1
|
Mohnke K, Conzelmann P, Renz M, Riedel J, Rissel R, Urmann A, Hain J, Duenges B, Ziebart A, Ruemmler R. Ultra-low tidal volume ventilation during cardiopulmonary resuscitation shows no mitigating effect on pulmonary end-organ damage compared to standard ventilation: insights from a porcine model. Intensive Care Med Exp 2023; 11:81. [PMID: 38006467 PMCID: PMC10676323 DOI: 10.1186/s40635-023-00568-6] [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: 07/30/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023] Open
Abstract
OBJECTIVE This study aimed to determine whether ultra-low tidal volume ventilation (ULTVV) applied during cardiopulmonary resuscitation (CPR) compared with standard ventilation (intermittent positive pressure ventilation, IPPV) can reduce pulmonary end-organ damage in the post-resuscitation period. METHODS A prospective, randomized trial was conducted using a porcine model (n = 45). The animals were divided into three groups: IPPV, ULTVV, and a sham control group. Juvenile male pigs underwent CPR after inducing ventricular fibrillation and received the designated ventilation intervention [IPPV: tidal volume 6-8 ml per kilogram body weight (ml/kg BW), respiratory rate 10/min, FiO2 1.0; ULTVV: tidal volume 2-3 ml/kg BW, respiratory rate 50/min, FiO2 1.0]. A 20-h observation period followed if return of spontaneous circulation was achieved. Histopathological examination using the diffuse alveolar damage scoring system was performed on postmortem lung tissue samples. Arterial and venous blood gas analyses and ventilation/perfusion measurements via multiple inert gas elimination technique (MIGET) were repeatedly recorded during the experiment. RESULTS Out of the 45 experiments conducted, 28 animals were excluded based on predefined criteria. Histopathological analysis showed no significant differences in lung damage between the ULTVV and IPPV groups. ULTVV demonstrated adequate oxygenation and decarboxylation. MIGET measurements during and after resuscitation revealed no significant differences between the intervention groups. CONCLUSION In the short-term follow-up phase, ULTVV demonstrated similar histopathological changes and functional pulmonary parameters compared to standard ventilation. Further research is needed to investigate the long-term effects and clinical implications of ULTVV in resuscitation settings.
Collapse
Affiliation(s)
- Katja Mohnke
- Department of Anesthesiology, Medical Center of Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Philipp Conzelmann
- Department of Anesthesiology, Medical Center of Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Miriam Renz
- Department of Anesthesiology, Medical Center of Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Julian Riedel
- Department of Anesthesiology, Medical Center of Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - René Rissel
- Department of Anesthesiology, Medical Center of Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Andrea Urmann
- Department of Anesthesiology, Medical Center of Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Johanna Hain
- Department of Anesthesiology, Medical Center of Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Bastian Duenges
- Department of Anesthesiology, Medical Center of Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Alexander Ziebart
- Department of Anesthesiology, Medical Center of Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Robert Ruemmler
- Department of Anesthesiology, Medical Center of Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| |
Collapse
|
2
|
Rissel R, Moellmann C, Albertsmeier V, Renz M, Ruemmler R, Kamuf J, Hartmann EK, Ziebart A. Clinical dosage of lidocaine does not impact the biomedical outcome of sepsis-induced acute respiratory distress syndrome in a porcine model. PeerJ 2023; 11:e15875. [PMID: 37637154 PMCID: PMC10448879 DOI: 10.7717/peerj.15875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
Background Sepsis is a common disease in intensive care units worldwide, which is associated with high morbidity and mortality. This process is often associated with multiple organ failure including acute lung injury. Although massive research efforts have been made for decades, there is no specific therapy for sepsis to date. Early and best treatment is crucial. Lidocaine is a common local anesthetic and used worldwide. It blocks the fast voltage-gated sodium (Na+) channels in the neuronal cell membrane responsible for signal propagation. Recent studies show that lidocaine administered intravenously improves pulmonary function and protects pulmonary tissue in pigs under hemorrhagic shock, sepsis and under pulmonary surgery. The aim of this study is to show that lidocaine inhalative induces equivalent effects as lidocaine intravenously in pigs in a lipopolysaccharide (LPS)-induced sepsis with acute lung injury. Methods After approval of the local State and Institutional Animal Care Committee, to induce the septic inflammatory response a continuous infusion of lipopolysaccharide (LPS) was administered to the pigs in deep anesthesia. Following induction and stabilisation of sepsis, the study medication was randomly assigned to one of three groups: (1) lidocaine intravenously, (2) lidocaine per inhalation and (3) sham group. All animals were monitored for 8 h using advanced and extended cardiorespiratory monitoring. Postmortem assessment included pulmonary mRNA expression of mediators of early inflammatory response (IL-6 & TNF-alpha), wet-to-dry ratio and lung histology. Results Acute respiratory distress syndrome (ARDS) was successfully induced after sepsis-induction with LPS in all three groups measured by a significant decrease in the PaO2/FiO2 ratio. Further, septic hemodynamic alterations were seen in all three groups. Leucocytes and platelets dropped statistically over time due to septic alterations in all groups. The wet-to-dry ratio and the lung histology showed no differences between the groups. Additionally, the pulmonary mRNA expression of the inflammatory mediators IL-6 and TNF-alpha showed no significant changes between the groups. The proposed anti-inflammatory and lung protective effects of lidocaine in sepsis-induced acute lung injury could not be proven in this study.
Collapse
Affiliation(s)
- René Rissel
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Christian Moellmann
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Victoria Albertsmeier
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Miriam Renz
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Robert Ruemmler
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Jens Kamuf
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Erik K. Hartmann
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Alexander Ziebart
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| |
Collapse
|
3
|
Rissel R, Kirchner L, Renz M, Mohnke K, Riedel J, Ruemmler R, Hartmann EK, Kamuf J, Ziebart A. Resveratrol influences pulmonary mechanics and inflammatory response in a porcine ARDS model. Life Sci 2023; 319:121410. [PMID: 36681185 DOI: 10.1016/j.lfs.2023.121410] [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: 11/04/2022] [Revised: 12/29/2022] [Accepted: 01/15/2023] [Indexed: 01/21/2023]
Abstract
AIMS Influencing the inflammatory response represents an important branch in ARDS research. The naturally occurring polyphenol derivative resveratrol has already been confirmed to have strong anti-inflammatory effects on the cardiac and metabolic system. In the present study, we investigated the propagated anti-inflammatory effects of intravenous resveratrol in a porcine ARDS model. MAIN METHODS 20 domestic pigs (30 ± 2 kg; approval G20-1-135), divided into three groups: 1. resveratrol high dose (HD; n = 8), single bolus of 20 mg/kg over 15 min. 2. resveratrol low dose (LD; n = 8), single bolus of 10 mg/kg over 15 min. 3. Vehicle (n = 4), with the carrier solution DMSO over 15 min administered after ARDS induction. ARDS induction: using BAL/oleic acid and a subsequent test period of 8 h. Measurement parameters: Hemodynamics/spirometry data were collected continuously, BGA/laboratory parameters repetitively. Post-mortem: analysis of pulmonary inflammatory markers. STATISTICS Two-way analysis of variance (repeated measurement) and Student-Newman-Keuls method. KEY FINDINGS Resveratrol HD significantly reduced the expression of TNF-alpha in lung tissue compared to the LD group (p < 0.05). A significantly increased functional residual capacity (FRC) could be demonstrated for the HD group at the end of the test (p < 0.05 for HD vs. LD/vehicle). Further, resveratrol HD reduced statistically the EVLWI compared to LD/vehicle (p < 0.05 at T4/T8). SIGNIFICANCE In this study, resveratrol HD ameliorated pulmonary mechanics as reported for the FRC and EVLWI. Further, the proposed anti-inflammatory effects of resveratrol, a significant reduction in the expression of TNF-alpha was observed in the HD group.
