Ventilator „Chirana Aura V“ In Two Models Of Neonatal Acute Lung Injury - A Pilot Study

Abstract In severe respiratory insufficiency, neonatal and pediatric patients should be ventilated artificially by a ventilator. Aim of this experimental study was to evaluate whether the newly developed ventilator Chirana Aura V may effectively ventilate the lungs of animals with two different models of acute lung injury: acute respiratory distress syndrome (ARDS) induced by repetitive saline lavage and meconium aspiration syndrome (MAS) induced by intratracheal instillation of neonatal meconium. The experiments were performed on 10 adult rabbits (New Zealand white). In ARDS group (n=5), the lungs were repetitively lavaged with saline (30 ml/kg) until partial pressure of oxygen (PaO2) in arterial blood was under 26.7 kPa at inspiratory fraction of oxygen FiO2=1.0. In MAS group (n=5), animals were instilled 4 ml/kg of suspension of human meconium (25 mg/ml). When the model of acute lung injury was developed, animals were ventilated for additional 2 hours with pressure control ventilation (PCV) regime by ventilator Chirana Aura V. Ventilatory parameters, blood gases, acid-base balance, end-tidal CO2, O2 saturation of hemoglobin, oxygenation indexes, ventilation efficiency index, dynamic lung compliance, and right-to-left pulmonary shunts were measured and calculated in regular time intervals. In both experimental groups, used ventilatory settings provided acceptable gas exchange within the period of observation. Thus, the results indicate that ventilator Chirana Aura V might be suitable for ventilation of animal models of acute lung injury. However, further pre-clinical investigation is needed before its use may be recommended in neonatal and/or pediatric patients with acute lung injury.

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Effect of Thoracentesis on Intubated Patients with Acute Lung Injury

The American Surgeon ◽

10.1177/000313481608200321 ◽

2016 ◽

Vol 82 (3) ◽

pp. 266-270

Author(s):

Matthew B. Bloom ◽

Derek Serna-Gallegos ◽

Mark Ault ◽

Ahsan Khan ◽

Rex Chung ◽

...

Keyword(s):

Acute Lung Injury ◽

Lung Injury ◽

Blood Gases ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

Arterial Blood ◽

Tertiary Center ◽

Before And After ◽

The Impact

Pleural effusions occur frequently in mechanically ventilated patients, but no consensus exists regarding the clinical benefit of effusion drainage. We sought to determine the impact of thoracentesis on gas exchange in patients with differing severities of acute lung injury (ALI). A retrospective analysis was conducted on therapeutic thoracenteses performed on intubated patients in an adult surgical intensive care unit of a tertiary center. Effusions judged by ultrasound to be 400 mL or larger were drained. Subjects were divided into groups based on their initial P:F ratios: normal >300, ALI 200 to 300, and acute respiratory distress syndrome (ARDS) <200. Baseline characteristics, physiologic variables, arterial blood gases, and ventilator settings before and after the intervention were analyzed. The primary end point was the change in measures of oxygenation. Significant improvements in P:F ratios (mean ± SD) were seen only in patients with ARDS (50.4 ± 38.5, P = 0.001) and ALI (90.6 ± 161.7, P = 0.022). Statistically significant improvement was observed in the pO2 (31.1, P = 0.005) and O2 saturation (4.1, P < 0.001) of the ARDS group. The volume of effusion removed did not correlate with changes in individual patient's oxygenation. These data support the role of therapeutic thoracentesis for intubated patients with abnormal P:F ratios.

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Somatostatin Reduces the Acute Lung Injury of Mice via Increasing the Affinity of Glucocorticoid Receptor

Cellular Physiology and Biochemistry ◽

10.1159/000443079 ◽

2016 ◽

Vol 38 (4) ◽

pp. 1354-1364 ◽

Cited By ~ 2

Author(s):

Yan Zhao ◽

Min Zhang ◽

Ren-Ping Xiong ◽

Xing-Yun Chen ◽

Ping Li ◽

...

