and 101 to Acute Respiratory Distress Syndrome network protocol. Main outcome measures were 60-day and ICU mortalities, and ventilator-free days. Mortality at day-60 (29% open lung approach vs. 33% Acute Respiratory Distress Syndrome Network protocol, p = 0.18, log rank test), ICU mortality (25% open lung approach vs. 30% Acute Respiratory Distress Syndrome network protocol, p = 0.53 Fisher's exact test), and ventilator-free days (8 [0-20] open lung approach vs. 7 [0-20] d Acute Respiratory Distress Syndrome network protocol, p = 0.53 Wilcoxon rank test) were not significantly different. Airway driving pressure (plateau pressure - positive end-expiratory pressure) and PaO2/FIO2 improved significantly at 24, 48 and 72 hours in patients in open lung approach compared with patients in Acute Respiratory Distress Syndrome network protocol. Barotrauma rate was similar in both groups. CONCLUSIONS In patients with established acute respiratory distress syndrome, open lung approach improved oxygenation and driving pressure, without detrimental effects on mortality, ventilator-free days, or barotrauma. This pilot study supports the need for a large, multicenter trial using recruitment maneuvers and a decremental positive end-expiratory pressure trial in persistent acute respiratory distress syndrome.
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Wang C, Wang X, Chi C, Guo L, Guo L, Zhao N, Wang W, Pi X, Sun B, Lian A, Shi J, Li E. Lung ventilation strategies for acute respiratory distress syndrome: a systematic review and network meta-analysis. Sci Rep 2016; 6:22855. [PMID: 26955891 PMCID: PMC4783789 DOI: 10.1038/srep22855] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/23/2016] [Indexed: 02/03/2023] Open
Abstract
To identify the best lung ventilation strategy for acute respiratory distress syndrome (ARDS), we performed a network meta-analysis. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science were searched, and 36 eligible articles were included. Compared with higher tidal volumes with FiO2-guided lower positive end-expiratory pressure [PEEP], the hazard ratios (HRs) for mortality were 0.624 (95% confidence interval (CI) 0.419-0.98) for lower tidal volumes with FiO2-guided lower PEEP and prone positioning and 0.572 (0.34-0.968) for pressure-controlled ventilation with FiO2-guided lower PEEP. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning had the greatest potential to reduce mortality, and the possibility of receiving the first ranking was 61.6%. Permissive hypercapnia, recruitment maneuver, and low airway pressures were most likely to be the worst in terms of all-cause mortality. Compared with higher tidal volumes with FiO2-guided lower PEEP, pressure-controlled ventilation with FiO2-guided lower PEEP and lower tidal volumes with FiO2-guided lower PEEP and prone positioning ventilation are associated with lower mortality in ARDS patients. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning ventilation and lower tidal volumes with pressure-volume (P-V) static curve-guided individual PEEP are potential optimal strategies for ARDS patients.
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Affiliation(s)
- Changsong Wang
- Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.,Department of critical care medicine, the Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaoyang Wang
- Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.,Department of Anesthesiology, JILIN GUO WEN Hospital, Gongzhuling, China
| | - Chunjie Chi
- Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Libo Guo
- Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lei Guo
- Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Nana Zhao
- Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Weiwei Wang
- Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xin Pi
- Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bo Sun
- Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ailing Lian
- Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jinghui Shi
- Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Enyou Li
- Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
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Hypothermic Total Liquid Ventilation Is Highly Protective Through Cerebral Hemodynamic Preservation and Sepsis-Like Mitigation After Asphyxial Cardiac Arrest. Crit Care Med 2015; 43:e420-30. [PMID: 26110489 DOI: 10.1097/ccm.0000000000001160] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Total liquid ventilation provides ultrafast and potently neuro- and cardioprotective cooling after shockable cardiac arrest and myocardial infarction in animals. Our goal was to decipher the effect of hypothermic total liquid ventilation on the systemic and cerebral response to asphyxial cardiac arrest using an original pressure- and volume-controlled ventilation strategy in rabbits. DESIGN Randomized animal study. SETTING Academic research laboratory. SUBJECTS New Zealand Rabbits. INTERVENTIONS Thirty-six rabbits were submitted to 13 minutes of asphyxia, leading to cardiac arrest. After resumption of spontaneous circulation, they underwent either normothermic life support (control group, n = 12) or hypothermia induced by either 30 minutes of total liquid ventilation (total liquid ventilation group, n = 12) or IV cold saline (conventional cooling group, n = 12). MEASUREMENTS AND MAIN RESULTS Ultrafast cooling with total liquid ventilation (32 °C within 5 min in the esophagus) dramatically attenuated the post-cardiac arrest syndrome regarding survival, neurologic dysfunction, and histologic lesions (brain, heart, kidneys, liver, and lungs). Final survival rate achieved 58% versus 0% and 8% in total liquid ventilation, control, and conventional cooling groups (p < 0.05), respectively. This was accompanied by an early preservation of the blood-brain barrier integrity and cerebral hemodynamics as well as reduction in the immediate reactive oxygen species production in the brain, heart, and kidneys after cardiac arrest. Later on, total liquid ventilation also mitigated the systemic inflammatory response through alteration of monocyte chemoattractant protein-1, interleukin-1β, and interleukin-8 transcripts levels compared with control. In the conventional cooling group, cooling was achieved more slowly (32 °C within 90-120 min in the esophagus), providing none of the above-mentioned systemic or organ protection. CONCLUSIONS Ultrafast cooling by total liquid ventilation limits the post-cardiac arrest syndrome after asphyxial cardiac arrest in rabbits. This protection involves an early limitation in reactive oxidative species production, blood-brain barrier disruption, and delayed preservation against the systemic inflammatory response.