Collapse
Affiliation(s)
- René Rissel
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
| | - Louisa Kirchner
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Miriam Renz
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
| | - Katja Mohnke
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
| | - Julian Riedel
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
| | - Robert Ruemmler
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
| | - Erik K Hartmann
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
| | - Jens Kamuf
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
| | - Alexander Ziebart
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
| |
Collapse
|
4
|
Renz M, Noack RRC, Rissel R, Mohnke K, Riedel J, Dunges B, Ziebart A, Hartmann EK, Rummler R. Synchronized ventilation during resuscitation in pigs does not necessitate high inspiratory pressures to provide adequate oxygenation. World J Emerg Med 2023; 14:393-396. [PMID: 37908797 PMCID: PMC10613795 DOI: 10.5847/wjem.j.1920-8642.2023.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/10/2023] [Indexed: 11/02/2023] Open
Affiliation(s)
- Miriam Renz
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg University, Mainz 55131, Germany
| | - Raphael René Cinto Noack
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg University, Mainz 55131, Germany
| | - René Rissel
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg University, Mainz 55131, Germany
| | - Katja Mohnke
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg University, Mainz 55131, Germany
| | - Julian Riedel
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg University, Mainz 55131, Germany
| | - Bastian Dunges
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg University, Mainz 55131, Germany
| | - Alexander Ziebart
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg University, Mainz 55131, Germany
| | - Erik Kristoffer Hartmann
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg University, Mainz 55131, Germany
| | - Robert Rummler
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg University, Mainz 55131, Germany
| |
Collapse
|
5
|
Renz M, Müllejans L, Riedel J, Mohnke K, Rissel R, Ziebart A, Duenges B, Hartmann EK, Ruemmler R. High PEEP Levels during CPR Improve Ventilation without Deleterious Haemodynamic Effects in Pigs. J Clin Med 2022; 11:jcm11164921. [PMID: 36013161 PMCID: PMC9410261 DOI: 10.3390/jcm11164921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Invasive ventilation during cardiopulmonary resuscitation (CPR) is very complex due to unique thoracic pressure conditions. Current guidelines do not provide specific recommendations for ventilation during ongoing chest compressions regarding positive end-expiratory pressure (PEEP). This trial examines the cardiopulmonary effects of PEEP application during CPR. Methods: Forty-two German landrace pigs were anaesthetised, instrumented, and randomised into six intervention groups. Three PEEP levels (0, 8, and 16 mbar) were compared in high standard and ultralow tidal volume ventilation. After the induction of ventricular fibrillation, mechanical chest compressions and ventilation were initiated and maintained for thirty minutes. Blood gases, ventilation/perfusion ratio, and electrical impedance tomography loops were taken repeatedly. Ventilation pressures and haemodynamic parameters were measured continuously. Postmortem lung tissue damage was assessed using the diffuse alveolar damage (DAD) score. Statistical analyses were performed using SPSS, and p values <0.05 were considered significant. Results: The driving pressure (Pdrive) showed significantly lower values when using PEEP 16 mbar than when using PEEP 8 mbar (p = 0.045) or PEEP 0 mbar (p < 0.001) when adjusted for the ventilation mode. Substantially increased overall lung damage was detected in the PEEP 0 mbar group (vs. PEEP 8 mbar, p = 0.038; vs. PEEP 16 mbar, p = 0.009). No significant differences in mean arterial pressure could be detected. Conclusion: The use of PEEP during CPR seems beneficial because it optimises ventilation pressures and reduces lung damage without significantly compromising blood pressure. Further studies are needed to examine long-term effects in resuscitated animals.
Collapse
|
6
|
Levosimendan Ameliorates Cardiopulmonary Function but Not Inflammatory Response in a Dual Model of Experimental ARDS. Biomedicines 2022; 10:biomedicines10051031. [PMID: 35625767 PMCID: PMC9138326 DOI: 10.3390/biomedicines10051031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/28/2022] Open
Abstract
The calcium sensitiser levosimendan, which is used as an inodilator to treat decompensated heart failure, may also exhibit anti-inflammatory properties. We examined whether treatment with levosimendan improves cardiopulmonary function and is substantially beneficial to the inflammatory response in acute respiratory response syndrome (ARDS). Levosimendan was administered intravenously in a new experimental porcine model of ARDS. For comparison, we used milrinone, another well-known inotropic agent. Our results demonstrated that levosimendan intravenously improved hemodynamics and lung function in a porcine ARDS model. Significant beneficial alterations in the inflammatory response and lung injury were not detected.
Collapse
|
7
|
Rissel R, Schaefer M, Kamuf J, Ruemmler R, Riedel J, Mohnke K, Renz M, Hartmann EK, Ziebart A. Lung-brain 'cross-talk': systemic propagation of cytokines in the ARDS via the bloodstream using a blood transfusion model does not influence cerebral inflammatory response in pigs. PeerJ 2022; 10:e13024. [PMID: 35265399 PMCID: PMC8900612 DOI: 10.7717/peerj.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/07/2022] [Indexed: 01/11/2023] Open
Abstract
Background Interorgan cross-talk describes the phenomenon in which a primarily injured organ causes secondary damage to a distant organ. This cross-talk is well known between the lung and brain. One theory suggests that the release and systemic distribution of cytokines via the bloodstream from the primarily affected organ sets in motion proinflammatory cascades in distant organs. In this study, we analysed the role of the systemic distribution of cytokines via the bloodstream in a porcine ARDS model for organ cross-talk and possible inflammatory changes in the brain. Methods After approval of the State and Institutional Animal Care Committee, acute respiratory distress syndrome (ARDS) induction with oleic acid injection was performed in seven animals. Eight hours after ARDS induction, blood (35-40 ml kg-1) was taken from these seven 'ARDS donor' pigs. The collected 'ARDS donor' blood was transfused into seven healthy 'ARDS-recipient' pigs. Three animals served as a control group, and blood from these animals was transfused into three healthy pigs after an appropriate ventilation period. All animals were monitored for 8 h using advanced cardiorespiratory monitoring. Postmortem assessment included cerebral (hippocampal and cortex) mediators of early inflammatory response (IL-6, TNF-alpha, iNOS, sLCN-2), wet-to-dry ratio and lung histology. TNF-alpha serum concentration was measured in all groups. Results ARDS was successfully induced in the 'ARDS donor' group, and serum TNF-alpha levels were elevated compared with the 'ARDS-recipient' group. In the 'ARDS-recipient' group, neither significant ARDS alterations nor upregulation of inflammatory mediators in the brain tissue were detected after high-volume random allogenic 'ARDS-blood' transfusion. The role of the systemic distribution of inflammatory cytokines from one affected organ to another could not be confirmed in this study.