Keyword(s):

Acute Lung Injury ◽

Lung Injury ◽

Glucocorticoid Receptor ◽

Binding Capacity ◽

Blood Gases ◽

Protective Role ◽

Lung Water ◽

Beneficial Effects ◽

Arterial Blood ◽

Lung Injuries

Background/Aims: Although it has been reported that somatostatin (SOM) upregulated the level of 90-kD heat shock protein (Hsp90), which participates in the inflammatory regulation by its client proteins, such as glucocorticoid receptor (GR), it remains unclear if it has a protective role against acute lung injury (ALI). Methods: ALI model was established by the injection of oleic acid (OA) into the tail vein of mice. Lung injury was assessed by histological analysis, lung water content and arterial blood gases. The levels of Hsp90 and GR, the binding capacity and the affinity of GR were examined. Results: It was showed that pretreatment with SOM significantly increased Hsp90 levels and alleviated lung injuries in OA-injected mice. Furthermore, SOM increased the GR expression and improved the affinity of the GR in animals with lung injury. However, little alteration was found in the maximum binding capacity of the GR in mice with or without SOM. Conclusion: The data indicate SOM exerts a protective effect by increasing Hsp90 abundant and further enhancing the affinity of the GR. The beneficial effects of SOM treatment provide a new strategy for modulation of GR efficiency and alleviation of acute lung injury.

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Select dietary fatty acids attenuate cardiopulmonary dysfunction during acute lung injury in pigs

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1995.269.6.h2090 ◽

1995 ◽

Vol 269 (6) ◽

pp. H2090-H2099 ◽

Cited By ~ 5

Author(s):

M. J. Murray ◽

M. Kumar ◽

T. J. Gregory ◽

P. L. Banks ◽

H. D. Tazelaar ◽

...

Keyword(s):

Acute Lung Injury ◽

Lung Injury ◽

Pulmonary Vascular Resistance ◽

Vascular Resistance ◽

Blood Gases ◽

Dietary Fatty Acids ◽

Arterial Blood ◽

Pulmonary Arterial ◽

O2 Delivery ◽

Arterial Po2

We examined the effect of substituting linoleic acid (LA) with eicosapentaenoic acid (EPA) and gamma-linolenic acid (gamma-LA), precursors of trienoic and monoenoic eicosanoids, respectively, on acute lung injury (ALI). Three groups (n = 8/group) of pigs were fed enteral diets containing LA (diet A), EPA (diet B), or EPA+gamma-LA (diet C) for 8 days. ALI was then induced with a 0.1 mg/kg bolus of Escherichia coli endotoxin followed by a continuous infusion for 4 h (0.075 mg.kg-1.h-1). Pulmonary arterial and capillary wedge pressures, cardiac index (CI), arterial blood gases, arterial O2 content, and plasma thromboxane B2 (TxB2) were measured. Arterial PO2 decreased at 20 min in animals fed diet A. This change was attenuated with diets B and C. The EPA- and EPA + gamma-LA-enriched diets attenuated the fall in O2 delivery at 20 min, an improvement that was sustained throughout the 4-h study period with the EPA+gamma-LA-enriched diet only. This improvement in O2 delivery was due not only to the improved arterial PO2, but also to the maintenance of CI at 20 min in animals fed diets B and C and throughout the 4-h study period in animals fed diet C. At 4 h, TxB2 increased 10-fold over baseline in animals fed diet A, whereas in animals fed diets B and C the increase was only 3-fold. These decreased TxB2 levels in animals fed diets B and C correlate with an attenuation in the increase in pulmonary vascular resistance that was observed at 20 min after endotoxin infusion in animals fed diet A. These data suggest that specialized enteral diets enriched in EPA+gamma-LA improve gas exchange and O2 delivery, presumably in part through a modification of TxB2 production with a decrease in pulmonary vascular resistance and an increase in CI, during ALI.