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Mychaliska G, Bryner B, Dechert R, Kreutzman J, Becker M, Hirschl R. Safety and efficacy of perflubron-induced lung growth in neonates with congenital diaphragmatic hernia: Results of a prospective randomized trial. J Pediatr Surg 2015; 50:1083-7. [PMID: 25799085 DOI: 10.1016/j.jpedsurg.2015.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Mechanical transduction has been shown to promote fetal lung growth. We examined the safety and efficacy of perflubron-induced lung growth (PILG) in neonates with congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO). METHODS Infants with left-sided CDH requiring ECMO were eligible. Exclusion criteria included active air leak, intracranial hemorrhage, major congenital anomalies, and oxygenation index >25 for 24hours. Perflubron was instilled endotracheally and continuous positive airway pressure was applied without ventilation. Survival to discharge was the primary outcome. Daily chest radiographs were used to quantify lung size (the secondary outcome). Midway through the study our institutional practice shifted toward earlier repair of CDH. RESULTS Eight infants were randomized to each arm. In the conventional-ventilation arm, six survived to discharge (75%). In the perflubron arm, four survived (50%); the others succumbed to suprasystemic pulmonary hypertension. No adverse events related to perflubron occurred. Within the perflubron group, 4/8 patients had "late repair" (15-19days of life [DOL]) and 4 had "early repair" (2-3 DOL). "Early repair" patients had similar total lung growth, but accelerated growth and shorter ECMO runs. CONCLUSION PILG is safe in CDH and doubles the total lung size on average (accelerated with early repair). Despite amelioration of pulmonary hypoplasia with PILG, pulmonary hypertension persists.
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Affiliation(s)
- George Mychaliska
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI.
| | - Benjamin Bryner
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Ronald Dechert
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Jeannie Kreutzman
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Mike Becker
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Ronald Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI
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Abstract
Human have lungs to breathe air and they have no gills to breath liquids like fish. When the surface tension at the air-liquid interface of the lung increases as in acute lung injury, scientists started to think about filling the lung with fluid instead of air to reduce the surface tension and facilitate ventilation. Liquid ventilation (LV) is a technique of mechanical ventilation in which the lungs are insufflated with an oxygenated perfluorochemical liquid rather than an oxygen-containing gas mixture. The use of perfluorochemicals, rather than nitrogen as the inert carrier of oxygen and carbon dioxide offers a number of advantages for the treatment of acute lung injury. In addition, there are non-respiratory applications with expanding potential including pulmonary drug delivery and radiographic imaging. It is well-known that respiratory diseases are one of the most common causes of morbidity and mortality in intensive care unit. During the past few years several new modalities of treatment have been introduced. One of them and probably the most fascinating, is of LV. Partial LV, on which much of the existing research has concentrated, requires partial filling of lungs with perfluorocarbons (PFC's) and ventilation with gas tidal volumes using conventional mechanical ventilators. Various physico-chemical properties of PFC's make them the ideal media. It results in a dramatic improvement in lung compliance and oxygenation and decline in mean airway pressure and oxygen requirements. No long-term side-effect reported.
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Affiliation(s)
- Suman Sarkar
- Department of Anesthesiology, West Bengal Medical Education Service, West Bengal, India
| | - Anil Paswan
- Department of Anesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - S Prakas
- Department of Anesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Kakiuchi K, Matsuda K, Harii N, Sou K, Aoki J, Takeoka S. Establishment of a total liquid ventilation system using saline-based oxygen micro/nano-bubble dispersions in rats. J Artif Organs 2015; 18:220-7. [PMID: 25854604 DOI: 10.1007/s10047-015-0835-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
Micro/nano-bubbles are practical nanomaterials designed to increase the gas content in liquids. We attempted to use oxygen micro/nano-bubble dispersions as an oxygen-rich liquid as a means for total liquid ventilation. To determine the oxygen content in the bubble dispersion, a new method based on a spectrophotometric change between oxy- and deoxy-hemoglobin was established. The oxygen micro/nano-bubble dispersion was supplied to an experimental total ventilation liquid in anesthetic rats. Though the amount of dissolving oxygen was as low as 6 mg/L in physiological saline, the oxygen content in the oxygen micro/nano-bubble dispersion was increased to 45 mg/L. The positive correlation between the oxygen content and the life-saving time under liquid ventilation clearly indicates that the life-saving time is prolonged by increasing the oxygen content in the oxygen micro/nano-bubble dispersion. This is the first report indicating that the oxygen micro/nano-bubbles containing a sufficient amount of oxygen are useful in producing oxygen-rich liquid for the process of liquid ventilation.