Collapse
|
8
|
Hanafy NAN, El-Kemary MA. Silymarin/curcumin loaded albumin nanoparticles coated by chitosan as muco-inhalable delivery system observing anti-inflammatory and anti COVID-19 characterizations in oleic acid triggered lung injury and in vitro COVID-19 experiment. Int J Biol Macromol 2022; 198:101-110. [PMID: 34968533 PMCID: PMC8712435 DOI: 10.1016/j.ijbiomac.2021.12.073] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/28/2021] [Accepted: 12/11/2021] [Indexed: 02/08/2023]
Abstract
Respiratory infected by COVID-19 represents a major global health problem at moment even after recovery from virus corona. Since, the lung lesions for infected patients are still sufferings from acute respiratory distress syndrome including alveolar septal edema, pneumonia, hyperplasia, and hyaline membranes Therefore, there is an urgent need to identify additional candidates having ability to overcome inflammatory process and can enhance efficacy in the treatment of COVID-19. The polypenolic extracts were integrated into moeties of bovine serum albumin (BSA) and then were coated by chitosan as a mucoadhesion polymer. The results of interleukin-6, and c-reactive protein showed significant reduction in group treated by Encap. SIL + CUR (64 ± 0.8 Pg/μL & 6 ± 0.5 μg/μL) compared to group treated by Cham. + CUR (102 ± 0.8 Pg/μL & 7 ± 0.5 μg/μL) respectively and free capsules (with no any drug inside) (148 ± 0.6 Pg/μL & 10 ± 0.6 μg/μL) respectively. Histopathology profile was improved completely. Additionally, encapsulating silymarin showed anti-viral activity in vitro COVID-19 experiment. It can be summarized that muco-inhalable delivery system (MIDS) loaded by silymarin can be used to overcome inflammation induced by oleic acid and to overcome COVID-19.
Collapse
Affiliation(s)
- Nemany A N Hanafy
- Nanomedicine group, Institute of Nanoscience and Nanotechnology, Kafrelsheikh University, 33516 Kafrelsheikh, Egypt.
| | - Maged A El-Kemary
- Nanomedicine group, Institute of Nanoscience and Nanotechnology, Kafrelsheikh University, 33516 Kafrelsheikh, Egypt.
| |
Collapse
|
9
|
Thomas R, Liu T, Schad A, Ruemmler R, Kamuf J, Rissel R, Ott T, David M, Hartmann EK, Ziebart A. Hyaluronic acid plasma levels during high versus low tidal volume ventilation in a porcine sepsis model. PeerJ 2022; 9:e12649. [PMID: 35036142 PMCID: PMC8742546 DOI: 10.7717/peerj.12649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/28/2021] [Indexed: 11/20/2022] Open
Abstract
Background Shedding of the endothelial glycocalyx can be observed regularly during sepsis. Moreover, sepsis may be associated with acute respiratory distress syndrome (ARDS), which requires lung protective ventilation with the two cornerstones of application of low tidal volume and positive end-expiratory pressure. This study investigated the effect of a lung protective ventilation on the integrity of the endothelial glycocalyx in comparison to a high tidal volume ventilation mode in a porcine model of sepsis-induced ARDS. Methods After approval by the State and Institutional Animal Care Committee, 20 male pigs were anesthetized and received a continuous infusion of lipopolysaccharide to induce septic shock. The animals were randomly assigned to either low tidal volume ventilation, high tidal volume ventilation, or no-LPS-group groups and observed for 6 h. In addition to the gas exchange parameters and hematologic analyses, the serum hyaluronic acid concentrations were determined from central venous blood and from pre- and postpulmonary and pre- and postcerebral circulation. Post-mortem analysis included histopathological evaluation and determination of the pulmonary and cerebral wet-to-dry ratios. Results Both sepsis groups developed ARDS within 6 h of the experiment and showed significantly increased serum levels of hyaluronic acid in comparison to the no-LPS-group. No significant differences in the hyaluronic acid concentrations were detected before and after pulmonary and cerebral circulation. There was also no significant difference in the serum hyaluronic acid concentrations between the two sepsis groups. Post-mortem analysis showed no significant difference between the two sepsis groups. Conclusion In a porcine model of septic shock and ARDS, the serum hyaluronic acid levels were significantly elevated in both sepsis groups in comparison to the no-LPS-group. Intergroup comparison between lung protective ventilated and high tidal ventilated animals revealed no significant differences in the serum hyaluronic acid levels.
Collapse
Affiliation(s)
- Rainer Thomas
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Tanghua Liu
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Arno Schad
- Institute of Pathology, Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Robert Ruemmler
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Jens Kamuf
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - René Rissel
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Thomas Ott
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Matthias David
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Erik K Hartmann
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Alexander Ziebart
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| |
Collapse
|
10
|
Kamuf J, Garcia Bardon A, Ziebart A, Ruemmler R, Schwab J, Dib M, Daiber A, Thal SC, Hartmann EK. Influence of rosuvastatin treatment on cerebral inflammation and nitro-oxidative stress in experimental lung injury in pigs. BMC Anesthesiol 2021; 21:224. [PMID: 34517845 PMCID: PMC8435760 DOI: 10.1186/s12871-021-01436-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many patients with acute respiratory distress syndrome (ARDS) suffer from cognitive impairment after hospital discharge. Different mechanisms have been implicated as potential causes for this impairment, inter alia cerebral inflammation. A class of drugs with antioxidant and anti-inflammatory properties are β-HMG-CoA-reductase inhibitors ("statins"). We hypothesized that treatment with rosuvastatin attenuates cerebral cytokine mRNA expression and nitro-oxidative stress in an animal model of acute lung injury. METHODS After approval of the institutional and state animal care committee, we performed this prospective randomized controlled animal study in accordance with the international guidelines for the care and use of laboratory animals. Thirty-two healthy male pigs were randomized to one of four groups: lung injury by central venous injection of oleic acid (n = 8), statin treatment before and directly after lung injury (n = 8), statin treatment after lung injury (n = 8), or ventilation-only controls (n = 8). About 18 h after lung injury and standardized treatment, the animals were euthanised, and the brains and lungs were collected for further examinations. We determined histologic lung injury and cerebral and pulmonal cytokine and 3-nitrotyrosine production. RESULTS We found a significant increase in hippocampal IL-6 mRNA after lung injury (p < 0.05). Treatment with rosuvastatin before and after induction of lung injury led to a significant reduction of hippocampal IL-6 mRNA (p < 0.05). Cerebral 3-nitrotyrosine was significantly higher in lung-injured animals compared with all other groups (p < 0.05 vs. animals treated with rosuvastatin after lung injury induction; p < 0.001 vs. all other groups). 3-Nitrotyrosine was also increased in the lungs of the lung-injured pigs compared to all other groups (p < 0.05 each). CONCLUSIONS Our findings highlight cerebral cytokine production and nitro-oxidative stress within the first day after induction of lung injury. The treatment with rosuvastatin reduced IL-6 mRNA and 3-nitrotyrosine concentration in the brains of the animals. In earlier trials, statin treatment did not reduce mortality in ARDS patients but seemed to improve quality of life in ARDS survivors. Whether this is attributable to better cognitive function because of reduced nitro-oxidative stress and inflammation remains to be elucidated.
