Effects Of Intravascular Volume Replacement On Lung Function And Damage In Non-Septic Experimental Lung Injury

Abstract Background: Intravascular volume replacement is often required in the presence of increased pulmonary capillary leakage, for example in patients with volutrauma with major hemorrhage. In the present study, the effects of Ringer’s acetate (RA), gelatin-polysuccinate (GEL), and a modern hydroxyethyl starch (HES, 6% 130/0.42) on lung and kidney function and damage were compared in a two-hit model of acute lung injury. The authors hypothesized that GEL and HES, compared to RA: (1) reduced lung histological damage, (2) impaired kidney morphology and function. Methods: Acute lung injury was induced in 30 anesthetized pigs by tidal volumes approximately 40 ml/kg, after saline lung lavage. Protective ventilation was initiated and approximately≈25% of estimated blood volume was drawn. Animals were randomly assigned to receive RA, GEL, or HES (n = 10/group) aimed at approximately 90% of intrathoracic blood volume before blood drainage. Results: Fluid volumes were higher with RA (2,250 ± 764 ml) than GEL (704 ± 159 ml) and HES (837 ± 82 ml) (P < 0.05). Compared to RA, HES reduced diffuse alveolar damage overall, and GEL in nondependent zones only. GEL and HES yielded lower wet-to-dry ratios compared to RA (6.5 ± 0.5 and 6.5 ± 0.6 vs. 7.9 ± 0.9, respectively, P < 0.05). HES and RA resulted in less kidney damage than GEL, but kidney function did not differ significantly among groups. Compared to GEL, HES yielded lower lung elastance (55 ± 12 vs. 45 ± 13 cm H2O/l, P < 0.05) and intra-abdominal pressure (15 ± 5 vs. 11 ± 4 cm 14;H2O, P < 0.05). Conclusions: In this model of acute lung injury, intravascular volume expansion after major hemorrhage with HES yielded less lung damage than RA and less kidney damage than GEL.

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High oxygen concentrations predispose mouse lungsto the deleterious effects of high stretch ventilation

Journal of Applied Physiology ◽

10.1152/japplphysiol.00619.2002 ◽

2003 ◽

Vol 94 (3) ◽

pp. 975-982 ◽

Cited By ~ 46

Author(s):

Timothy C. Bailey ◽

Erica L. Martin ◽

Lin Zhao ◽

Ruud A. W. Veldhuizen

Keyword(s):

Mechanical Ventilation ◽

Acute Lung Injury ◽

Lung Function ◽

Lung Injury ◽

Inflammatory Cytokines ◽

Pulmonary Surfactant ◽

Ex Vivo ◽

Lung Stretch ◽

Isolated Lungs ◽

Mechanical Ventilation Group

Mechanical ventilation is a necessary intervention for patients with acute lung injury. However, mechanical ventilation can propagate acute lung injury and increase systemic inflammation. The exposure to >21% oxygen is often associated with mechanical ventilation yet has not been examined within the context of lung stretch. We hypothesized that mice exposed to >90% oxygen will be more susceptible to the deleterious effects of high stretch mechanical ventilation. C57B1/6 mice were randomized into 48-h exposure of 21 or >90% oxygen; mice were then killed, and isolated lungs were randomized into a nonstretch or an ex vivo, high-stretch mechanical ventilation group. Lungs were assessed for compliance and lavaged for surfactant analysis, and cytokine measurements or lungs were homogenized for surfactant-associated protein analysis. Mice exposed to >90% oxygen + stretch had significantly lower compliance, altered pulmonary surfactant, and increased inflammatory cytokines compared with all other groups. Our conclusion is that 48 h of >90% oxygen and high-stretch mechanical ventilation deleteriously affect lung function to a greater degree than stretch alone.

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Comparative effects of proportional assist and variable pressure support ventilation on lung function and damage in experimental lung injury*

Critical Care Medicine ◽

10.1097/ccm.0b013e3182592021 ◽

2012 ◽

Vol 40 (9) ◽

pp. 2654-2661 ◽

Cited By ~ 23

Author(s):

Peter M. Spieth ◽

Andreas Güldner ◽

Alessandro Beda ◽

Nadja Carvalho ◽

Thomas Nowack ◽

...