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Affiliation(s)
- Kenta Kakiuchi
- Department of Life Science and Medical Bioscience, Graduate School of Advanced Science and Engineering, Waseda University (TWIns), 2-2 Wakamatsu-Cho, Shinjuku-Ku, Tokyo, 162-8480, Japan
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López-Aguilar J, Lucangelo U, Albaiceta GM, Nahum A, Murias G, Cañizares R, Oliva JC, Romero PV, Blanch L. Effects on lung stress of position and different doses of perfluorocarbon in a model of ARDS. Respir Physiol Neurobiol 2015; 210:30-7. [PMID: 25662756 DOI: 10.1016/j.resp.2015.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/22/2015] [Accepted: 01/30/2015] [Indexed: 01/09/2023]
Abstract
We determined whether the combination of low dose partial liquid ventilation (PLV) with perfluorocarbons (PFC) and prone positioning improved lung function while inducing minimal stress. Eighteen pigs with acute lung injury were assigned to conventional mechanical ventilation (CMV) or PLV (5 or 10 ml/kg of PFC). Positive end-expiratory pressure (PEEP) trials in supine and prone positions were performed. Data were analyzed by a multivariate polynomial regression model. The interplay between PLV and position depended on the PEEP level. In supine PLV dampened the stress induced by increased PEEP during the trial. The PFC dose of 5 ml/kg was more effective than the dose 10 ml/kg. This effect was not observed in prone. Oxygenation was significantly higher in prone than in supine position mainly at lower levels of PEEP. In conclusion, MV settings should take both gas exchange and stress/strain into account. When protective CMV fails, rescue strategies combining prone positioning and PLV with optimal PEEP should improve gas exchange with minimal stress.
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Affiliation(s)
- Josefina López-Aguilar
- Fundació Parc Taulí, Corporació Sanitària Parc Taulí, Sabadell, Spain; Institut de Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Campus d' Excelència Internacional, Bellaterra, Spain; Critical Care Center, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Umberto Lucangelo
- Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, Trieste University, Trieste, Italy
| | - Guillermo M Albaiceta
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Dpto. Biologia Funcional, Universidad de Oviedo, Instituto Universitario de Oncologia del Principado de Asturias, Oviedo, Spain; Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Avi Nahum
- Pulmonary and Critical Care Department, St. Paul-Ramsey Medical Center, University of Minnesota, St. Paul, MN, USA
| | - Gastón Murias
- Clínica Bazterrica y Clínica Santa Isabel, Buenos Aires, Argentina
| | | | - Joan Carles Oliva
- Fundació Parc Taulí, Corporació Sanitària Parc Taulí, Sabadell, Spain; Institut de Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Campus d' Excelència Internacional, Bellaterra, Spain
| | - Pablo V Romero
- Laboratory of Experimental Pneumology, IDIBELL, L'Hospitalet, Spain
| | - Lluís Blanch
- Fundació Parc Taulí, Corporació Sanitària Parc Taulí, Sabadell, Spain; Institut de Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Campus d' Excelència Internacional, Bellaterra, Spain; Critical Care Center, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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Chenoune M, De Rochefort L, Bruneval P, Lidouren F, Kohlhauer M, Seemann A, Ghaleh B, Korn M, Dubuisson RM, Ben Yahmed A, Maître X, Isabey D, Ricard JD, Kerber RE, Darrasse L, Berdeaux A, Tissier R. Evaluation of lung recovery after static administration of three different perfluorocarbons in pigs. BMC Pharmacol Toxicol 2014; 15:53. [PMID: 25253660 PMCID: PMC4177717 DOI: 10.1186/2050-6511-15-53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 09/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The respiratory properties of perfluorocarbons (PFC) have been widely studied for liquid ventilation in humans and animals. Several PFC were tested but their tolerance may depend on the species. Here, the effects of a single administration of liquid PFC into pig lungs were assessed and compared. Three different PFC having distinct evaporative and spreading coefficient properties were evaluated (Perfluorooctyl bromide [PFOB], perfluorodecalin [PFD] and perfluoro-N-octane [PFOC]). METHODS Pigs were anesthetized and submitted to mechanical ventilation. They randomly received an intra-tracheal administration of 15 ml/kg of either PFOB, PFD or PFOC with 12 h of mechanical ventilation before awakening and weaning from ventilation. A Control group was submitted to mechanical ventilation with no PFC administration. All animals were followed during 4 days after the initial PFC administration to investigate gas exchanges and clinical recovery. They were ultimately euthanized for histological analyses and assessment of PFC residual concentrations within the lungs using dual nuclei fluorine and hydrogen Magnetic Resonance Imaging (MRI). Sixteen animals were included (4/group). RESULTS In the PFD group, animals tended to be hypoxemic after awakening. In PFOB and PFOC groups, blood gases were not significantly different from the Control group after awakening. The poor tolerance of PFD was likely related to a large amount of residual PFC, as observed using MRI in all lung samples (≈10% of lung volume). This percentage was lower in the PFOB group (≈1%) but remained significantly greater than in the Control group. In the PFOC group, the percentage of residual PFC was not significantly different from that of the Control group (≈0.1%). Histologically, the most striking feature was an alveolar infiltration with foam macrophages, especially in the groups treated by PFD or PFOB. CONCLUSIONS Of the three tested perfluorocarbons, PFOC offered the best tolerance in terms of lung function, gas exchanges and residuum in the lung. PFOC was rapidly cleared from the lungs and virtually disappeared after 4 days whereas PFOB persisted at significant levels and led to foam macrophage infiltration. PFOC could be relevant for short term total liquid ventilation with a rapid weaning.