Collapse
Affiliation(s)
- Jens Kamuf
- Department of Anesthesiology, University Medical Centre, Mainz, Germany.
| | | | - Alexander Ziebart
- Department of Anesthesiology, University Medical Centre, Mainz, Germany
| | - Robert Ruemmler
- Department of Anesthesiology, University Medical Centre, Mainz, Germany
| | - Johannes Schwab
- Department of Anesthesiology, University Medical Centre, Mainz, Germany
| | - Mobin Dib
- Department of Cardiology, University Medical Centre, Mainz, Germany
| | - Andreas Daiber
- Department of Cardiology, University Medical Centre, Mainz, Germany
| | - Serge C Thal
- Department of Anesthesiology, University Medical Centre, Mainz, Germany
| | - Erik K Hartmann
- Department of Anesthesiology, University Medical Centre, Mainz, Germany
| |
Collapse
|
11
|
Ruemmler R, Ziebart A, Britten E, Gosling M, Rissel R, Hartmann EK. Intrabronchial application of extracellular histones shows no proinflammatory effects in swine in a translational pilot study. BMC Res Notes 2021; 14:285. [PMID: 34301315 PMCID: PMC8306385 DOI: 10.1186/s13104-021-05704-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022] Open
Abstract
Objective Extracellular histones have been identified as one molecular factor that can cause and sustain alveolar damage and were linked to high mortality rates in critically ill patients. In this pilot study, we wanted to validate the proinflammatory in vivo effects of local histone application in a prospective translational porcine model. This was combined with the evaluation of an experimental acute lung injury model using intrabronchial lipopolysaccharides, which has been published previously. Results The targeted application of histones was successful in all animals. Animals showed decreased oxygenation after instillation, but no differences could be detected between the sham and histone treatments. The histologic analyses and inflammatory responses indicated that there were no differences in tissue damage between the groups. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05704-7.
Collapse
Affiliation(s)
- Robert Ruemmler
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Alexander Ziebart
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Elisabeth Britten
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Moritz Gosling
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Rene Rissel
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Erik K Hartmann
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| |
Collapse
|
12
|
Ziebart A, Breit C, Ruemmler R, Hummel R, Möllmann C, Jungmann F, Kamuf J, Garcia-Bardon A, Thal SC, Kreitner KF, Schäfer MKE, Hartmann EK. Effect of fluid resuscitation on cerebral integrity: A prospective randomised porcine study of haemorrhagic shock. Eur J Anaesthesiol 2021; 38:411-421. [PMID: 33399378 DOI: 10.1097/eja.0000000000001416] [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: 11/25/2022]
Abstract
BACKGROUND The treatment of haemorrhagic shock is a challenging task. Colloids have been regarded as standard treatment, but their safety and benefit have been the subject of controversial debates. Negative effects, including renal failure and increased mortality, have resulted in restrictions on their administration. The cerebral effects of different infusion regimens are largely unknown. OBJECTIVES The current study investigated the impact of gelatine-polysuccinate, hydroxyethyl starch (HES) and balanced electrolyte solution (BES) on cerebral integrity, focusing on cerebral inflammation, apoptosis and blood flow in pigs. DESIGN Randomised experimental study. SETTING University-affiliated large animal research unit. ANIMALS Twenty-four juvenile pigs aged 8 to 12 weeks. INTERVENTION Haemorrhagic shock was induced by controlled arterial blood withdrawal to achieve a combination of relevant blood loss (30 to 40 ml kg-1) and haemodynamic deterioration. After 30 min of shock, fluid resuscitation was started with either gelatine-polysuccinate, HES or BES. The animals were then monitored for 4 h. MAIN OUTCOME MEASURES Cerebral perfusion and diffusion were measured via arterial-spin-labelling MRI. Peripheral tissue perfusion was evaluated via white light spectroscopy. Cortical and hippocampal samples were collected at the end of the experiment. The numbers of cerebral cell nuclei were counted and mRNA expression of markers for cerebral apoptosis [glucose transporter protein type 1 (SLC2A), lipocalin 2 (LCN-2), aquaporin-4 (AQP4)] and inflammation [IL-6, TNF-α, glial fibrillary acidic protein (GFAP)] were determined. RESULTS The three fluid protocols all stabilised the macrocirculation. Fluid resuscitation significantly increased the cerebral perfusion. Gelatine-polysuccinate and HES initially led to a higher cardiac output but caused haemodilution. Cerebral cell counts (as cells μm-2) were lower after colloid administration in the cortex (gelatine-polysuccinate, 1.8 ± 0.3; HES, 1.9 ± 0.4; each P < 0.05 vs. BES, 2.3 ± 0.2) and the hippocampus (gelatine-polysuccinate, 0.8 ± 0.2; HES, 0.9 ± 0.2; each P < 0.05 vs. BES, 1.1 ± 0.1). After gelatine-polysuccinate, the hippocampal SLC2A and GFAP were lower. After gelatine-polysuccinate, the cortical LCN-2 and TNF-α expression levels were increased (each P < 0.05 vs. BES). CONCLUSION In a porcine model, fluid resuscitation by colloids, particularly gelatine-polysuccinate, was associated with the occurrence of cerebral injury. ETHICAL APPROVAL NUMBER 23 177-07/G 15-1-092; 01/2016.
