Differential effects of sustained inflation recruitment maneuvers on alveolar epithelial and lung endothelial injury*

2005 ◽  
Vol 33 (1) ◽  
pp. 181-188 ◽  
Author(s):  
James A. Frank ◽  
Danny F. McAuley ◽  
Jorge A. Gutierrez ◽  
Brian M. Daniel ◽  
Leland Dobbs ◽  
...  
Keyword(s):  
Endothelial Injury ◽  
Differential Effects ◽  
Alveolar Epithelial ◽  
Recruitment Maneuvers ◽  
Sustained Inflation

scholarly journals Markers of endothelial and epithelial pulmonary injury in mechanically ventilated COVID-19 ICU patients

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Savino Spadaro ◽  
Alberto Fogagnolo ◽  
Gianluca Campo ◽  
Ottavio Zucchetti ◽  
Marco Verri ◽  
...  
Keyword(s):  
Plasma Levels ◽  
Endothelial Injury ◽  
University Hospital ◽  
Intercellular Adhesion Molecule ◽  
Secondary Outcome ◽  
Intercellular Adhesion Molecule 1 ◽  
Mechanically Ventilated ◽  
Adhesion Protein ◽  
Alveolar Epithelial ◽  
Angiopoietin 2

Abstract Background Biomarkers can be used to detect the presence of endothelial and/or alveolar epithelial injuries in case of ARDS. Angiopoietin-2 (Ang-2), soluble intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion protein-1 (VCAM-1), P-selectin and E-selectin are biomarkers of endothelial injury, whereas the receptor for advanced glycation end-products (RAGE) reflects alveolar epithelial injury. The aims of this study were to evaluate whether the plasma concentration of the above-mentioned biomarkers was different 1) in survivors and non-survivors of COVID-19-related ARDS and 2) in COVID-19-related and classical ARDS. Methods This prospective study was performed in two COVID-19-dedicated Intensive Care Units (ICU) and one non-COVID-19 ICU at Ferrara University Hospital. A cohort of 31 mechanically ventilated patients with COVID-19 ARDS and a cohort of 11 patients with classical ARDS were enrolled. Ang-2, ICAM-1, VCAM-1, P-selectin, E-selectin and RAGE were determined with a bead-based multiplex immunoassay at three time points: inclusion in the study (T1), after 7 ± 2 days (T2) and 14 ± 2 days (T3). The primary outcome was to evaluate the plasma trend of the biomarker levels in survivors and non-survivors. The secondary outcome was to evaluate the differences in respiratory mechanics variables and gas exchanges between survivors and non-survivors. Furthermore, we compared the plasma levels of the biomarkers at T1 in patients with COVID-19-related ARDS and classical ARDS. Results In COVID-19-related ARDS, the plasma levels of Ang-2 and ICAM-1 at T1 were statistically higher in non-survivors than survivors, (p = 0.04 and p = 0.03, respectively), whereas those of P-selectin, E-selectin and RAGE did not differ. Ang-2 and ICAM-1 at T1 were predictors of mortality (AUROC 0.650 and 0.717, respectively). At T1, RAGE and P-selectin levels were higher in classical ARDS than in COVID-19-related ARDS. Ang-2, ICAM-1 and E-selectin were lower in classical ARDS than in COVID-19-related ARDS (all p < 0.001). Conclusions COVID-19 ARDS is characterized by an early pulmonary endothelial injury, as detected by Ang-2 and ICAM-1. COVID-19 ARDS and classical ARDS exhibited a different expression of biomarkers, suggesting different pathological pathways. Trial registration NCT04343053, Date of registration: April 13, 2020

scholarly journals Physiological Effects of Different Recruitment Maneuvers in a Pig Model of ARDS

2020 ◽  
Author(s):  
Feiping Xia ◽  
Chun Pan ◽  
Lihui Wang ◽  
Ling Liu ◽  
Songqiao Liu ◽  
...  
Keyword(s):  
Random Order ◽  
Pig Model ◽  
Physiological Effects ◽  
Impedance Tomography ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Recruitment Maneuvers ◽  
Sustained Inflation ◽  
Significant Difference ◽  
Before And After