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DIGITALIS TOLERANCE IN YOUNG PUPPIES

PEDIATRICS ◽

10.1542/peds.46.5.730 ◽

1970 ◽

Vol 46 (5) ◽

pp. 730-736

Author(s):

Katherine H. Halloran ◽

Steven C. Schimpff ◽

Jean G. Nicolas ◽

Norman S. Talner

Keyword(s):

Blood Gases ◽

Acid Base Balance ◽

Acid Base ◽

Littermate Control ◽

Premature Ventricular Contractions ◽

Toxic Dose ◽

Arterial Blood ◽

Wide Range ◽

Base Balance ◽

The Mean

Tolerance to acetyl strophanthidin, a rapid-acting cardiac aglycone, was determined in 28 anesthetized mongrel puppies, ages 16 to 56 days, and compared to tolerance in 16 littermate puppies in whom acute hypercapnic acidemia was produced. The tolerance was also compared to that of four adult mongrel dogs. The toxic dose was defined as the intravenous amount required to produce four consecutive premature ventricular contractions. A marked variation in the toxic dose was found in the 28 control puppies (range 83 to 353 µg/kg, mean 169 µg/kg) which could not be correlated with age, arterial blood gases or pH, serum potassium or sodium, arterial pressure, or heart rate. The toxic dose was significantly greater in the puppies than in the adult dogs, in whom the mean toxic dose was 64 µg/kg (range 50 to 89 µg/kg). A significant increase in tolerance was also observed in the puppies with hypercapnic acidemia (mean toxic dose 220 µg/kg, range 93 to 375 µg/kg) in comparison to tolerance in the control puppies and despite the wide range of tolerance, each of the puppies with hypercapnic acidemia showed greater tolerance than its littermate control puppy. Assessment of the clinical implications of these findings will require study of the effects of alterations in acid-base balance on the inotropic effect of acetyl strophanthidin in addition to the toxic electrophysiologic effects.

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Keratinocyte growth factor therapy in murine oleic acid-induced acute lung injury

AJP Lung Cellular and Molecular Physiology ◽

10.1152/ajplung.00450.2004 ◽

2005 ◽

Vol 288 (6) ◽

pp. L1179-L1192 ◽

Cited By ~ 40

Author(s):

K. Ulrich ◽

M. Stern ◽

M. E. Goddard ◽

J. Williams ◽

J. Zhu ◽

...

Keyword(s):

Cell Proliferation ◽

Acute Lung Injury ◽

Gene Delivery ◽

Lung Injury ◽

Time Course ◽

Lung Compliance ◽

Alveolar Type ◽

Protein Therapy ◽

Cell Numbers ◽

Atii Cell

Alveolar type II (ATII) cell proliferation and differentiation are important mechanisms in repair following injury to the alveolar epithelium. KGF is a potent ATII cell mitogen, which has been demonstrated to be protective in a number of animal models of lung injury. We have assessed the effect of recombinant human KGF (rhKGF) and liposome-mediated KGF gene delivery in vivo and evaluated the potential of KGF as a therapy for acute lung injury in mice. rhKGF was administered intratracheally in male BALB/c mice to assess dose response and time course of proliferation. SP-B immunohistochemistry demonstrated significant increases in ATII cell numbers at all rhKGF doses compared with control animals and peaked 2 days following administration of 10 mg/kg rhKGF. Protein therapy in general is very expensive, and gene therapy has been suggested as a cheaper alternative for many protein replacement therapies. We evaluated the effect of topical and systemic liposome-mediated KGF-gene delivery on ATII cell proliferation. SP-B immunohistochemistry showed only modest increases in ATII cell numbers following gene delivery, and these approaches were therefore not believed to be capable of reaching therapeutic levels. The effect of rhKGF was evaluated in a murine model of OA-induced lung injury. This model was found to be associated with significant alveolar damage leading to severe impairment of gas exchange and lung compliance. Pretreatment with rhKGF 2 days before intravenous OA challenge resulted in significant improvements in Po2, Pco2, and lung compliance. This study suggests the feasibility of KGF as a therapy for acute lung injury.