Collapse
Affiliation(s)
- Alexander Ziebart
- From the Department of Anaesthesiology (AZ, RR, RH, CM, JK, AG-B, SCT, MKES, EKH), Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University (CB, FJ, K-FK), Focus Program Translational Neurosciences (MKES) and Research Centre for Immunotherapy, Johannes Gutenberg-University of Mainz, Mainz, Germany (MKES)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Kamuf J, Garcia Bardon A, Ziebart A, Frauenknecht K, Folkert K, Schwab J, Ruemmler R, Renz M, Cana D, Thal SC, Hartmann EK. Experimental lung injury induces cerebral cytokine mRNA production in pigs. PeerJ 2020; 8:e10471. [PMID: 33354426 PMCID: PMC7733330 DOI: 10.7717/peerj.10471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/11/2020] [Indexed: 12/02/2022] Open
Abstract
Background Acute respiratory distress syndrome (ARDS) is an important disease with a high incidence among patients admitted to intensive care units. Over the last decades, the survival of critically ill patients has improved; however, cognitive deficits are among the long-term sequelae. We hypothesize that acute lung injury leads to upregulation of cerebral cytokine synthesis. Methods After approval of the institutional and animal care committee, 20 male pigs were randomized to one of three groups: (1) Lung injury by oleic acid injection (OAI), (2) ventilation only (CTR) or (3) untreated. We compared neuronal numbers, proportion of neurons with markers for apoptosis, activation state of Iba-1 stained microglia cells and cerebral mRNA levels of different cytokines between the groups 18 hours after onset of lung injury. Results We found an increase in hippocampal TNFalpha (p < 0.05) and IL-6 (p < 0.05) messenger RNA (mRNA) in the OAI compared to untreated group as well as higher hippocampal IL-6 mRNA compared to control (p < 0.05). IL-8 and IL-1beta mRNA showed no differences between the groups. We found histologic markers for beginning apoptosis in OAI compared to untreated (p < 0.05) and more active microglia cells in OAI and CTR compared to untreated (p < 0.001 each). Conclusion Hippocampal cytokine transcription increases within 18 hours after the induction of acute lung injury with histological evidence of neuronal damage. It remains to be elucidated if increased cytokine mRNA synthesis plays a role in the cognitive decline observed in survivors of ARDS.
Collapse
Affiliation(s)
- Jens Kamuf
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Andreas Garcia Bardon
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Alexander Ziebart
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Katrin Frauenknecht
- Institute of Neuropathology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Konstantin Folkert
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Johannes Schwab
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Robert Ruemmler
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Miriam Renz
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Denis Cana
- Institute of Neuropathology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Serge C Thal
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Erik K Hartmann
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| |
Collapse
|
14
|
Endo Y, Miyasho T, Imahase H, Kawamura Y, Sakamoto Y, Yamashita K. Use of perfusion index to detect hemodynamic changes in endotoxemic pigs. J Vet Emerg Crit Care (San Antonio) 2020; 30:534-542. [PMID: 32652875 DOI: 10.1111/vec.12985] [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: 08/09/2017] [Revised: 12/23/2018] [Accepted: 01/30/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The perfusion index (PI) derived from plethysmographic signals provides a noninvasive indication of peripheral perfusion. This study aimed to investigate changes in PI and other hemodynamic variables in pigs subjected to endotoxemia. DESIGN Prospective experimental study. SETTING University teaching hospital. ANIMALS Twelve healthy pigs weighing a mean (± standard deviation [SD]) of 31.7 ± 2.0 kg. INTERVENTIONS Pigs were divided into control and endotoxin groups (n = 6 each). Endotoxemia was induced by IV infusion of lipopolysaccharide. Heart rate, mean arterial pressure, cardiac index (CI), central venous pressure, systemic vascular resistance index (SVRI), extravascular lung water index (ELWI), Global end-diastolic volume (GEDV) index, and pulmonary permeability index were measured using a transpulmonary thermodilution monitor in all pigs. PI was measured using a pulse oximeter probe attached to the tail. Pao2 , Paco2 , and plasma lactate concentration were measured by blood gas analysis. Measurements were taken at baseline (T0 ). Saline or lipopolysaccharide was then administered for 30 min to all pigs (control or endotoxemia group, respectively), and each parameter was measured every 30 min up to 270 min. Data were analyzed by analysis of variance and Student's t-tests. MEASUREMENTS AND MAIN RESULTS There were no significant changes in any variables in the control group, but CI, SVRI, PI, ELWI, blood lactate concentration, and Pao2 changed significantly from baseline in the endotoxin group (P < 0.001, P = 0.0048, P < 0.001, P = 0.0064, P < 0.001, and P = 0.0220, respectively). In the endotoxin group, mean (± SD) %PI increased from T0 to 154 ± 34% at T60 (P = .001) and 135 ± 50% at T90 (P =0 .004), which mirrored significant changes in %CI and %SVRI. CONCLUSION The PI may be useful to detect changes in CI and SVRI.
Collapse
Affiliation(s)
- Yusuke Endo
- Departments of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Taku Miyasho
- Departments of Veterinary Science, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Hisashi Imahase
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yoshio Kawamura
- Department of Veterinary Pathobiology, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Yuichiro Sakamoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazuto Yamashita
- Departments of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| |
Collapse
|
15
|
Ruemmler R, Ziebart A, Kuropka F, Duenges B, Kamuf J, Garcia-Bardon A, Hartmann EK. Bi-Level ventilation decreases pulmonary shunt and modulates neuroinflammation in a cardiopulmonary resuscitation model. PeerJ 2020; 8:e9072. [PMID: 32377456 PMCID: PMC7195831 DOI: 10.7717/peerj.9072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/06/2020] [Indexed: 11/23/2022] Open
Abstract
Background Optimal ventilation strategies during cardiopulmonary resuscitation are still heavily debated and poorly understood. So far, no convincing evidence could be presented in favour of outcome relevance and necessity of specific ventilation patterns. In recent years, alternative models to the guideline-based intermittent positive pressure ventilation (IPPV) have been proposed. In this randomized controlled trial, we evaluated a bi-level ventilation approach in a porcine model to assess possible physiological advantages for the pulmonary system as well as resulting changes in neuroinflammation compared to standard measures. Methods Sixteen male German landrace pigs were anesthetized and instrumented with arterial and venous catheters. Ventricular fibrillation was induced and the animals were left untreated and without ventilation for 4 minutes. After randomization, the animals were assigned to either the guideline-based group (IPPV, tidal volume 8–10 ml/kg, respiratory rate 10/min, FiO21.0) or the bi-level group (inspiratory pressure levels 15–17 cmH2O/5cmH2O, respiratory rate 10/min, FiO21.0). Mechanical chest compressions and interventional ventilation were initiated and after 5 minutes, blood samples, including ventilation/perfusion measurements via multiple inert gas elimination technique, were taken. After 8 minutes, advanced life support including adrenaline administration and defibrillations were started for up to 4 cycles. Animals achieving ROSC were monitored for 6 hours and lungs and brain tissue were harvested for further analyses. Results Five of the IPPV and four of the bi-level animals achieved ROSC. While there were no significant differences in gas exchange or hemodynamic values, bi-level treated animals showed less pulmonary shunt directly after ROSC and a tendency to lower inspiratory pressures during CPR. Additionally, cytokine expression of tumour necrosis factor alpha was significantly reduced in hippocampal tissue compared to IPPV animals. Conclusion Bi-level ventilation with a constant positive end expiratory pressure and pressure-controlled ventilation is not inferior in terms of oxygenation and decarboxylation when compared to guideline-based IPPV ventilation. Additionally, bi-level ventilation showed signs for a potentially ameliorated neurological outcome as well as less pulmonary shunt following experimental resuscitation. Given the restrictions of the animal model, these advantages should be further examined.