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Goikoetxea E, Murgia X, Serna-Grande P, Valls-i-Soler A, Rey-Santano C, Rivas A, Antón R, Basterretxea FJ, Miñambres L, Méndez E, Lopez-Arraiza A, Larrabe-Barrena JL, Gomez-Solaetxe MA. In vitro surfactant and perfluorocarbon aerosol deposition in a neonatal physical model of the upper conducting airways. PLoS One 2014; 9:e106835. [PMID: 25211475 PMCID: PMC4161382 DOI: 10.1371/journal.pone.0106835] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 08/02/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Aerosol delivery holds potential to release surfactant or perfluorocarbon (PFC) to the lungs of neonates with respiratory distress syndrome with minimal airway manipulation. Nevertheless, lung deposition in neonates tends to be very low due to extremely low lung volumes, narrow airways and high respiratory rates. In the present study, the feasibility of enhancing lung deposition by intracorporeal delivery of aerosols was investigated using a physical model of neonatal conducting airways. METHODS The main characteristics of the surfactant and PFC aerosols produced by a nebulization system, including the distal air pressure and air flow rate, liquid flow rate and mass median aerodynamic diameter (MMAD), were measured at different driving pressures (4-7 bar). Then, a three-dimensional model of the upper conducting airways of a neonate was manufactured by rapid prototyping and a deposition study was conducted. RESULTS The nebulization system produced relatively large amounts of aerosol ranging between 0.3±0.0 ml/min for surfactant at a driving pressure of 4 bar, and 2.0±0.1 ml/min for distilled water (H2Od) at 6 bar, with MMADs between 2.61±0.1 µm for PFD at 7 bar and 10.18±0.4 µm for FC-75 at 6 bar. The deposition study showed that for surfactant and H2Od aerosols, the highest percentage of the aerosolized mass (∼65%) was collected beyond the third generation of branching in the airway model. The use of this delivery system in combination with continuous positive airway pressure set at 5 cmH2O only increased total airway pressure by 1.59 cmH2O at the highest driving pressure (7 bar). CONCLUSION This aerosol generating system has the potential to deliver relatively large amounts of surfactant and PFC beyond the third generation of branching in a neonatal airway model with minimal alteration of pre-set respiratory support.
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Affiliation(s)
- Estibalitz Goikoetxea
- Research Unit for Experimental Neonatal Respiratory Physiology, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Thermal and Fluids Engineering Division, Mechanical Engineering Department, TECNUN, University of Navarra, San Sebastian, Gipuzkoa, Spain
| | - Xabier Murgia
- Research Unit for Experimental Neonatal Respiratory Physiology, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Pablo Serna-Grande
- Research Unit for Experimental Neonatal Respiratory Physiology, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Adolf Valls-i-Soler
- Neonatal Intensive Care Unit, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Carmen Rey-Santano
- Research Unit for Experimental Neonatal Respiratory Physiology, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Alejandro Rivas
- Thermal and Fluids Engineering Division, Mechanical Engineering Department, TECNUN, University of Navarra, San Sebastian, Gipuzkoa, Spain
| | - Raúl Antón
- Thermal and Fluids Engineering Division, Mechanical Engineering Department, TECNUN, University of Navarra, San Sebastian, Gipuzkoa, Spain
| | - Francisco J. Basterretxea
- Department of Physical Chemistry, Faculty of Science and Technology, University of the Basque Country, Leioa, Bizkaia, Spain
| | - Lorena Miñambres
- Department of Physical Chemistry, Faculty of Science and Technology, University of the Basque Country, Leioa, Bizkaia, Spain
| | - Estíbaliz Méndez
- Department of Physical Chemistry, Faculty of Science and Technology, University of the Basque Country, Leioa, Bizkaia, Spain
| | - Alberto Lopez-Arraiza
- Department of Electronics and Electrotechnics, High Technical School of Maritime Studies, University of the Basque Country, Bilbao, Bizkaia, Spain
| | - Juan Luis Larrabe-Barrena
- Department of Electronics and Electrotechnics, High Technical School of Maritime Studies, University of the Basque Country, Bilbao, Bizkaia, Spain
| | - Miguel Angel Gomez-Solaetxe
