pulmonary protection
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2022 ◽  
Author(s):  
Peizheng Yan ◽  
Qingxiang Zhang ◽  
Zhu Qingjun ◽  
Xing Chang ◽  
Meng Qingyan ◽  
...  

Abstract Background and ObjectivesAsthma is a severe public health issue since it causes a progressive decline of pulmonary function and a lot of unnecessary deaths. Traditional Chinese medicine has played a great role in the prevention and treatment of asthma, Wenyang-Huayin (WYHY) formulation is one of the useful prescriptions in clinical, which the pharmacological mechanism has not yet been revealed. In this study, we explored its anti-airway inflammation and pulmonary protection effects in the treatment of asthma induced by ovalbumin (OVA), to provide support for its deeply clinical applications.MethodsAsthma model with the syndrome of accumulation of cold fluid in the lung in chronic bronchitis (a common type of Traditional Chinese Medicine (TCM) syndrome) was induced in SPF male Wistar rats by sensitizing and challenging with OVA, followed by drink, body cold and fatigue stimulation. WYHY was orally administered at 9.82142857 g·(kg·d)−1 body weight for 21 days, Rapamycin and the other two traditional Chinese medicines (Xiaoqinglong decoction and Astragalus granules) were used as positive controls. After intervention, the pulmonary function was measured by AniRes 2005 Animal pulmonary function Analysis system, the pathological features of pulmonary alveolus and bronchus were observed after Hematoxylin-Eosin (H&E) staining, and serum interleukin-13 (IL-13), transforming growth factor -β1 (TGF-β1), tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ) levels were determined by enzyme linked immunosorbent assay (ELISA) assay.ResultsThe model rats showed heavy signs of airway inflammation and remodeling like chronic asthma, evidenced by the damaged pulmonary alveolus structure, increased inflammatory cell infiltration, declined pulmonary function, and abnormal changes of cytokines. All treatment methods could slow down the damage caused by molding factors, and WYHY might have an advantage in pulmonary protection effects than the others.ConcludeWYHY has a good effect on anti-airway inflammation and protecting pulmonary function in the treatment of OVA-Induced asthma rats, and its mechanism is worth of in-depth study.


Antioxidants ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1874
Author(s):  
Hye-Youn Cho ◽  
Laura Miller-DeGraff ◽  
Ligon A. Perrow ◽  
Wesley Gladwell ◽  
Vijayalakshmi Panduri ◽  
...  

NRF2 protects against oxidant-associated airway disorders via cytoprotective gene induction. To examine if NRF2 is an important determinant of respiratory syncytial virus (RSV) susceptibility after neonate lung injury, Nrf2-deficient (Nrf2−/−) and wild-type (Nrf2+/+) mice neonatally exposed to hyperoxia were infected with RSV. To investigate the prenatal antioxidant effect on neonatal oxidative lung injury, time-pregnant Nrf2−/−and Nrf2+/+mice were given an oral NRF2 agonist (sulforaphane) on embryonic days 11.5–17.5, and offspring were exposed to hyperoxia. Bronchoalveolar lavage and histopathologic analyses determined lung injury. cDNA microarray analyses were performed on placenta and neonatal lungs. RSV-induced pulmonary inflammation, injury, oxidation, and virus load were heightened in hyperoxia-exposed mice, and injury was more severe in hyperoxia-susceptible Nrf2−/− mice than in Nrf2+/+ mice. Maternal sulforaphane significantly alleviated hyperoxic lung injury in both neonate genotypes with more marked attenuation of severe neutrophilia, edema, oxidation, and alveolarization arrest in Nrf2−/− mice. Prenatal sulforaphane altered different genes with similar defensive functions (e.g., inhibition of cell/perinatal death and inflammation, potentiation of angiogenesis/organ development) in both strains, indicating compensatory transcriptome changes in Nrf2−/− mice. Conclusively, oxidative injury in underdeveloped lungs NRF2-dependently predisposed RSV susceptibility. In utero sulforaphane intervention suggested NRF2-dependent and -independent pulmonary protection mechanisms against early-life oxidant injury.


2021 ◽  
Vol 8 ◽  
Author(s):  
Tokio Kinoshita ◽  
Ken Kouda ◽  
Yasunori Umemoto ◽  
Yoshinori Yasuoka ◽  
Yuta Minoshima ◽  
...  

Patients with severe coronavirus disease (COVID-19) and admitted to the intensive care unit (ICU) are at high risk of developing ICU-acquired weakness and disuse syndrome. Although their medical management may include prolonged deep sedation for pulmonary protection and ventilator management, we aim for early mobilization of these patients with COVID-19. We present the case of a 71-year-old man with chronic obstructive pulmonary disease (COPD) and COVID-19 pneumonia. Passive range of motion training and sitting on the edge of the bed were started in the ICU while the patient was under deep sedation. His activities of daily living eventually improved to where he could independently walk to the toilet without respiratory distress. Patients with severe COVID-19 who require mechanical ventilation are at risk of muscle weakness and exercise intolerance. These patients require rehabilitation therapy, beginning in the acute phase of illness, to recover their physical function. Although validation with a larger cohort is necessary, our results suggest that patients with COPD and COVID-19 pneumonia should undergo rehabilitation concurrently with status-driven changes in respiratory management.


eLife ◽  
2020 ◽  
Vol 9 ◽  
Author(s):  
Gian Paolo Rossi ◽  
Viola Sanga ◽  
Matthias Barton