Collapse
Affiliation(s)
- Robert Ruemmler
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Alexander Ziebart
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Frances Kuropka
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Bastian Duenges
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Jens Kamuf
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Andreas Garcia-Bardon
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Erik K Hartmann
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| |
Collapse
|
16
|
Ziebart A, Ruemmler R, Möllmann C, Kamuf J, Garcia-Bardon A, Thal SC, Hartmann EK. Fluid resuscitation-related coagulation impairment in a porcine hemorrhagic shock model. PeerJ 2020; 8:e8399. [PMID: 32095322 PMCID: PMC7017792 DOI: 10.7717/peerj.8399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/16/2019] [Indexed: 12/21/2022] Open
Abstract
Background Fast and effective treatment of hemorrhagic shock is one of the most important preclinical trauma care tasks e.g., in combat casualties in avoiding severe end-organ damage or death. In scenarios without immediate availability of blood products, alternate regimens of fluid resuscitation represent the only possibility of maintaining sufficient circulation and regaining adequate end-organ oxygen supply. However, the fluid choice alone may affect the extent of the bleeding by interfering with coagulation pathways. This study investigates the impact of hydroxyethyl starch (HES), gelatine-polysuccinate (GP) and balanced electrolyte solution (BES) as commonly used agents for fluid resuscitation on coagulation using a porcine hemorrhagic shock model. Methods Following approval by the State and Institutional Animal Care Committee, life-threatening hemorrhagic shock was induced via arterial blood withdrawal in 24 anesthetized pigs. Isovolumetric fluid resuscitation with either HES, GP or BES (n = 3 × 8) was performed to compensate for the blood loss. Over four hours, hemodynamics, laboratory parameters and rotational thromboelastometry-derived coagulation were analyzed. As secondary endpoint the porcine values were compared to human blood. Results All the agents used for fluid resuscitation significantly affected coagulation. We measured a restriction of laboratory parameters, clot development and clot firmness, particularly in HES- and GP-treated animals. Hemoglobin content dropped in all groups but showed a more pronounced decline in colloid-treated pigs. This effect was not maintained over the four-hour monitoring period. Conclusion HES, GP, and BEL sufficiently stabilized the macrocirculation, but significantly affected coagulation. These effects were most pronounced after colloid and particularly HES administration. Despite suitability for rapid hemodynamic stabilization, colloids have to be chosen with caution, because their molecular properties may affect coagulation directly and as a consequence of pronounced hemodilution. Our comparison of porcine and human coagulation showed increased coagulation activity in pig blood.
Collapse
Affiliation(s)
- Alexander Ziebart
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Robert Ruemmler
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Christian Möllmann
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Jens Kamuf
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Andreas Garcia-Bardon
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Serge C Thal
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Erik K Hartmann
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| |
Collapse
|
17
|
Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study. Crit Care Med 2019; 47:229-238. [PMID: 30379668 PMCID: PMC6336491 DOI: 10.1097/ccm.0000000000003519] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Supplemental Digital Content is available in the text. Objectives: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. Design: Planned secondary analysis of a prospective, observational, multicentre cohort study. Setting: International sample of 459 ICUs from 50 countries. Patients: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. Interventions: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. Measurements and Main Results: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92–1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93–1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0–22] vs 8 [0–20]; p = 0.014) and shorter duration of ICU stay (11 [6–20] vs 12 [7–22]; p = 0.04). Conclusions: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required.
Collapse
|
18
|
Ziebart A, Schaefer MM, Thomas R, Kamuf J, Garcia-Bardon A, Möllmann C, Ruemmler R, Heid F, Schad A, Hartmann EK. Random allogeneic blood transfusion in pigs: characterisation of a novel experimental model. PeerJ 2019; 7:e7439. [PMID: 31440432 PMCID: PMC6699485 DOI: 10.7717/peerj.7439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 07/08/2019] [Indexed: 12/29/2022] Open
Abstract
Background Organ cross-talk describes interactions between a primary affected organ and a secondarily injured remote organ, particularly in lung-brain interactions. A common theory is the systemic distribution of inflammatory mediators that are released by the affected organ and transferred through the bloodstream. The present study characterises the baseline immunogenic effects of a novel experimental model of random allogeneic blood transfusion in pigs designed to analyse the role of the bloodstream in organ cross-talk. Methods After approval of the State and Institutional Animal Care Committee, 20 anesthetized pig were randomized in a donor and an acceptor (each n = 8): the acceptor animals each received high-volume whole blood transfusion from the donor (35–40 ml kg−1). Four animals received balanced electrolyte solution instead of blood transfusion (control group; n = 4). Afterwards the animals underwent extended cardiorespiratory monitoring for eight hours. Post mortem assessment included pulmonary, cerebral and systemic mediators of early inflammatory response (IL-6, TNF-alpha, iNOS), wet to dry ratio, and lung histology. Results No adverse events or incompatibilities occurred during the blood transfusion procedures. Systemic cytokine levels and pulmonary function were unaffected. Lung histopathology scoring did not display relevant intergroup differences. Neither within the lung nor within the brain an up-regulation of inflammatory mediators was detected. High volume random allogeneic blood transfusion in pigs neither impaired pulmonary integrity nor induced systemic, lung, or brain inflammatory response. Conclusion This approach can represent a novel experimental model to characterize the blood-bound transmission in remote organ injury.
Collapse
Affiliation(s)
- Alexander Ziebart
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Moritz M Schaefer
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Rainer Thomas
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Jens Kamuf
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Andreas Garcia-Bardon
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Christian Möllmann
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Robert Ruemmler
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Florian Heid
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Arno Schad
- Institute of Pathology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Erik K Hartmann
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| |
Collapse
|
19
|
Zadeh JK, Ruemmler R, Hartmann EK, Ziebart A, Ludwig M, Patzak A, Xia N, Li H, Pfeiffer N, Gericke A. Responses of retinal arterioles and ciliary arteries in pigs with acute respiratory distress syndrome (ARDS). Exp Eye Res 2019; 184:152-161. [DOI: 10.1016/j.exer.2019.04.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/29/2019] [Accepted: 04/17/2019] [Indexed: 01/16/2023]
|
20
|
Ruemmler R, Ziebart A, Moellmann C, Garcia-Bardon A, Kamuf J, Kuropka F, Duenges B, Hartmann EK. Ultra-low tidal volume ventilation-A novel and effective ventilation strategy during experimental cardiopulmonary resuscitation. Resuscitation 2018; 132:56-62. [PMID: 30176273 DOI: 10.1016/j.resuscitation.2018.08.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/05/2018] [Accepted: 08/28/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The effects of different ventilation strategies during CPR on patient outcomes and lung physiology are still poorly understood. This study compares positive pressure ventilation (IPPV) to passive oxygenation (CPAP) and a novel ultra-low tidal volume ventilation (ULTVV) regimen in an experimental ventricular fibrillation animal model. STUDY DESIGN Prospective randomized controlled trial. ANIMALS 30 male German landrace pigs (16-20 weeks). METHODS Ventricular fibrillation was induced in anesthetized and instrumented pigs and the animals were randomized into three groups. Mechanical CPR was initiated and ventilation was either provided by means of standard IPPV (RR: 10/min, Vt: 8-9 ml/kg, FiO2: 1,0, PEEP: 5 mbar), CPAP (O2-Flow: 10 l/min, PEEP: 5 mbar) or ULTVV (RR: 50/min, Vt: 2-3 ml/kg, FiO2: 1,0, PEEP: 5 mbar). Guideline-based advanced life support was applied for a maximum of 4 cycles and animals achieving ROSC were monitored for 6 h before terminating the experiment. Ventilation/perfusion ratios were performed via multiple inert gas elimination, blood gas analyses were taken hourly and extended cardiovascular measurements were collected constantly. Brain and lung tissue samples were taken and analysed for proinflammatory cytokine expression. RESULTS ULTVV provided sufficient oxygenation and ventilation during CPR while demanding significantly lower respiratory and intrathoracic pressures. V/Q mismatch was significantly decreased and lung injury was mitigated in surviving animals compared to IPPV and CPAP. Additionally, cerebral cytokine expression was dramatically reduced. CONCLUSION Ultra-low-volume ventilation during CPR in a porcine model is feasible and may provide lung-protective benefits as well as neurological outcome improvement due to lower inflammation. Our results warrant further studies and might eventually lead to new therapeutic options in the resuscitation setting.