- Department of Electronics and Electrotechnics, High Technical School of Maritime Studies, University of the Basque Country, Bilbao, Bizkaia, Spain
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Chu SJ, Huang KL, Wu SY, Ko FC, Wu GC, Li RY, Li MH. Systemic administration of FC-77 dampens ischemia-reperfusion-induced acute lung injury in rats. Inflammation 2014; 36:1383-92. [PMID: 23807052 PMCID: PMC7101555 DOI: 10.1007/s10753-013-9678-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Systemic administration of perfluorocarbons (PFCs) reportedly attenuates acute lung injury induced by acid aspiration and phorbol myristate acetate. However, the effects of PFCs on ischemia–reperfusion (IR)-induced lung injury have not been investigated. Typical acute lung injury was induced in rats by 60 min of ischemia and 60 min of reperfusion in isolated and perfused rat lung model. Rat lungs were randomly assigned to receive PBS (control), 1 % FC-77, IR only, or IR with different doses of FC-77 (0.1 %, 0.5 %, or 1 %). Subsequently, bronchoalveolar lavage fluid (BALF), perfusate, and lung tissues were collected to evaluate the degree of lung injury. IR caused a significant increase in the following parameters: pulmonary arterial pressure, capillary filtration coefficient, lung weight gain, lung weight/body weight ratio, wet/dry lung weight ratio, and protein concentration in BALF. TNF-α and cytokine-induced neutrophil chemoattractant-1 concentrations in perfusate samples and MDA concentration and MPO activities in lung tissues were also significantly increased. Histopathology showed increased septal thickness and neutrophil infiltration in the lung tissues. Furthermore, NF-κB activity was significantly increased in the lungs. However, pretreatment with 1 % FC-77 prior to IR significantly attenuated the increases in these parameters. In conclusion, our results suggest that systemic FC-77 administration had a protective effect on IR-induced acute lung injury. These protective mechanisms may have been mediated by the inhibition of NF-κB activation and attenuation of subsequent inflammatory response.
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Affiliation(s)
- Shi-Jye Chu
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Orizondo RA, Babcock CI, Fabiilli ML, Pavlovsky L, Fowlkes JB, Younger JG, Cook KE. Characterization of a reverse-phase perfluorocarbon emulsion for the pulmonary delivery of tobramycin. J Aerosol Med Pulm Drug Deliv 2014; 27:392-9. [PMID: 24476046 DOI: 10.1089/jamp.2013.1058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Aerosolized delivery of antibiotics is hindered by poor penetration within distal and plugged airways. Antibacterial perfluorocarbon ventilation (APV) is a proposed solution in which the lungs are partially or totally filled with perfluorocarbon (PFC) containing emulsified antibiotics. The purpose of this study was to evaluate emulsion stability and rheological, antibacterial, and pharmacokinetic characteristics. METHODS This study examined emulsion aqueous droplet diameter and number density over 24 hr and emulsion and neat PFC viscosity and surface tension. Additionally, Pseudomonas aeruginosa biofilm growth was measured after 2-hr exposure to emulsion with variable aqueous volume percentages (0.25, 1, and 2.5%) and aqueous tobramycin concentrations (Ca=0.4, 4, and 40 mg/mL). Lastly, the time course of serum and pulmonary tobramycin concentrations was evaluated following APV and conventional aerosolized delivery of tobramycin in rats. RESULTS The initial aqueous droplet diameter averaged 1.9±0.2 μm with little change over time. Initial aqueous droplet number density averaged 3.5±1.7×10(9) droplets/mL with a significant (p<0.01) decrease over time. Emulsion and PFC viscosity were not significantly different, averaging 1.22±0.03×10(-3) Pa·sec. The surface tensions of PFC and emulsion were 15.0±0.1×10(-3) and 14.6±0.6×10(-3) N/m, respectively, and the aqueous interfacial tensions were 46.7±0.3×10(-3) and 26.9±11.0×10(-3) N/m (p<0.01), respectively. Biofilm growth decreased markedly with increasing Ca and, to a lesser extent, aqueous volume percentage. Tobramycin delivered via APV yielded 2.5 and 10 times larger pulmonary concentrations at 1 and 4 hr post delivery, respectively, and significantly (p<0.05) lower serum concentrations compared with aerosolized delivery. CONCLUSIONS The emulsion is bactericidal, retains the rheology necessary for pulmonary delivery, is sufficiently stable for this application, and results in increased pulmonary retention of the antibiotic.
