scholarly journals Impact of Different Positive End-Expiratory Pressures on Lung Mechanics in the Setting of Moderately Elevated Intra-Abdominal Pressure and Acute Lung Injury in a Porcine Model

2021 ◽  
Vol 10 (2) ◽  
pp. 306
Author(s):  
Mascha O. Fiedler ◽  
Emilis Simeliunas ◽  
B. Luise Deutsch ◽  
Dovile Diktanaite ◽  
Alexander Harms ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Transpulmonary Pressure ◽  
Lung Compliance ◽  
Lung Mechanics ◽  
Lung Injury Score ◽  
Abdominal Pressure ◽  
Injury Score ◽  
Group A ◽  
Over Time

The effects of a moderately elevated intra-abdominal pressure (IAP) on lung mechanics in acute respiratory distress syndrome (ARDS) have still not been fully analyzed. Moreover, the optimal positive end-expiratory pressure (PEEP) in elevated IAP and ARDS is unclear. In this paper, 18 pigs under general anesthesia received a double hit lung injury. After saline lung lavage and 2 h of injurious mechanical ventilation to induce an acute lung injury (ALI), an intra-abdominal balloon was filled until an IAP of 10 mmHg was generated. Animals were randomly assigned to one of three groups (group A = PEEP 5, B = PEEP 10 and C = PEEP 15 cmH2O) and ventilated for 6 h. We measured end-expiratory lung volume (EELV) per kg bodyweight, driving pressure (ΔP), transpulmonary pressure (ΔPL), static lung compliance (Cstat), oxygenation (P/F ratio) and cardiac index (CI). In group A, we found increases in ΔP (22 ± 1 vs. 28 ± 2 cmH2O; p = 0.006) and ΔPL (16 ± 1 vs. 22 ± 2 cmH2O; p = 0.007), with no change in EELV/kg (15 ± 1 vs. 14 ± 1 mL/kg) when comparing hours 0 and 6. In group B, there was no change in ΔP (26 ± 2 vs. 25 ± 2 cmH2O), ΔPL (19 ± 2 vs. 18 ± 2 cmH2O), Cstat (21 ± 3 vs. 21 ± 2 cmH2O/mL) or EELV/kg (12 ± 2 vs. 13 ± 3 mL/kg). ΔP and ΔPL were significantly lower after 6 h when comparing between group C and A (21 ± 1 vs. 28 ± 2 cmH2O; p = 0.020) and (14 ± 1 vs. 22 ± 2 cmH2O; p = 0.013)). The EELV/kg increased over time in group C (13 ± 1 vs. 19 ± 2 mL/kg; p = 0.034). The P/F ratio increased in all groups over time. CI decreased in groups B and C. The global lung injury score did not significantly differ between groups (A: 0.25 ± 0.05, B: 0.21 ± 0.02, C: 0.22 ± 0.03). In this model of ALI, elevated IAP, ΔP and ΔPL increased further over time in the group with a PEEP of 5 cmH2O applied over 6 h. This was not the case in the groups with a PEEP of 10 and 15 cmH2O. Although ΔP and ΔPL were significantly lower after 6 hours in group C compared to group A, we could not show significant differences in histological lung injury score.

scholarly journals The assessment of severity of lung injury in sepsis

2004 ◽  
Vol 132 (11-12) ◽  
pp. 404-408
Author(s):  
Ljubica Arsenijevic ◽  
Nada Popovic ◽  
Zvezdana Kojic
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Lung Injury Score ◽  
Pulmonary Dysfunction ◽  
Lethal Outcome ◽  
Injury Score ◽  
Respiratory Dysfunction

Adult respiratory distress syndrome (ARDS) is an acute and severe pulmonary dysfunction. It is clinically characterized by dyspnea and tachypnea, progressive hypoxemia (within 12-48 hours), reduction of pulmonary compliance and diffuse bilateral infiltrates seen on pulmonary radiogram. Etiological factors giving rise to development of the syndrome are numerous. The acute lung injury (AU) is defined as the inflammation syndrome and increased permeability, which is associated with radiological and physiological disorders. Lung injury score (LIS), which is composed of four components, is used for making a distinction between two separate but rather similar syndromes. The study was aimed at the assessment of the severity of the lung injury in patients who had suffered from sepsis of the gynecological origin and its influence on the outcome of the disease. The total of 43 female patients was analyzed. Twenty patients (46.51%) were diagnosed as having ARDS based on the lung injury score, while 23 patients (53.48%) were diagnosed with acute lung injury. In our series, lung injury score ranged from 0.7 to 3.3 in ARDS patients, and lethal outcome ensued in 11 (55%) cases in this group. As for the patients with the acute lung injury, the score values ranged from 0.3 to 1.3 and only one patient from this group died (4.34%). The obtained results indicate that high values of the lung injury score are suggestive of the severe respiratory dysfunction as well as that lethal outcome is dependent on LIS value.