Collapse
Affiliation(s)
- Robert Ruemmler
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany.
| | - Alexander Ziebart
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany
| | - Christian Moellmann
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany
| | - Andreas Garcia-Bardon
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany
| | - Jens Kamuf
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany
| | - Frances Kuropka
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany
| | - Bastian Duenges
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany
| | - Erik Kristoffer Hartmann
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany
| |
Collapse
|
21
|
Kamuf J, Garcia-Bardon A, Ziebart A, Thomas R, Folkert K, Frauenknecht K, Thal SC, Hartmann EK. Lung injury does not aggravate mechanical ventilation-induced early cerebral inflammation or apoptosis in an animal model. PLoS One 2018; 13:e0202131. [PMID: 30092082 PMCID: PMC6084980 DOI: 10.1371/journal.pone.0202131] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 07/02/2018] [Indexed: 12/11/2022] Open
Abstract
Introduction The acute respiratory distress syndrome is not only associated with a high mortality, but also goes along with cognitive impairment in survivors. The cause for this cognitive impairment is still not clear. One possible mechanism could be cerebral inflammation as result of a “lung-brain-crosstalk”. Even mechanical ventilation itself can induce cerebral inflammation. We hypothesized, that an acute lung injury aggravates the cerebral inflammation induced by mechanical ventilation itself and leads to neuronal damage. Methods After approval of the institutional and state animal care committee 20 pigs were randomized to one of three groups: lung injury by central venous injection of oleic acid (n = 8), lung injury by bronchoalveolar lavage in combination with one hour of injurious ventilation (n = 8) or control (n = 6). Brain tissue of four native animals from a different study served as native group. For six hours all animals were ventilated with a tidal volume of 7 ml kg-1 and a scheme for positive end-expiratory pressure and inspired oxygen fraction, which was adapted from the ARDS network tables. Afterwards the animals were killed and the brains were harvested for histological (number of neurons and microglia) and molecular biologic (TNFalpha, IL-1beta, and IL-6) examinations. Results There was no difference in the number of neurons or microglia cells between the groups. TNFalpha was significantly higher in all groups compared to native (p < 0.05), IL-6 was only increased in the lavage group compared to native (p < 0.05), IL-1beta showed no difference between the groups. Discussion With our data we can confirm earlier results, that mechanical ventilation itself seems to trigger cerebral inflammation. This is not aggravated by acute lung injury, at least not within the first 6 hours after onset. Nevertheless, it seems too early to dismiss the idea of lung-injury induced cerebral inflammation, as 6 hours might be just not enough time to see any profound effect.
Collapse
Affiliation(s)
- Jens Kamuf
- Department of Anesthesiology, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
- * E-mail:
| | - Andreas Garcia-Bardon
- Department of Anesthesiology, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alexander Ziebart
- Department of Anesthesiology, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rainer Thomas
- Department of Anesthesiology, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Konstantin Folkert
- Department of Anesthesiology, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Katrin Frauenknecht
- Institute of Neuropathology, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Serge C. Thal
- Department of Anesthesiology, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Erik K. Hartmann
- Department of Anesthesiology, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
| |
Collapse
|
22
|
Ziebart A, Möllmann C, Garcia-Bardon A, Kamuf J, Schäfer M, Thomas R, Hartmann EK. Effect of gelatin-polysuccinat on cerebral oxygenation and microcirculation in a porcine haemorrhagic shock model. Scand J Trauma Resusc Emerg Med 2018; 26:15. [PMID: 29426350 PMCID: PMC5807741 DOI: 10.1186/s13049-018-0477-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/11/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND During early treatment of haemorrhagic shock maintenance of cerebral and end-organ oxygen supply by fluid resuscitation is mandatory. Gelatin-polysuccinat (GP) recently regained attention despite a still unclear risk profile and widely unknown effects on cerebral and peripheral microcirculation. This study investigates the effects of GP versus balanced electrolyte solution (BEL) with focus on cerebral regional oxygen saturation and peripheral microcirculation in a porcine haemorrhagic shock model. METHODS After Animal Care Committee approval haemorrhagic shock was induced by arterial blood withdrawal in 27 anaesthetized pigs. Consequently, the animals received rapid fluid resuscitation by either GP or BEL to replace the removed amount of blood, or remained untreated (n = 3 × 9). Over two hours cerebral regional oxygen saturation by near-infrared spectroscopy and peripheral buccal microcirculation by combined white-light spectrometry and laser-Doppler flowmetry were recorded. Secondary parameters included extended haemodynamics, spirometry, haematological and blood gas parameters. RESULTS Both fluid resuscitation regimes sufficiently stabilized the macro- and microcirculation in haemorrhagic shock with a more pronounced effect following GP infusion. GP administration led to a persisting, critical impairment of cerebral regional oxygen saturation through considerable haemodilution. Survival rates were 100% in both fluid resuscitation groups, but only 33% in the untreated control. CONCLUSION Equal amounts of GP and BEL sufficiently stabilize systemic circulation and microcirculatory perfusion. Forced fluid resuscitation by GP should be applied with caution to prevent haemodilution-induced impairment of cerebral oxygen delivery.
