Nakagawa NK; Jukemura J, Aikawa P, Nogueira RA, Poli-de-Figueiredo LF, and Sannomiya P. In vivo observation of mesenteric leukocyte-endothelial interactions after cecal ligation/puncture and surgical sepsis source control. Clinics. 2007;62(3):321-6. PURPOSE: Cecal ligation and puncture (CLP) has been used as a useful model for the induction of polymicrobial sepsis. Necrotic tissue resection and peritoneal lavage (REL) are the surgical procedures for controlling perforated appendicitis. The aim of this study was to evaluate leukocyte-endothelial interactions in the rat mesentery in vivo after CLP and REL. METHODS: Thirty-seven male Wistar rats (250-300 g) underwent laparotomy and were randomly assigned to the following groups: 1) SHAM; 2) CLP: animals submitted to CLP, 3) CLP+REL: animals submitted to CLP and REL. Mesenteric leukocyteendothelial interactions were studied by intravital microscopy assessed once in each animal (3-5 postcapillary venules, 15-25 µm diameter) 24 hours after intervention. Follow-up was performed in all animals; this included analysis of glycemia, lactate, hematocrit, white blood cell count as well as a functional score that was the sum of scoring on the following parameters: alertness, mobility, piloerection, diarrhea, encrusted eyes, and dirty nose and tail. RESULTS: None of the animals showed significant changes in body weight (265 ± 20 g) or in hematocrit levels (46% ± 2%) during the experimental protocol. Compared to SHAM animals, CLP animals showed an increased number of rolling (2x), adherent, and migrating leukocytes (7x) in the mesenteric microcirculation, an increase in blood glucose (136 ± 8 mg/dL), lactate (3.58 ± 0.94 mmol/L), white cell count (23,570 ± 4,991 cells/mm 3 ) and functional alterations (score 11 ± 1), characterized by impaired alertness and mobility, and presence of piloerection, diarrhea, encrusted eyes, and dirty nose and tail. The REL procedure normalized the number of rolling, adherent, and migrated leukocytes in the mesentery; glycemia; lactate; and white blood cell count. The REL procedure also improved the functional score (7 ± 1). CONCLUSION: Local and systemic inflammation was induced by CLP, while REL completely overcame the inflammatory process.
Mechanical ventilation with positive end expiratory pressure (PEEP) improves oxygenation and treats acute pulmonary failure. However, increased intrathoracic pressure may cause regional blood flow alterations that may contribute to mesenteric ischemia and gastrointestinal failure. We investigated the effects of different PEEP levels on mesenteric leukocyte-endothelial interactions.
Forty-four male Wistar rats were initially anesthetized (Pentobarbital I.P. 50mg/kg) and randomly assigned to one of the following groups: 1) NAIVE (only anesthesia; n=9), 2) PEEP 0 (PEEP of 0 cmH
O, n=13), 3) PEEP 5 (PEEP of 5 cmH
O, n=12), and 4) PEEP 10 (PEEP of 10 cmH
O, n=13). Positive end expiratory pressure groups were tracheostomized and mechanically ventilated with a tidal volume of 10 mL/kg, respiratory rate of 70 rpm, and inspired oxygen fraction of 1. Animals were maintained under isoflurane anesthesia. After two hours, laparotomy was performed, and leukocyte-endothelial interactions were evaluated by intravital microscopy.
No significant changes were observed in mean arterial blood pressure among groups during the study. Tracheal peak pressure was smaller in PEEP 5 compared with PEEP 0 and PEEP 10 groups (11, 15, and 16 cmH
O, respectively; p<0.05). After two hours of MV, there were no differences among NAIVE, PEEP 0 and PEEP 5 groups in the number of rollers (118±9,127±14 and 147±26 cells/10minutes, respectively), adherent leukocytes (3±1,3±1 and 4±2 cells/100μm venule length, respectively), and migrated leukocytes (2±1,2±1 and 2±1 cells/5,000μm
, respectively) at the mesentery. However, the PEEP 10 group exhibited an increase in the number of rolling, adherent and migrated leukocytes (188±15 cells / 10 min, 8±1 cells / 100 μm and 12±1 cells / 5,000 μm
, respectively; p<0.05).