scholarly journals Thaliporphine Derivative Improves Acute Lung Injury after Traumatic Brain Injury

2015 ◽  
Vol 2015 ◽  
pp. 1-10
Author(s):  
Gunng-Shinng Chen ◽  
Kuo-Feng Huang ◽  
Chien-Chu Huang ◽  
Jia-Yi Wang
Keyword(s):  
Traumatic Brain Injury ◽  
Acute Lung Injury ◽  
Brain Injury ◽  
Lung Injury ◽  
Weight Ratio ◽  
Dry Weight ◽  
Lung Injury Score ◽  
Injury Score ◽  
Aqp4 Expression ◽  
Protein Levels

Acute lung injury (ALI) occurs frequently in patients with severe traumatic brain injury (TBI) and is associated with a poor clinical outcome. Aquaporins (AQPs), particularly AQP1 and AQP4, maintain water balances between the epithelial and microvascular domains of the lung. Since pulmonary edema (PE) usually occurs in the TBI-induced ALI patients, we investigated the effects of a thaliporphine derivative, TM-1, on the expression of AQPs and histological outcomes in the lung following TBI in rats. TM-1 administered (10 mg/kg, intraperitoneal injection) at 3 or 4 h after TBI significantly reduced the elevated mRNA expression and protein levels of AQP1 and AQP4 and diminished the wet/dry weight ratio, which reflects PE, in the lung at 8 and 24 h after TBI. Postinjury TM-1 administration also improved histopathological changes at 8 and 24 h after TBI. PE was accompanied with tissue pathological changes because a positive correlation between the lung injury score and the wet/dry weight ratio in the same animal was observed. Postinjury administration of TM-1 improved ALI and reduced PE at 8 and 24 h following TBI. The pulmonary-protective effect of TM-1 may be attributed to, at least in part, downregulation of AQP1 and AQP4 expression after TBI.

scholarly journals Comparison between cardiac output values measured by thermodilution and partial carbon dioxide rebreathing in patients with acute lung injury

2004 ◽  
Vol 122 (6) ◽  
pp. 233-238 ◽  
Author(s):  
Jorge Luís dos Santos Valiatti ◽  
José Luiz Gomes do Amaral
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Output ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Lung Injury Score ◽  
Controlled Study ◽  
Carbon Dioxide Rebreathing ◽  
Significant Difference ◽  
Group A ◽  
Group B

CONTEXT: Thermodilution, which is considered to be a standard technique for measuring the cardiac output in critically ill patients, is not free from relevant risks. There is a need to find alternative, noninvasive, automatic, simple and accurate methods for monitoring cardiac output at the bedside. OBJECTIVE: To compare cardiac output measurements by thermodilution and partial carbon dioxide rebreathing in patients with acute lung injury at two levels of severity (lung injury score, LIS: below 2.5, group A; and above 2.5, group B). TYPE OF STUDY: Comparative, prospective and controlled study. SETTING: Intensive Care Units of two university hospitals. METHODS: Cardiac output was measured by thermodilution and partial carbon dioxide rebreathing. Twenty patients with acute lung failure (PaO2/FiO2 < 300) who were under mechanical ventilation and from whom 294 measurements were taken: 164 measurements in group A (n = 11) and 130 in group B (n = 9), ranging from 14 to 15 determinations per patient. RESULTS: There was a poor positive correlation between the methods studied for the patients from groups A (r = 0.52, p < 0.001) and B (r = 0.47, p < 0.001). The application of the Bland-Altman test made it possible to expose the lack of agreement between the methods (group A: -0.9 ± 2.71 l/min; 95% CI = -1.14 to -0.48; and group B: -1.75 ± 2.05 l/min; 95% CI = -2.11 to -1.4). The comparison of the results (Student t and Mann-Whitney tests) within each group and between the groups showed significant difference (p = 0.000, p < 0.05). DISCUSSION: Errors in estimating CaCO2 (arterial CO2 content) from ETCO2 (end-tidal CO2) and situations of hyperdynamic circulation associated with dead space and/or increased shunt possibly explain our results. CONCLUSION: Under the conditions of this study, the results obtained allow us to conclude that, in patients with acute lung injury, the cardiac output determined by partial rebreathing of CO2 differs from the measurements obtained by thermodilution. This difference becomes greater, the more critical the lung injury is.

