Effects of dynamic ventilatory factors on ventilator-induced lung injury in acute respiratory distress syndrome dogs

doi:10.5847/wjem.j.issn.1920-8642.2012.04.009

Abstract

Abstract:

BACKGROUND: Mechanical ventilation is a double-edged sword to acute respiratory distress syndrome (ARDS) including lung injury, and systemic inflammatory response high tidal volumes are thought to increase mortality. The objective of this study is to evaluate the effects of dynamic ventilatory factors on ventilator induced lung injury in a dog model of ARDS induced by hydrochloric acid instillation under volume controlled ventilation and to investigate the relationship between the dynamic factors and ventilator-induced lung injuries (VILI) and to explore its potential mechanisms.

METHODS: Thirty-six healthy dogs were randomly divided into a control group and an experimental group. Subjects in the experimental group were then further divided into four groups by different inspiratory stages of flow. Two mL of alveolar fluid was aspirated for detection of IL-8 and TNF-α. Lung tissue specimens were also extracted for total RNA, IL-8 by western blot and observed under an electronic microscope.

RESULTS: IL-8 protein expression was significantly higher in group B than in groups A and D. Although the IL-8 protein expression was decreased in group C compared with group B, the difference was not statistically significant. The TNF-α ray degree of group B was significantly higher than that in the other groups (P<0.01), especially in group C (P>0.05). The alveolar volume of subjects in group B was significantly smaller, and cavity infiltration and cell autolysis were marked with a significant thicker alveolar septa, disorder of interval structures, and blurring of collagenous and elastic fiber structures. A large number of necrotic debris tissue was observed in group B.

CONCLUSION: Mechanical ventilation with a large tidal volume, a high inspiratory flow and a high ventilation frequency can cause significant damage to lung tissue structure. It can significantly increase the expression of TNF-α and IL-8 as well as their mRNA expression. Furthermore, the results of our study showed that small tidal ventilation significantly reduces the release of pro-inflammatory media. This finding suggests that greater deterioration in lung injury during ARDS is associated with high inspiratory flow and high ventilation rate.

Key words: Acute respiratory distress syndrome, Dynamic factors, Inspiratory flow, Ventilator-induced lung injury

Rui-lan Wang, Kan Xu, Kang-long Yu, Xue Tang, Hui Xie. Effects of dynamic ventilatory factors on ventilator-induced lung injury in acute respiratory distress syndrome dogs[J]. World Journal of Emergency Medicine, 2012, 3(4): 287-293.