Abstract Background: In acute respiratory distress syndrome (ARDS), lung recruitment maneuvers can recruit collapsed alveoli in gravity-dependent lung regions, improving the homogeneity of ventilation distribution. This study used electrical impedance tomography (EIT) to investigate the physiological effects of different recruitment maneuvers for alveolar recruitment in a pig model of ARDS. Methods: ARDS was induced in ten healthy male pigs with repeated bronchoalveolar lavage until the arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) (P/F ratio) was < 100 mmHg and remained stable for 30 minutes (TARDS). ARDS pigs underwent three sequential recruitment maneuvers, including sustained inflation (SI), increments of positive end-expiratory pressure (PEEP) (IP), and pressure-controlled ventilation (PCV) applied in random order, with 30 mins at a PEEP of 5 cmH2O between maneuvers. Respiratory mechanics, hemodynamics, arterial blood gas, and EIT were recorded at baseline, TARDS, and before and after each recruitment maneuver.Results: In all ten pigs, ARDS was successfully induced with a mean 2.8±1.03L (2800±1032.80ml) bronchoalveolar lavages. PaO2, SO2, P/F, and compliance were significantly improved after recruitment with SI, IP or PCV (all p<0.05), and there were no significant differences between maneuvers. Global inhomogeneity (GI) was significantly decreased after recruitment with SI, IP, or PCV. There were no significant differences in GI before or after recruitment with the different maneuvers. The decrease in GI (ΔGI) was significantly greater after recruitment with IP compared to SI (p=0.023), but there was no significant difference in ΔGI between IP and PCV.Conclusion: SI, IP, and PCV increased oxygenation, and regional and global compliance of the respiratory system, and decreased inhomogeneous gas distribution in ARDS pigs. IP significantly improved inhomogeneity of the lung compared to SI.

Differential effects of pirfenidone and nintedanib on mouse alveolar epithelial organoids

2020 ◽  
Author(s):  
Manon Woest ◽  
Vasiliki Verschut ◽  
Reinoud Gosens ◽  
Loes Kistemaker
Keyword(s):  
Differential Effects ◽  
Alveolar Epithelial

scholarly journals Distinct temporal characteristics of circulating alveolar epithelial and endothelial injury markers in ARDS with COVID-19

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Kentaro Tojo ◽  
Natsuhiro Yamamoto ◽  
Takahiro Mihara ◽  
Miyo Abe ◽  
Takahisa Goto
Keyword(s):  
Endothelial Injury ◽  
Temporal Characteristics ◽  
Alveolar Epithelial

Sustained inflation: The lung recruitment maneuvers for neonates

2020 ◽  
Vol 36 ◽  
pp. 142-150
Author(s):  
Ke-Yun Chao ◽  
Yu-Wen Lin ◽  
Chen-En Chiang ◽  
Chi-Wei Tseng ◽  
Shu-Chi Mu
Keyword(s):  
Lung Recruitment ◽  
Recruitment Maneuvers ◽  
Sustained Inflation

scholarly journals Physiological Effects of Different Recruitment Maneuvers for Improved Lung Inhomogeneity in a Pig Model of ARDS

2020 ◽  
Author(s):  
Feiping Xia ◽  
Chun Pan ◽  
Lihui Wang ◽  
Ling Liu ◽  
Songqiao Liu ◽  
...  
Keyword(s):  
Random Order ◽  
Pig Model ◽  
Physiological Effects ◽  
Impedance Tomography ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Recruitment Maneuvers ◽  
Sustained Inflation ◽  
Significant Difference ◽  
Before And After

Abstract Background: In acute respiratory distress syndrome (ARDS), lung recruitment maneuvers can recruit collapsed alveoli in gravity-dependent lung regions, improving the homogeneity of ventilation distribution. This study used electrical impedance tomography (EIT) to investigate the physiological effects of different recruitment maneuvers for alveolar recruitment in a pig model of ARDS. Methods: ARDS was induced in ten healthy male pigs with repeated bronchoalveolar lavage until the arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) (P/F ratio) was < 100 mmHg and remained stable for 30 minutes (TARDS). ARDS pigs underwent three sequential recruitment maneuvers, including sustained inflation (SI), increments of positive end-expiratory pressure (PEEP) (IP), and pressure-controlled ventilation (PCV) applied in random order, with 30 mins at a PEEP of 5 cmH2O between maneuvers. Respiratory mechanics, hemodynamics, arterial blood gas, and EIT were recorded at baseline, TARDS, and before and after each recruitment maneuver.Results: In all ten pigs, ARDS was successfully induced with a mean 2.8±1.03L (2800±1032.80ml) bronchoalveolar lavages. PaO2, SO2, P/F, and compliance were significantly improved after recruitment with SI, IP or PCV (all p<0.05), and there were no significant differences between maneuvers. Global inhomogeneity (GI) was significantly decreased after recruitment with SI, IP, or PCV. There were no significant differences in GI before or after recruitment with the different maneuvers. The decrease in GI (ΔGI) was significantly greater after recruitment with IP compared to SI (p=0.023), but there was no significant difference in ΔGI between IP and PCV.Conclusion: SI, IP, and PCV increased oxygenation, and regional and global compliance of the respiratory system, and decreased inhomogeneous gas distribution in ARDS pigs. IP significantly improved inhomogeneity of the lung compared to SI.

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