scholarly journals Η εκτίμηση λειτουργικότητας του πνευμονικού ενδοθηλίου σε ασθενείς με οξεία πνευμονική βλάβη

2014 ◽  
Author(s):  
Αικατερίνη Ψευδή
Keyword(s):  
Cardiac Output ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Angiotensin Converting Enzyme ◽  
Indicator Dilution ◽  
Apache Ii ◽  
Lung Injury Score ◽  
Converting Enzyme ◽  
Injury Score ◽  
Indicator Dilution Techniques

Οι διαταραχές στη δραστικότητα του μετατρεπτικού ενζύμου της αγγειοτενσίνης (Angiotensin-Converting Enzyme- ΑCE) στο ενδοθήλιο των τριχοειδών του πνεύμονα αποτελούν έναν πρώιμο , ευαίσθητο και ποσοτικά μετρήσιμο δείκτη πνευμονικής βλάβης σε πειραματόζωα. Υποθέσαμε πρώτον ότι οι αλλοιώσεις του ACE στο πνευμονικό ενδοθήλιο μπορούν να εντοπιστούν και σε ασθενείς με οξεία πνευμονική βλάβη (Acute Lung Injury - ALI) και δεύτερον ότι η δραστηριότητα του ACE στο τριχοειδικό ενδοθήλιο των πνευμόνων μπορεί να συσχετιστεί με τη σοβαρότητα της πνευμονικής βλάβης και να χρησιμοποιηθεί ως ποσοτικά μετρούμενος δείκτης στη υποκείμενη πνευμονική τριχοειδική ενδοθηλιακή δυσλειτουργία.Μέθοδος και Αποτελέσματα . Εφαρμόζοντας μεθόδους αραίωσης του δείκτη ( indicator-dilution techniques) μετρήσαμε την διαπνευμονική υδρόλυση του ACE υποστρώματος ,το 3H-benzoyl-Phe-Ala-Pro (BPAP) σε 33 βαρέως πάσχοντες ασθενείς υπό μηχανικό αερισμό και με σκορ πνευμονικής βλάβης (Lung Injury Score- LIS) κυμαινόμενο από 0 (μη πνευμονική βλάβη) έως 3.7( σοβαρή πνευμονική βλάβη). Επίσης μετρήθηκε η παράμετρος Amax/Km. Και οι δύο παράμετροι μειώθηκαν νωρίς κατά τη διάρκεια του ALI και ήταν αντιστρόφως ανάλογες με τη βαθμολογία APACHE II και LIS. Η υδρόλυση μειώθηκε με την αύξηση της καρδιακής παροχής (Cardiac output- CO), ενώ δυο διαφορετικά μοτίβα παρατηρήθηκαν μεταξύ CO και Amax / Km.Συμπεράσματα. Η δραστικότητα του PCEB-ACE μπορεί να μετρηθεί σε βαρέως πάσχοντες ασθενείς παρά την κλίνη, δίνοντας άμεσα πληροφορίες για τον δείκτη λειτουργικότητας του πνευμονικού ενδοθηλίου. Η δραστικότητα του ACE μειώνεται κατά τη διάρκεια του ALI, συσχετίζεται με την κλινική βαρύτητα τόσο της πνευμονικής βλάβης όσο και με την υποκείμενη νόσο, και μπορεί να χρησιμοποιηθεί ως ποσοτικά μετρούμενος δείκτης στη υποκείμενη τριχοειδική ενδοθηλιακή δυσλειτουργία.

Correlation between lung injury score and serum albumin levels in patients at risk for developing acute lung injury

Nutrition ◽  
2000 ◽  
Vol 16 (2) ◽  
pp. 91-94 ◽  
Author(s):  
Sanjeev Maskara ◽  
Nagamani Sen ◽  
John Prakash Raj ◽  
Ipeson Korah ◽  
B. Antonisamy
Keyword(s):  
At Risk ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Serum Albumin ◽  
Lung Injury Score ◽  
Injury Score ◽  
Patients At Risk
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