The assessment of severity of lung injury in sepsis

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.

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The 67gallium-transferrin Pulmonary Leak Index in Pneumonia and Associated Adult Respiratory Distress Syndrome

Clinical Science ◽

10.1042/cs0930463 ◽

1997 ◽

Vol 93 (5) ◽

pp. 463-470 ◽

Cited By ~ 2

Author(s):

A. B. Johan Groeneveld ◽

Pieter G. H. M. Raijmakers

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Lung Injury ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Adult Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Lung Injury Score ◽

Injury Score

1. The aim of the study was to determine the role of increased microvascular protein permeability, as measured by the 67gallium (Ga)-transferrin pulmonary leak index, in pneumonia and associated adult respiratory distress syndrome (ARDS). 2. Eighteen consecutive patients with microbiologically confirmed pneumonia (radiographic infiltrates, purulent sputum) and needing respiratory monitoring (n = 2) or mechanical ventilation (n = 16) in the intensive care unit were studied prospectively. The pulmonary leak index using 67Ga-transferrin and 99mTc red blood cells was measured with a mobile probe system over both lung apices (normal value below 14.1 × 10−3 min−1) within 72 h of intensive care unit admission, and the lung injury score was calculated from radiographic, ventilatory and lung mechanical data. 3. Patients with pneumonia (lung injury score <2.5, n = 10) had a lower (P < 0.01) pulmonary leak index, averaged for both lungs, with a median of 23.9 [range (7.0–47.0) × 10−3 min−1] than patients with pneumonia-associated ARDS (lung injury score ≥2.5, n = 8), and an average pulmonary leak index of 37.5 [(23.4–144.2) × 10−3 min−1], so that, for all patients, the pulmonary leak index, averaged for both lungs, directly related to the lung injury score (rs = 0.61, P < 0.01). A normal average pulmonary leak index excluded pneumonia-associated ARDS. Patients with unilateral pneumonia had a greater inter-lung difference (P < 0.01) in the pulmonary leak index between affected and unaffected lung than patients with bilateral pneumonia. The index did not have prognostic significance. 4. The 67Ga-transferrin pulmonary leak index parallels the degree of radiographic, ventilatory and lung mechanical abnormalities of pneumonia and evolving ARDS. The data support the idea that the clinical manifestations of pneumonia culminating in ARDS directly relate to the degree of microvascular injury. Conversely, the pulmonary leak index may be used to monitor the effect of anti-inflammatory drugs in the adjunctive treatment for severe pneumonia aimed at circumventing mechanical ventilation in future studies.

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A comparison of four different models of acute respiratory distress syndrome in sheep

10.21203/rs.2.24165/v2 ◽

2020 ◽

Author(s):

Monique Engel ◽

Relana M.E. Nowacki ◽

Elly M. Jonker ◽

Daan Ophelders ◽

Maria Nikiforou ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Lung Injury ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Oxygenation Index ◽

Lung Injury Score ◽

Alveolar Wall ◽

Injury Score ◽

Study Objective

Abstract Background: Acute respiratory distress syndrome (ARDS) can have various causes. The study objective was to investigate whether different pathophysiologic models of ARDS would show different respiratory, cardiovascular and inflammatory outcomes. Methods: We performed a prospective, randomized study in 27 ventilated ewes inducing ARDS using three different techniques to mimic the pulmonary causes of ARDS (ARDSp): warm saline lavage (n=6), intratracheal hydrochloric acid (HCl; n=6), intratracheal albumin (n=10), and one technique to mimic an extrapulmonary cause of ARDS (ARDSexp): intravenous lipopolysaccharide (LPS iv; n=5). ARDS was defined when PaO 2 was <15kPa (112 mmHg) when ventilated with PEEP 10cm H 2 O and FiO 2 =1.0. The effects on gas exchange were investigated by calculating the oxygenation index (OI) and the ventilation efficacy index (VEI) every 30 minutes for a period of 4 hours. Post mortem lung lavage was performed to obtain broncho-alveolar lavage fluid (BALF) to assess lung injury and inflammation. Lung injury and inflammation were assessed by measuring the total number and differentiation of leukocytes, the concentration of protein and disaturated phospholipids, and interleukine-6 and -8 in the BALF. Histology of the lung was evaluated by measuring the mean alveolar size, alveolar wall thickness and the lung injury score system by Matute-Bello et al., as markers of lung injury. The concentration of interleukin-6 was determined in plasma, as a marker of systematic inflammation. Results: The OI and VEI were most affected in the LPS iv group and thereafter the HCl group, after meeting the ARDS criteria. Diastolic blood pressure was lowest in the LPS iv group. There were no significant differences found in the total number and differentiation of leukocytes, the concentration of protein and disaturated phospholipids, or interleukin-8 in the BALF, histology of the lung and the lung injury score. IL-6 in BALF and plasma was highest in the LPS iv group, but no significant differences were found between the other groups. It took a significantly longer period of time to meet the ARDS criteria in the LPS iv group. Conclusions: The LPS model caused the most severe pulmonary and cardiovascular insufficiency. Surprisingly, there were limited significant differences in lung injury and inflammatory markers, despite the different pathophysiological models, when the clinical definition of ARDS was applied.

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