High intrathoracic pressure was harmful to mesenteric microcirculation in the experimental model of rats with normal lungs and stable systemic blood pressure, a finding that may have relevance for complications related to mechanical ventilation.
INTRODUÇÃO: Os programas de reabilitação cardíaca (PRC) vêm diminuindo a morbidade e a mortalidade em pacientes após cirurgias de revascularização do miocárdio (CRM). OBJETIVO: Observar a adesão de pacientes submetidos à CRM isoladamente na fase tardia a um PRC e analisar a qualidade de vida e capacidade funcional antes e após o treinamento físico de três meses de PRC. MÉTODOS: Foram contatados todos os pacientes submetidos à CRM isoladamente no período de um ano para participarem de um PRC com duração de três meses com três sessões semanais de uma hora de duração. Todos os pacientes realizaram exames bioquímicos de sangue, teste de força muscular de uma repetição máxima (1-RM) para membros superiores e inferiores, teste de caminhada dos 6 minutos (TC6) e responderam o questionário de qualidade de vida SF-36 antes e após o treinamento. RESULTADOS: De todos os 86 pacientes contatados, apenas 13% (n = 11) concluíram o PRC. A média de idade foi 67 ± 9 anos. O sexo masculino foi predominante, 73% (oito homens). Não houve alterações significativas nos exames bioquímicos laboratoriais. No TC6 houve um aumento significativo na distância percorrida (p = 0,014); quanto à força muscular houve um aumento significativo na carga para o teste em membros superiores (p = 0,043); e no questionário SF-36 não observamos diferenças significativas nos escores antes e depois dos três meses de PRC. CONCLUSÃO: A adesão ao PRC foi baixa, logo é de suma importância a divulgação da participação de pacientes que realizaram CRM nesses programas para proporcionar maior capacidade funcional.
Objective: To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients ≥ 65 years-old.Methods: Patients undergoing isolated on-pump CABG from December 1 st 2010 to July 31 th 2012 were divided in two groups: GE (elderly ≥ 65 years-old, n=103) and GA (adults < 65 years-old, n=150). Preoperative data, intraoperative (as cardiopulmonar bypass time, aortic clamping time, time length of stay in mechanical ventilation -MV -and number of grafts), and postoperative variable (as morbidity, mortality and time length of stay in hospital) were analyzed during hospitalization.Results: In GE, the morbidity rate was greater than in GA (30% vs. 14%, P=0.004), but there was no difference in the mortality rate (5.8% vs. 2.0%, P=0.165). In GA, there was higher prevalence DM (39.6% vs. 27%, P=0.043) and smoking (32.2% versus 19.8%, P=0.042); and in GE, higher prevalence of stroke (17% vs. 6.7%, P=0.013). There was no difference between the groups regarding intraoperative variables. After multivariate analysis, age ≥ 65-year-old was associated with greater morbidity, but it was not independent predictive factor for in-hospital mortality. Considering in-hospital mortality, stay in ward time length (P=0.006), cardiac (P=0.011) and respiratory complications (P=0.026) were independent predictive factors.Conclusion: This study suggests that patients ≥ 65-yearold were at increased risk of postoperative complications when submitted to isolated on-pump CABG in comparison to patients < 65-year-old, but not under increased risk of death.
BACKGROUND:The combination of high PEEP and low tidal volume (V T ) decreases some risks of mechanical ventilation, including pulmonary overdistention, damage due to cyclic opening and closing of the alveoli, and inflammatory responses that can lead to multiple-organ dysfunction. We hypothesized that high V T and high PEEP induce mesenteric microcirculatory disturbances and that those disturbances would be attenuated by pentoxifylline, which is anti-inflammatory. METH-ODS: We anesthetized (isoflurane 1.5%), tracheostomized, and mechanically ventilated 57 male Wistar rats with PEEP of 10 cm H 2 O and F IO 2 of 0.21 for 2 hours. One group received low V T (7 mL/kg), another group received high V T (10 mL/kg), and a third group received high V T plus pentoxifylline (25 mg/kg). We measured mean arterial pressure, respiratory mechanics, mesenteric blood flow, and leukocyte-endothelial interactions. RESULTS: The mean arterial pressure was similar among the groups at baseline (
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