Keyword(s):

Lung Function ◽

Lung Injury ◽

Pressure Support Ventilation ◽

Pressure Support ◽

Variable Pressure ◽

Support Ventilation

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Radiation Therapy Planning of Thoracic Tumors: A Review of Challenges Associated With Lung Toxicities and Potential Perspectives of Gallium-68 Lung PET/CT Imaging

Frontiers in Medicine ◽

10.3389/fmed.2021.723748 ◽

2021 ◽

Vol 8 ◽

Author(s):

François Lucia ◽

Martin Rehn ◽

Frédérique Blanc-Béguin ◽

Pierre-Yves Le Roux

Keyword(s):

Radiation Therapy ◽

Lung Function ◽

Lung Injury ◽

Ct Imaging ◽

Therapy Planning ◽

Significant Treatment ◽

Radiation Therapy Planning ◽

Pet Ct ◽

Thoracic Radiation ◽

Radiation Induced

Despite the introduction of new radiotherapy techniques, such as intensity modulated radiation therapy or stereotactic body radiation therapy, radiation induced lung injury remains a significant treatment related adverse event of thoracic radiation therapy. Functional lung avoidance radiation therapy is an emerging concept in the treatment of lung disease to better preserve lung function and to reduce pulmonary toxicity. While conventional ventilation/perfusion (V/Q) lung scintigraphy is limited by a relatively low spatial and temporal resolution, the recent advent of 68Gallium V/Q lung PET/CT imaging offers a potential to increase the accuracy of lung functional mapping and to better tailor lung radiation therapy plans to the individual's lung function. Lung PET/CT imaging may also improve our understanding of radiation induced lung injury compared to the current anatomical based dose–volume constraints. In this review, recent advances in radiation therapy for the management of primary and secondary lung tumors and in V/Q PET/CT imaging for the assessment of functional lung volumes are reviewed. The new opportunities and challenges arising from the integration of V/Q PET/CT imaging in radiation therapy planning are also discussed.

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Intravascular Volume Replacement Therapy

Pharmacology and Physiology for Anesthesia ◽

10.1016/b978-1-4377-1679-5.00033-8 ◽

2013 ◽

pp. 574-592 ◽

Cited By ~ 1

Author(s):

Christer Svensén ◽

Peter Rodhe

Keyword(s):

Replacement Therapy ◽

Volume Replacement ◽

Intravascular Volume ◽

Volume Replacement Therapy

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Metabolomics of World Trade Center-Lung Injury: a machine learning approach

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2017-000274 ◽

2018 ◽

Vol 5 (1) ◽

pp. e000274 ◽

Cited By ~ 11

Author(s):

George Crowley ◽

Sophia Kwon ◽

Syed Hissam Haider ◽

Erin J Caraher ◽

Rachel Lam ◽

...

Keyword(s):

Machine Learning ◽

Lung Function ◽

Lung Injury ◽

World Trade ◽

World Trade Center ◽

Forced Expiratory Volume ◽

Machine Learning Techniques ◽

Maximal Class ◽

Class Separation ◽

Trade Center

IntroductionBiomarkers of metabolic syndrome expressed soon after World Trade Center (WTC) exposure predict development of WTC Lung Injury (WTC-LI). The metabolome remains an untapped resource with potential to comprehensively characterise many aspects of WTC-LI. This case–control study identified a clinically relevant, robust subset of metabolic contributors of WTC-LI through comprehensive high-dimensional metabolic profiling and integration of machine learning techniques.MethodsNever-smoking, male, WTC-exposed firefighters with normal pre-9/11 lung function were segregated by post-9/11 lung function. Cases of WTC-LI (forced expiratory volume in 1s <lower limit of normal, n=15) and controls (n=15) were identified from previous cohorts. The metabolome of serum drawn within 6 months of 9/11 was quantified. Machine learning was used for dimension reduction to identify metabolites associated with WTC-LI.Results580 metabolites qualified for random forests (RF) analysis to identify a refined metabolite profile that yielded maximal class separation. RF of the refined profile correctly classified subjects with a 93.3% estimated success rate. 5 clusters of metabolites emerged within the refined profile. Prominent subpathways include known mediators of lung disease such as sphingolipids (elevated in cases of WTC-LI), and branched-chain amino acids (reduced in cases of WTC-LI). Principal component analysis of the refined profile explained 68.3% of variance in five components, demonstrating class separation.ConclusionAnalysis of the metabolome of WTC-exposed 9/11 rescue workers has identified biologically plausible pathways associated with loss of lung function. Since metabolites are proximal markers of disease processes, metabolites could capture the complexity of past exposures and better inform treatment. These pathways warrant further mechanistic research.

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