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April 2021 Critical Care Case of the Month: Abnormal Acid-Base Balance in a Post-Partum Woman

Southwest Journal of Pulmonary and Critical Care ◽

10.13175/swjpcc007-21 ◽

2021 ◽

Vol 22 (4) ◽

pp. 81-85

Author(s):

Mohammad Mahmoud ◽

Keyword(s):

Emergency Department ◽

Complete Blood Count ◽

Post Partum ◽

Healthy Woman ◽

Blood Gases ◽

Ambient Air ◽

Physical Exam ◽

Acid Base Balance ◽

Arterial Blood ◽

Base Balance

No abstract available. Article truncated after first page. History of Present Illness: A 29-year-old healthy woman, who is 8 weeks postpartum, presented to the emergency department with severe shortness of breath, fast shallow breathing, nausea, several episodes of nonbloody nonbilious emesis, abdominal pain and malaise for 1 week. The patient delivered a healthy boy at full-term by spontaneous vaginal delivery. Her pregnancy was uneventful. She denied smoking or use of alcohol. Physical Exam: On presentation to the emergency department her blood pressure was found to be 121/71, temperature 36.8°C, pulse 110 beats per minute, respiratory rate 20 breaths per minute and SpO2 saturation of 99% while breathing ambient air. Physical exam was remarkable except for dry mucous membranes, sinus tachycardia, and tachypnea with mild epigastric tenderness with light palpation. Which of the following should be done? 1. Complete blood count (CBC) 2. Metabolic panel 3. Chest x-ray 4. Arterial blood gases (ABGs) 5. All of the above …

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Effect of Recruitment and Body Positioning on Lung Volume and Oxygenation in Acute Lung Injury Model

Anaesthesia and Intensive Care ◽

10.1177/0310057x0803600607 ◽

2008 ◽

Vol 36 (6) ◽

pp. 792-797 ◽

Cited By ~ 2

Author(s):

H. G. Ryu ◽

J.-H. Bahk ◽

H.-J. Lee ◽

J.-G. Im

Keyword(s):

Acute Lung Injury ◽

Oleic Acid ◽

Lung Injury ◽

Lung Volume ◽

Supine Position ◽

Recruitment Manoeuvre ◽

Prone Positioning ◽

Dependent Lung ◽

Arterial Blood Gas ◽

Arterial Blood

The mechanism of oxygenation improvement after recruitment manoeuvres or prone positioning in acute lung injury or acute respiratory distress syndrome is still unclear. We tried to determine the mechanism responsible for the effects of recruitment manoeuvres or prone positioning on lung aeration using a whole lung computed tomography scan in an oleic acid induced acute lung injury canine model. Twelve adult mongrel dogs were allocated into either the supine group (n=6) or the prone group (n = 6). After the establishment of acute lung injury, three recruitment manoeuvres were performed at one-hour intervals. Haemodynamic and ventilatory variables, arterial blood gas analyses and CT scans of the whole lung were obtained 90 minutes after oleic acid injection and five minutes before and after each recruitment manoeuvre. Recruitment manoeuvres in the supine position improved oxygenation (P=0.025) that correlated with increase of the poorly- and well-aerated dorsal (dependent) lung volume (r=0.436, P=0.016). Prone positioning increased oxygenation (P=0.004) that also correlated with increase of the poorly- and well-aerated dorsal (nondependent) lung volume (r=0.787, P <0.001). However, the recruitment manoeuvre in the prone position had no effect on oxygenation despite an increase in ventral (dependent) lung volume. The increase in PO2 after recruitment manoeuvres in the supine position or after prone positioning is related to the increase of the poorly- and well-aerated dorsal lung.