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Affiliation(s)
- Ryan A Orizondo
- 1 Department of Biomedical Engineering, University of Michigan , Ann Arbor, MI
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Hussein O, Walters B, Stroetz R, Valencia P, McCall D, Hubmayr RD. Biophysical determinants of alveolar epithelial plasma membrane wounding associated with mechanical ventilation. Am J Physiol Lung Cell Mol Physiol 2013; 305:L478-84. [PMID: 23997173 DOI: 10.1152/ajplung.00437.2012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Mechanical ventilation may cause harm by straining lungs at a time they are particularly prone to injury from deforming stress. The objective of this study was to define the relative contributions of alveolar overdistension and cyclic recruitment and "collapse" of unstable lung units to membrane wounding of alveolar epithelial cells. We measured the interactive effects of tidal volume (VT), transpulmonary pressure (PTP), and of airspace liquid on the number of alveolar epithelial cells with plasma membrane wounds in ex vivo mechanically ventilated rat lungs. Plasma membrane integrity was assessed by propidium iodide (PI) exclusion in confocal images of subpleural alveoli. Cyclic inflations of normal lungs from zero end-expiratory pressure to 40 cmH2O produced VT values of 56.9 ± 3.1 ml/kg and were associated with 0.12 ± 0.12 PI-positive cells/alveolus. A preceding tracheal instillation of normal saline (3 ml) reduced VT to 49.1 ± 6 ml/kg but was associated with a significantly greater number of wounded alveolar epithelial cells (0.52 ± 0.16 cells/alveolus; P < 0.01). Mechanical ventilation of completely saline-filled lungs with saline (VT = 52 ml/kg) to pressures between 10 and 15 cmH2O was associated with the least number of wounded epithelial cells (0.02 ± 0.02 cells/alveolus; P < 0.01). In mechanically ventilated, partially saline-filled lungs, the number of wounded cells increased substantially with VT, but, once VT was accounted for, wounding was independent of maximal PTP. We found that interfacial stress associated with the generation and destruction of liquid bridges in airspaces is the primary biophysical cell injury mechanism in mechanically ventilated lungs.
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Affiliation(s)
- Omar Hussein
- Mayo Clinic, Division of Pulmonary and Critical Care Medicine, 200 1st St. SW, Rochester, MN 55905.
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Galvin IM, Steel A, Pinto R, Ferguson ND, Davies MW. Partial liquid ventilation for preventing death and morbidity in adults with acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev 2013; 2013:CD003707. [PMID: 23881653 PMCID: PMC6516802 DOI: 10.1002/14651858.cd003707.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are syndromes of severe respiratory failure that are associated with substantial mortality and morbidity. Artifical ventilatory support is commonly required and may exacerbate lung injury. Partial liquid ventilation (PLV) has been proposed as a less injurious form of ventilatory support for these patients. Although PLV has been shown to improve gas exchange and to reduce inflammation in experimental models of ALI, a previous systematic review did not find any evidence to support or refute its use in humans with ALI and ARDS. OBJECTIVES The primary objective of this review was to assess whether PLV reduced mortality (at 28 d, at discharge from the intensive care unit (ICU), at discharge from hospital and at one, two and five years) in adults with ALI or ARDS when compared with conventional ventilatory support.Secondary objectives were to determine how PLV compared with conventional ventilation with regard to duration of invasive mechanical ventilation, duration of respiratory support, duration of oxygen therapy, length of ICU stay, length of hospital stay, incidence of infection, long-term cognitive impairment, long-term health related quality of life, long- term lung function, long-term morbidity costs and adverse events. The following adverse events were considered: hypoxia (arterial PO2 <80 mm Hg), pneumothorax (any air leak into the pleural space requiring therapeutic intervention), hypotension (systolic blood pressure < 90 mm Hg sustained for longer than two minutes or requiring treatment with fluids or vasoactive drugs), bradycardia (heart rate < 50 beats per minute sustained for longer than one minute or requiring therapeutic intervention) and cardiac arrest (absence of effective cardiac output). SEARCH METHODS In this updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL Issue 10, 2012, in The Cochrane Library; MEDLINE (Ovid SP, 1966 to November 2012); EMBASE (Ovid SP, 1980 to November 2012) and CINAHL (EBSCOhost,1982 to November 2012) for published studies. In our original review, we searched until May 2004.Grey literature was identified by searching conference proceedings and trial registries and by contacting experts in the field. SELECTION CRITERIA As in the original review, review authors selected randomized controlled trials that compared PLV with other forms of ventilation in adults (16 y of age or older) with ALI or ARDS, reporting one or more of the following: mortality; duration of mechanical ventilation, respiratory support, oxygen therapy, stay in the intensive care unit or stay in hospital; infection; long-term cognitive impairment or health-related quality of life; long-term lung function or cost. DATA COLLECTION AND ANALYSIS Two review authors independently evaluated the quality of the relevant studies and extracted the data from included studies. MAIN RESULTS In this updated review, one new eligible study was identified and included, yielding a total of two eligible studies (including a combined total of 401 participants). Of those 401 participants, 170 received 'high'-dose partial liquid ventilation (i.e. a mean dose of at least 20 mL/kg), 99 received 'low-dose' partial liquid ventilation (i.e. a dose of 10 mL/kg) and 132 received conventional mechanical ventilation (CMV). Pooled estimates of effect were calculated for all those who received 'high'-dose PLV versus conventional