Figures/Tables 7

Table 1

Table 2

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

References 19

1	Slutsky AS. Ventilator-induced lung injury: From barotraumas to biotrauma. Respiratory Care 2005; 50:646-659. pmid: 15912625
2	Bruhn A, Bugedo D, Riquelme F, Varas J, Retamal J, Besa C. et al. Minerua Anestesiol 2011; 77:418-426.
3	Kotani M, Kotani T, Li Z, Silbajoris R, Piantadosi CA, Huang YC. Reduced inspiratory flow attenuates IL-8 release and MAPK activation of lung overstretch. Eur Respir J 2004; 24:238-246. doi: 10.1183/09031936.04.00128703 pmid: 15332391
4	Conrad SA, Zhang S, Arnold TC, Scott LK, Carden DL. Protective effects of low respiratory frequency in experiment ventilator-associated lung injury. Crit Care Med 2005; 33:835-840. doi: 10.1097/01.ccm.0000159532.56865.8a pmid: 15818113
5	Terragni PP, Rosboch GL, Lisi A, Viale AG, Ranieri VM. How respiratory system mechanics may help in minimising ventilator-induced lung injury in ARDS patients. Eur Respir J Suppl 2003; 42:15-21.
6	Welk B, Malloy JL, Joseph M, Yao LJ, Veldhuizen AW. Surfactant treatment for ventilation-induced lung injury in rats: effects on lung compliance and cytokines. Exp Lung Res 2001; 27:505-520. doi: 10.1080/019021401750414038 pmid: 11558967
7	Liu YY, Liao SK, Huang CC, Tsai YH, Quinn DA, Li LF. Role for nuclear factor-kappaB in augmented lung injury because of interaction between hyperoxia and high stretch ventilation. Transl Res 2009; 154:219-221. doi: 10.1016/j.trsl.2009.07.012 pmid: 19840762
8	Fujita Y, Fujino Y, Uchiyama A, Mashimo T, Nishimura M. High peak inspiratory flow can aggravate ventilator-induced lung injury in rabbits. Med Sci Monit 2007; 13:BR95-100. pmid: 17392642
9	Ricard JD, Dreyfuss D, Saumon G. Production of inflammatory cytokines in ventilation induced lung injury: a reappraisal. Am J Respir Crit Care Med 2001; 163:1176-1180. doi: 10.1164/ajrccm.163.5.2006053 pmid: 11316656
10	Verbrugge SJ, Uhlig S, Neggers SJ, Martin C, Held HD, Haitsma JJ. et al. Different ventilation strategies affect lung function but do not increase tumor necrosis factor-alpha and prostacylin production in lavaged rat lungs in vivo. Anesthesiology 1999; 91:1834-1843. doi: 10.1097/00000542-199912000-00038 pmid: 10598628
11	Liu YY, Liao SK, Huang CC, Tsai YH, Quinn DA, Li LF. Role for nuclear factor-kappaB in augmented lung injury because of interaction between hyperoxia and high stretch ventilation. Transl Res 2009; 154:228-240. doi: 10.1016/j.trsl.2009.06.006 pmid: 19840764
12	Tschumperlein DJ, Oswari J, Margulies AS. Deformation-induced injury of alveolar epithelial cells. Effect of frequency, duration and amplitude. Am J Respir Crit Care Med 2000; 162:357-362. doi: 10.1164/ajrccm.162.2.9807003 pmid: 10934053
13	Rich PB, Douillet CD, Hurd H, Boucher RC. Effect of ventilatory rate on airway cytokine levels and lung injury. J Surgical Res 2003; 113:139-145. doi: 10.1016/S0022-4804(03)00195-1
14	Downey GP, Dong Q, Kruger J, Dedhar S, Cherapanov V. Regulation of neutrophil activation in acute lung injury. Chest 1999; 116:46s-54s. doi: 10.1378/chest.116.suppl_1.46s pmid: 10424589
15	Ricard JD, Drefuss D, Saumon G. Ventilator-induced lung injury. Eur Respir J 2003; 42:2s-9s.
16	Chollet-Martin S, Jourdain B, Gibert C, Elbim C, Chastre J, Gougerot-Pocidalo MA. Interactions between neutrophils and cytokines in blood and alveolar spaces during ARDS. Am J Respir Crit Care Med 1996; 154:594-601. doi: 10.1164/ajrccm.154.3.8810592 pmid: 8810592
17	Imanaka H, Shimaoka M, Matsuura N, Nishimura M, Ohta N, Kiyono H. Ventilator-induced lung injury is associated with neutrophil infiltration, macrophage activation and TGF-beta1 mRNA upregulation in rat lungs. Anesth Analg 2001; 92:428-436 doi: 10.1097/00000539-200102000-00029 pmid: 11159246
18	Mukaida N, Matsumoto T, Yokoi K, Harada A, Matsushima K. Inhibition of neutrophil-mediated acute inflammation injury by an antibody against interleukin-8 (IL-8). Inflamm Res 1998; 47:S151-157. doi: 10.1007/s000110050308 pmid: 9831318
19	Groenevld AB, Raijmakers PG, Hack CE, Thijs LG. Interleukin 8-related neutrophil elastase and the severity of the adult respiratory distress syndrome. Cytokine 1995; 7:746-752. doi: 10.1006/cyto.1995.0089 pmid: 8580386