The discovery of angiotensin converting enzyme-2 (ACE-2) as the receptor for SARS- CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) has implicated the renin-angiotensin-aldosterone system in acute respiratory distress syndrome (ARDS) and respiratory failure in patients with coronavirus disease-19 (COVID-19). The angiotensin converting enzyme-1–angiotensin II–angiotensin AT1 receptor pathway contributes to the pathophysiology of ARDS, whereas activation of the ACE-2–angiotensin(1-7)-angiotensin AT2 receptor and the ACE-2–angiotensin(1-7)–Mas receptor pathways have been shown to be protective. Here we propose and discuss therapeutic considerations how to increase soluble ACE-2 in plasma in order for ACE-2 to capture and thereby inactivate SARS-CoV-2. This could be achieved by administering recombinant soluble ACE-2. We also discuss why and how ACEIs and ARBs provide cardiovascular, renal and also pulmonary protection in SARS-CoV-2- associated ARDS. Discontinuing these medications in COVID-19 patients may therefore potentially be harmful.


2019 ◽  
Author(s):  
Jinlu Li ◽  
Xuemei Wu ◽  
Hairui Liu ◽  
Ying Huang ◽  
Yueqin Liu ◽  
...  

Abstract Objective:To investigate the effects of protective lung ventilation on regional cerebral oxygen saturation during dura opening, that is from after dura opening (T1a) to before dura closing (T2b), in patients undergoing intracranial tumor surgery. Methods: This is a randomized, controlled trial which will be carried out at the second affiliated hospital of Soochow University. Fifty-four patients undergoing intracranial tumor surgery will be randomly allocated to the control group and the protective lung ventilation group. In the control group, tidal volume (VT) will be set at 8 ml/kg of ideal body weight, but positive end-expiratory pressure (PEEP) and recruitment maneuvers will not be used. In the protective lung ventilation group, VT will be set at 6 ml/kg of ideal body weight combined with individualized PEEP (PEEPx) during intraoperative dura mater opening, but in other periods of general anesthesia, VT will be set at 8 ml/kg of ideal body weight. Titration method of individualized PEEP (PEEPx) [1]: VT and respiratory rate will be fixed at 6ml/kg and 15 beats per minute during PEEP trial. Titration can only begin once the dura is opened. The titration for the individual PEEP can then be initiated by increasing PEEP from 2 to 10cm H2O incrementally. Each PEEP level (2, 3, 4, 5, 6, 7, 8, 9, 10cm H2O) will be maintained for 1 minute, and the pulmonary compliance of the last cycle will be recorded at each PEEP level. At last, the PEEP value at the highest compliance will be selected as the individual PEEP of patient. Regional cerebral oxygen saturation (rSO2), partial pressure of oxygen and carbon dioxide, oxygenation index, lactic acid level in arterial blood, and mean arterial pressure will be compared before anesthesia (T0), before dura opening (T1), after dura closing (T2) and 24 h after surgery (T3). Pulmonary ultrasound scores will be performed at T0 and T3.The degree of brain relaxation before and after protective lung ventilation will be evaluated by the surgeon using the brain relaxation scale. Amount of vasoactive drugs used and blood loss will be recorded during intraoperative dura mater opening. The total duration and secondary rate of surgery also will be recorded. Discussion: This study aims to determine whether intraoperative pulmonary protection strategy can improve regional cerebral oxygen saturation in patients undergoing intracranial tumor surgery, and to investigate whether intraoperative pulmonary protection strategy does not affect the degree of brain tissue swelling and the amount of blood loss during surgery. If our results are positive, this study will show that intraoperative pulmonary protection strategy can be used effectively and safely in neurosurgical patients undergoing craniotomy for tumor resection. Trial registration: chictr.org.cn, ID: ChiCTR1900025632. Registered on 3 September 2019. tudy protocol version 1.0.


2019 ◽  
Vol 36 (13) ◽  
pp. 1368-1376
Author(s):  
Gonzalo Zeballos Sarrato ◽  
Manuel Sánchez Luna ◽  
Susana Zeballos Sarrato ◽  
Alba Pérez Pérez ◽  
Isabel Pescador Chamorro ◽  
...  

Objective To investigate if the use of a visible respiratory function monitor (RFM) to use lower tidal volumes (Vts) during positive pressure ventilation (PPV) in the delivery room (DR) reduces the need of surfactant administration and invasive mechanical ventilation during the first 72 hours after birth of preterm infants <32 weeks' gestational age (GA). Study Design Infants <32 weeks' GA (n = 106) requiring noninvasive PPV were monitored with a RFM at birth and randomized to visible (n = 54) or masked (n = 52) display on RFM. Pulmonary data were recorded during the first 10 minutes after birth. Secondary analysis stratified patients by GA (<28, 28–29+6, or ≥30 weeks). Results Median expiratory Vts during inflations were greater in the masked group (7 mL/kg) than in the visible group (5.8 mL/kg; p = 0.001) same as peak inflation pressure (PIP) administered (21.5 vs. 19.7 cmH2O; p < 0.001). Consequently, minute volumes were greater in the masked group (256 vs. 214 mL/kg/min; p < 0.001), with no differences in respiratory rate. These differences were higher in those <30 weeks' GA. There was no difference in the need of surfactant administration or intubation during the first 72 hours of age. Conclusion Using a RFM in the DR prevents the use of large Vt and PIP during respiratory support inflations, mostly in the more immature newborn infants, but with no other short-term benefits.


2018 ◽  
Vol 17 ◽  
pp. S7-S8
Author(s):  
K. Thomsen ◽  
S. Larsen ◽  
L. Christophersen ◽  
C. Lerche ◽  
N. Høiby ◽  
...  

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