ventilation. No evidence indicated that 'high'-dose PLV either reduced mortality at 28 d (risk ratio (RR) 1.21, 95% confidence interval (CI) 0.79 to 1.85, P = 0.37) or increased the number of days free of CMV at 28 d (mean difference (MD) -2.24, 95% CI -4.71 to 0.23, P = 0.08). The pooled estimate of effect for bradycardia in those who received PLV was significantly greater than in those who received CMV (RR 2.51, 95% CI 1.31 to 4.81, P = 0.005). Pooled estimates of effect for the following adverse events- hypoxia, pneumothorax, hypotension and cardiac arrest- all showed a nonsignificant trend towards a higher occurrence of these events in those treated with PLV. Because neither eligible study addressed morbidity or mortality beyond 28 d, it was not possible to determine the effect of PLV on these outcomes. AUTHORS' CONCLUSIONS No evidence supports the use of PLV in ALI or ARDS; some evidence suggests an increased risk of adverse events associated with its use.
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Budinger GRS, Mutlu GM. Balancing the risks and benefits of oxygen therapy in critically III adults. Chest 2013; 143:1151-1162. [PMID: 23546490 DOI: 10.1378/chest.12-1215] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Oxygen therapy is an integral part of the treatment of critically ill patients. Maintenance of adequate oxygen delivery to vital organs often requires the administration of supplemental oxygen, sometimes at high concentrations. Although oxygen therapy is lifesaving, it may be associated with deleterious effects when administered for prolonged periods at high concentrations. Here, we review the recent advances in our understanding of the molecular responses to hypoxia and high levels of oxygen and review the current guidelines for oxygen therapy in critically ill patients.
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Affiliation(s)
- G R Scott Budinger
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Gökhan M Mutlu
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Early biomarker activity in severe sepsis and septic shock and a contemporary review of immunotherapy trials: not a time to give up, but to give it earlier. Shock 2013; 39:127-37. [PMID: 23324881 DOI: 10.1097/shk.0b013e31827dafa7] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Improving time to diagnosis and intervention has positively impacted outcomes in acute myocardial infarction, stroke, and trauma through elucidating the early pathogenesis of those diseases. This insight may partly explain the futility of time-insensitive immunotherapy trials for severe sepsis and septic shock. The aim of this study was to examine the early natural history of circulatory biomarker activity in sepsis, relative to previous animal and human outcome trials. We conducted a literature search using PubMed, MEDLINE, and Google Scholar to identify outcome trials targeting biomarkers with emphasis on the timing of therapy. These findings were compared with the biomarker activity observed over the first 72 h of hospital presentation in a cohort of severe sepsis and septic shock patients. Biomarker levels in animal and human research models are elevated within 30 min after exposure to an inflammatory septic stimulus. Consistent with these findings, the biomarker cascade is activated at the most proximal point of hospital presentation in our patient cohort. These circulatory biomarkers overlap; some have bimodal patterns and generally peak between 3 and 36 h while diminishing over the subsequent 72 h of observation. When this is taken into account, prior outcome immunotherapy trials have generally enrolled patients after peak circulatory biomarker concentrations. In previous immunotherapy sepsis trials, intervention was delayed after the optimal window of peak biomarker activity. As a result, future studies need to recalibrate the timing of enrollment and administration of immunotherapy agents that still may hold great promise for this deadly disease.
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Algaba Á, Nin N. Maniobras de reclutamiento alveolar en el síndrome de distrés respiratorio agudo. Med Intensiva 2013; 37:355-62. [DOI: 10.1016/j.medin.2013.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 01/29/2013] [Accepted: 01/30/2013] [Indexed: 01/14/2023]
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Rey-Santano C, Mielgo V, Gastiasoro E, Valls-i-Soler A, Murgia X. Effect of surfactant and partial liquid ventilation treatment on gas exchange and lung mechanics in immature lambs: influence of gestational age. PLoS One 2013; 8:e56127. [PMID: 23418521 PMCID: PMC3571983 DOI: 10.1371/journal.pone.0056127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 01/04/2013] [Indexed: 12/05/2022] Open
Abstract
Objectives Surfactant (SF) and partial liquid ventilation (PLV) improve gas exchange and lung mechanics in neonatal RDS. However, variations in the effects of SF and PLV with degree of lung immaturity have not been thoroughly explored. Setting Experimental Neonatal Respiratory Physiology Research Unit, Cruces University Hospital. Design Prospective, randomized study using sealed envelopes. Subjects 36 preterm lambs were exposed (at 125 or 133-days of gestational age) by laparotomy and intubated. Catheters were placed in the jugular vein and carotid artery. Interventions All the lambs were assigned to one of three subgroups given: 20 mL/Kg perfluorocarbon and managed with partial liquid ventilation (PLV), surfactant (Curosurf®, 200 mg/kg) or (3) no pulmonary treatment (Controls) for 3 h. Measurements and Main Results Cardiovascular parameters, blood gases and pulmonary mechanics were measured. In 125-day gestation lambs, SF treatment partially improved gas exchange and lung mechanics, while PLV produced significant rapid improvements in these parameters. In 133-day lambs, treatments with SF or PLV achieved similarly good responses. Neither surfactant nor PLV significantly affected the cardiovascular parameters. Conclusion SF therapy response was more effective in the older gestational age group whereas the effectiveness of PLV therapy was not gestational age dependent.