Group	VT (mL/kg )	f (breath/min)	Inspiratory flow (mL/kg/s)	I/E	Inspiratory time (s)	Ppeak (±s, cmH₂O)	PMAW (±s, cmH₂O)
A	6	30	6	1:1.0	1.0	9.75±0.31	4.60±0.17
B	20	30	20	1:1.0	1.0	21.00±0.93^**	6.37±0.34^*#
C	20	15	17	1:2.3	1.2	19.17±0.91^**	5.50±0.43
D	20	15	10	1:1.0	2.0	17.67±0.84^**	6.33±0.47^*

Primer	Sense	Anti-sense	bp
IL-8	5-ACTTCCAAGCTGGCTGTTGC-3	5-GGCCACTGTCAATCACTCTC-3	172
TNF-α	5-CCAAGTGACAAGCCAGTAGC-3	5′-TCTTGATGGCAGAGAGTAGG-3	274

[1]	Yu-qing Cui, Xian-fei Ding, Huo-yan Liang, Dong Wang, Xiao-juan Zhang, Li-feng Li, Quan-cheng Kan, Le-xin Wang, Tong-wen Sun. Efficacy and safety of low-dose corticosteroids for acute respiratory distress syndrome: A systematic review and meta-analysis [J]. World Journal of Emergency Medicine, 2021, 12(3): 207-213.
[2]	Hao-tian Chen, Jian-feng Xu, Xiao-xia Huang, Ni-ya Zhou, Yong-kui Wang, Yue Mao. Blood eosinophils and mortality in patients with acute respiratory distress syndrome: A propensity score matching analysis [J]. World Journal of Emergency Medicine, 2021, 12(2): 131-136.
[3]	Yi Han, Su-cheng Mu, Jian-li Wang, Wei Wei, Ming Zhu, Shi-lin Du, Min Min, Yun-jie Xu, Zhen-ju Song, Chao-yang Tong. MicroRNA-145 plays a role in mitochondrial dysfunction in alveolar epithelial cells in lipopolysaccharide-induced acute respiratory distress syndrome [J]. World Journal of Emergency Medicine, 2021, 12(1): 54-60.
[4]	Yu-ming Wang, Yan-jun Zheng, Ying Chen, Yun-chuan Huang, Wei-wei Chen, Ran Ji, Li-li Xu, Zhi-tao Yang, Hui-qiu Sheng, Hong-ping Qu, En-qiang Mao, Er-zhen Chen. Effects of fluid balance on prognosis of acute respiratory distress syndrome patients secondary to sepsis [J]. World Journal of Emergency Medicine, 2020, 11(4): 216-222.
[5]	Hui Xie, Zhi-gang Zhou, Wei Jin, Cheng-bin Yuan, Jiang Du, Jian Lu, Rui-lan Wang. Ventilator management for acute respiratory distress syndrome associated with avian influenza A (H7N9) virus infection: A case series [J]. World Journal of Emergency Medicine, 2018, 9(2): 118-124.
[6]	Ruo Wu, Shi-yun Lin, Hui-min Zhao. Albuterol in the treatment of acute respiratory distress syndrome: A meta-analysis of randomized controlled trials [J]. World Journal of Emergency Medicine, 2015, 6(3): 165-171.
[7]	Xiao-yan Wu, Ying-zi Huang, Huo-gen Liu, Dong-ya Huang, Rui Tang, Hai-bo Qiu. Effects of pulmonary stretch reflex on lung injury in rabbits with acute respiratory distress syndrome [J]. World Journal of Emergency Medicine, 2011, 2(4): 296-301.
[8]	Jian-guo Zhang, Xiao-juan Chen, Fen Liu, Zhen-guo Zeng, Ke-jian Qian. Lung recruitment maneuver effects on respiratory mechanics and extravascular lung water index in patients with acute respiratory distress syndrome [J]. World Journal of Emergency Medicine, 2011, 2(3): 201-205.