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Repeated lung injury due to alpha-naphthylthiourea causes right ventricular hypertrophy in rats

Journal of Applied Physiology ◽

10.1152/jappl.1984.56.2.388 ◽

1984 ◽

Vol 56 (2) ◽

pp. 388-396 ◽

Cited By ~ 14

Author(s):

N. S. Hill ◽

R. F. O'Brien ◽

S. Rounds

Keyword(s):

Pulmonary Hypertension ◽

Acute Lung Injury ◽

Lung Injury ◽

Right Ventricular ◽

Ventricular Hypertrophy ◽

Vascular Reactivity ◽

Tween 80 ◽

Left Ventricular ◽

Right Ventricular Hypertrophy ◽

Arterial Blood

Acute lung injury due to alpha-naphthylthiourea (ANTU) is associated with increased permeability edema, transient pulmonary hypertension, and increased vascular reactivity. We sought to determine whether repeated administration of ANTU caused right ventricular hypertrophy. Rats were injected weekly for 4 wk with ANTU or an equivalent volume of the vehicle Tween 80. Rats injected repeatedly with ANTU in doses of 5–10 mg/kg body wt had increased ratios of right ventricular to left ventricular plus septal weights. The right ventricular hypertrophy in ANTU-treated rats was associated with right ventricular systolic hypertension. Repeated injections of ANTU also caused transient pulmonary edema after each dose, as evidenced by increased wet-to-dry lung weight ratios after 4 h, which returned to normal by 24 h. Lungs isolated from ANTU-injected rats had greater pressor responses to hypoxia and to angiotensin II than lungs from Tween 80-injected rats. Pressure-flow curves of isolated lungs, arterial blood gases, and hematocrits were similar in rats treated repetitively with ANTU or Tween alone. Lung histology was also similar in ANTU and control lungs, as were measurements of arterial medial thickness and ratios of numbers of arteries/100 alveoli, indicating that substantial vascular remodeling had not occurred. Thus, four weekly ANTU injections in rats caused right ventricular hypertrophy, probably due to pulmonary hypertension. We speculate that the pulmonary hypertension was due, at least in part, to sustained vasoconstriction, which somehow resulted from repeated acute lung injury.

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Changes in blood gases and acid-base balance in the exercising dog

Journal of Applied Physiology ◽

10.1152/jappl.1962.17.4.656 ◽

1962 ◽

Vol 17 (4) ◽

pp. 656-660 ◽

Cited By ~ 10

Author(s):

Ronald L. Wathen ◽

Howard H. Rostorfer ◽

Sid Robinson ◽

Jerry L. Newton ◽

Michael D. Bailie

Keyword(s):

Venous Blood ◽

Blood Gases ◽

Respiratory Alkalosis ◽

Hydrogen Ion ◽

Ion Concentration ◽

Mixed Venous Blood ◽

Acid Base Balance ◽

Hydrogen Ion Concentration ◽

Arterial Blood ◽

Mixed Venous

Effects of varying rates of treadmill work on blood gases and hydrogen ion concentrations of four healthy young dogs were determined by analyses of blood for O2 and CO2 contents, Po2, Pco2, and pH. Changes in these parameters were also observed during 30-min recovery periods from hard work. Arterial and mixed venous blood samples were obtained simultaneously during work through a polyethylene catheter in the right ventricle and an indwelling needle in an exteriorized carotid artery. Mixed venous O2 content, Po2 and O2 saturation fell with increased work, whereas arterial values showed little or no change. Mixed venous CO2 content, Pco2, and hydrogen ion concentration exhibited little change from resting levels in two dogs but increased significantly in two others during exercise. These values always decreased in the arterial blood during exercise, indicating the presence of respiratory alkalosis. On cessation of exercise, hyperventilation increased the degree of respiratory alkalosis, causing it to be reflected on the venous side of the circulation. Submitted on January 8, 1962

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