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Affiliation(s)
- Carmen Rey-Santano
- Research Unit for Experimental Neonatal Respiratory Physiology, Cruces University Hospital, Barakaldo, Bizkaia, Spain.
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Forgiarini LA, Forgiarini LF, da Rosa DP, Mariano R, Ulbrich JM, Andrade CF. Endobronchial perfluorocarbon administration decreases lung injury in an experimental model of ischemia and reperfusion. J Surg Res 2013; 183:835-40. [PMID: 23434305 DOI: 10.1016/j.jss.2013.01.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 01/12/2013] [Accepted: 01/17/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To verify the effects of liquid endobronchial perfluorocarbon (PFC) administered before reperfusion in an animal model of lung ischemia-reperfusion injury. METHODS Eighteen Wistar rats were subjected to an experimental model of selective left pulmonary artery clamping for 45 min followed by reperfusion for 2 h. The animals were divided into three groups: the ischemia-reperfusion (IR) group, the sham group, and the PFC group. We recorded the hemodynamic parameters, blood gas analysis, and histology. A Western blot assay was used to measure the inducible nitric oxide synthase, caspase 3, and nuclear factor қB (subunit p65) activities. Lipid peroxidation was assessed by the thiobarbituric acid reactive substances assay and the activity of the antioxidant enzyme superoxide dismutase. RESULTS No significant differences were observed in lipid peroxidation among the groups. The superoxide dismutase activity was increased (P < 0.05) in the PFC-treated group. The expressions of nuclear factor қB, inducible nitric oxide synthase, and caspase 3 were significantly lower in the PFC group than in the IR group (P < 0.05). The histologic analysis showed a reduction in lung injuries in the PFC group compared with the sham and IR groups. CONCLUSION The use of endobronchial PFC reduces the inflammatory response, preserves the alveolar structure, and protects the lungs against the hazardous effects of ischemia-reperfusion injuries.
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Affiliation(s)
- Luiz Alberto Forgiarini
- Postgraduate Program in Pulmonary Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Schmidt M, Tachon G, Devilliers C, Muller G, Hekimian G, Bréchot N, Merceron S, Luyt CE, Trouillet JL, Chastre J, Leprince P, Combes A. Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adults. Intensive Care Med 2013; 39:838-46. [DOI: 10.1007/s00134-012-2785-8] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 12/05/2012] [Indexed: 12/21/2022]
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Aerosolized perfluorocarbon improves gas exchange and pulmonary mechanics in preterm lambs with severe respiratory distress syndrome. Pediatr Res 2012; 72:393-9. [PMID: 22797142 DOI: 10.1038/pr.2012.90] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Aerosolized perfluorocarbon (PFC) has been proposed as an alternative method of PFC administration; however, the efficacy of aerosolized PFC in a preterm animal model has not yet been demonstrated. METHODS Twelve preterm lambs were randomized to two groups: a perfluorodecalin (PFD) aerosol group (n = 6) receiving 10 ml/kg/h of PFD delivered by an intratracheal inhalation catheter followed by 4 h of mechanical ventilation (MV) or the control group, in which animals (n = 6) were managed for 6 h with MV. Gas exchange, pulmonary mechanics, cardiovascular parameters, and cerebral blood flow (CBF) were measured. RESULTS Both groups developed hypoxia, hypercarbia, and acidosis at baseline. Aerosolized PFD improved oxygenation (P < 0.0001) and pulmonary mechanics (P < 0.0001) and changed carbon dioxide values to normal physiological levels, unlike the treatment given to the controls (P < 0.0003). The time course of mean arterial blood pressure and CBF were significantly affected by PFD aerosolization, especially during the first hour of life. CBF gradually decreased during the first hour in the PFD aerosol group and remained stable until the end of the follow-up, whereas CBF remained higher in the control group (P < 0.0028). CONCLUSION Aerosolized PFD improves pulmonary function in preterm lambs and should be further investigated as an alternative mode of PFC administration.
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