Collapse
Affiliation(s)
- Alexander Ziebart
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Christian Möllmann
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Andreas Garcia-Bardon
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Jens Kamuf
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Moritz Schäfer
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Rainer Thomas
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Erik K. Hartmann
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| |
Collapse
|
23
|
An in vitro lung model to assess true shunt fraction by multiple inert gas elimination. PLoS One 2017; 12:e0184212. [PMID: 28877216 PMCID: PMC5587330 DOI: 10.1371/journal.pone.0184212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 08/21/2017] [Indexed: 11/19/2022] Open
Abstract
The Multiple Inert Gas Elimination Technique, based on Micropore Membrane Inlet Mass Spectrometry, (MMIMS-MIGET) has been designed as a rapid and direct method to assess the full range of ventilation-to-perfusion (V/Q) ratios. MMIMS-MIGET distributions have not been assessed in an experimental setup with predefined V/Q-distributions. We aimed (I) to construct a novel in vitro lung model (IVLM) for the simulation of predefined V/Q distributions with five gas exchange compartments and (II) to correlate shunt fractions derived from MMIMS-MIGET with preset reference shunt values of the IVLM. Five hollow-fiber membrane oxygenators switched in parallel within a closed extracorporeal oxygenation circuit were ventilated with sweep gas (V) and perfused with human red cell suspension or saline (Q). Inert gas solution was infused into the perfusion circuit of the gas exchange assembly. Sweep gas flow (V) was kept constant and reference shunt fractions (IVLM-S) were established by bypassing one or more oxygenators with perfusate flow (Q). The derived shunt fractions (MM-S) were determined using MIGET by MMIMS from the retention data. Shunt derived by MMIMS-MIGET correlated well with preset reference shunt fractions. The in vitro lung model is a convenient system for the setup of predefined true shunt fractions in validation of MMIMS-MIGET.
Collapse
|
24
|
Kamuf J, Garcia-Bardon A, Duenges B, Liu T, Jahn-Eimermacher A, Heid F, David M, Hartmann EK. Endexpiratory lung volume measurement correlates with the ventilation/perfusion mismatch in lung injured pigs. Respir Res 2017; 18:101. [PMID: 28535788 PMCID: PMC5442669 DOI: 10.1186/s12931-017-0585-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 05/15/2017] [Indexed: 12/30/2022] Open
Abstract
Background In acute respiratory respiratory distress syndrome (ARDS) a sustained mismatch of alveolar ventilation and perfusion (VA/Q) impairs the pulmonary gas exchange. Measurement of endexpiratory lung volume (EELV) by multiple breath-nitrogen washout/washin is a non-invasive, bedside technology to assess pulmonary function in mechanically ventilated patients. The present study examines the association between EELV changes and VA/Q distribution and the possibility to predict VA/Q normalization by means of EELV in a porcine model. Methods After approval of the state and institutional animal care committee 12 anesthetized pigs were randomized to ARDS either by bronchoalveolar lavage (n = 6) or oleic acid injection (n = 6). EELV, VA/Q ratios by multiple inert gas elimination and ventilation distribution by electrical impedance tomography were assessed at healthy state and at five different positive endexpiratory pressure (PEEP) steps in ARDS (0, 20, 15, 10, 5 cmH2O; each maintained for 30 min). Results VA/Q, EELV and tidal volume distribution all displayed the PEEP-induced recruitment in ARDS. We found a close correlation between VA/Q < 0.1 (representing shunt and low VA/Q units) and changes in EELV (spearman correlation coefficient −0.79). Logistic regression reveals the potential to predict VA/Q normalization (VA/Q < 0.1 less than 5%) from changes in EELV with an area under the curve of 0.89 with a 95%-CI of 0.81–0.96 in the receiver operating characteristic. Different lung injury models and recruitment characteristics did not influence these findings. Conclusion In a porcine ARDS model EELV measurement depicts PEEP-induced lung recruitment and is strongly associated with normalization of the VA/Q distribution in a model-independent fashion. Determination of EELV could be an intriguing addition in the context of lung protection strategies.
Collapse
Affiliation(s)
- Jens Kamuf
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Andreas Garcia-Bardon
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Bastian Duenges
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Tanghua Liu
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Antje Jahn-Eimermacher
- Institute of Medical Biostatistics, Epidemiology and Informatics, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Florian Heid
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Matthias David
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Erik K Hartmann
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| |
Collapse
|
25
|
Aeffner F, Bolon B, Davis IC. Mouse Models of Acute Respiratory Distress Syndrome: A Review of Analytical Approaches, Pathologic Features, and Common Measurements. Toxicol Pathol 2015; 43:1074-92. [PMID: 26296628 DOI: 10.1177/0192623315598399] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is a severe pulmonary reaction requiring hospitalization, which is incited by many causes, including bacterial and viral pneumonia as well as near drowning, aspiration of gastric contents, pancreatitis, intravenous drug use, and abdominal trauma. In humans, ARDS is very well defined by a list of clinical parameters. However, until recently no consensus was available regarding the criteria of ARDS that should be evident in an experimental animal model. This lack was rectified by a 2011 workshop report by the American Thoracic Society, which defined the main features proposed to delineate the presence of ARDS in laboratory animals. These should include histological changes in parenchymal tissue, altered integrity of the alveolar capillary barrier, inflammation, and abnormal pulmonary function. Murine ARDS models typically are defined by such features as pulmonary edema and leukocyte infiltration in cytological preparations of bronchoalveolar lavage fluid and/or lung sections. Common pathophysiological indicators of ARDS in mice include impaired pulmonary gas exchange and histological evidence of inflammatory infiltrates into the lung. Thus, morphological endpoints remain a vital component of data sets assembled from animal ARDS models.
Collapse
Affiliation(s)
- Famke Aeffner
- Flagship Biosciences Inc., Westminster, Colorado, USA
| | - Brad Bolon
- The Ohio State University, College of Veterinary Medicine, Department of Veterinary Biosciences, Columbus, Ohio, USA GEMpath Inc., Longmont, Colorado, USA
| | | |
Collapse
|
26
|
Ziebart A, Garcia-Bardon A, Kamuf J, Thomas R, Liu T, Schad A, Duenges B, David M, Hartmann EK. Pulmonary effects of expiratory-assisted small-lumen ventilation during upper airway obstruction in pigs. Anaesthesia 2015; 70:1171-9. [PMID: 26179167 DOI: 10.1111/anae.13154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 11/28/2022]
Abstract
Novel devices for small-lumen ventilation may enable effective inspiration and expiratory ventilation assistance despite airway obstruction. In this study, we investigated a porcine model of complete upper airway obstruction. After ethical approval, we randomly assigned 13 anaesthetised pigs either to small-lumen ventilation following airway obstruction (n = 8) for 30 min, or to volume-controlled ventilation (sham setting, n = 5). Small-lumen ventilation enabled adequate gas exchange over 30 min. One animal died as a result of a tension pneumothorax in this setting. Redistribution of ventilation from dorsal to central compartments and significant impairment of the distribution of ventilation/perfusion occurred. Histopathology demonstrated considerable lung injury, predominantly through differences in the dorsal dependent lung regions. Small-lumen ventilation maintained adequate gas exchange in a porcine airway obstruction model. The use of this technique for 30 min by inexperienced clinicians was associated with considerable end-expiratory collapse leading to lung injury, and may also carry the risk of severe injury.
Collapse
Affiliation(s)
- A Ziebart
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - A Garcia-Bardon
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - J Kamuf
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - R Thomas
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - T Liu
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - A Schad
- Institute of Pathology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - B Duenges
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - M David
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - E K Hartmann
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| |
Collapse
|