Dose-dependent effects of almitrine  on hemodynamics and gas exchange  in an animal model of acute lung injury

Sommerer, A.; Kaisers, Udo; Dembinski, Rolf; Bubser, H.; Falke, K. J.; Rossaint, Rolf

doi:10.1007/s001340051178

Cited by 13 publications

(6 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On its own, lower doses of almitrine increased P a O 2 and decreased shunt, usually in association with increased P PA and no change in Q , indicating increased PVR (390,391,583,1621,1815). These results are consistent with potentiation of HPV in shunt regions and enhanced diversion of perfusion to ventilated lung.…”

Section: Vi) Chronic Obstructive Pulmonary Diseasesupporting

confidence: 88%

Hypoxic Pulmonary Vasoconstriction

Sylvester

Shimoda

Aaronson

et al. 2012

Physiological Reviews

599

621

View full text Add to dashboard Cite

It has been known for more than 60 years, and suspected for over 100, that alveolar hypoxia causes pulmonary vasoconstriction by means of mechanisms local to the lung. For the last 20 years, it has been clear that the essential sensor, transduction, and effector mechanisms responsible for hypoxic pulmonary vasoconstriction (HPV) reside in the pulmonary arterial smooth muscle cell. The main focus of this review is the cellular and molecular work performed to clarify these intrinsic mechanisms and to determine how they are facilitated and inhibited by the extrinsic influences of other cells. Because the interaction of intrinsic and extrinsic mechanisms is likely to shape expression of HPV in vivo, we relate results obtained in cells to HPV in more intact preparations, such as intact and isolated lungs and isolated pulmonary vessels. Finally, we evaluate evidence regarding the contribution of HPV to the physiological and pathophysiological processes involved in the transition from fetal to neonatal life, pulmonary gas exchange, high-altitude pulmonary edema, and pulmonary hypertension. Although understanding of HPV has advanced significantly, major areas of ignorance and uncertainty await resolution.

show abstract

Section: Vi) Chronic Obstructive Pulmonary Diseasesupporting

confidence: 88%

Hypoxic Pulmonary Vasoconstriction

Sylvester

Shimoda

Aaronson

et al. 2012

Physiological Reviews

599

621

View full text Add to dashboard Cite

show abstract

“…Therefore ALM may also improve pulmonary gas exchange by reducing intrapulmonary rightto-left shunt, as indicated by previous studies [15,16,17,18,19]. In surfactant-depleted pigs our own group have demonstrated a dose-dependent improvement in pulmonary gas exchange due to intravenous ALM alone [20,21].…”

supporting

confidence: 48%

“…Furthermore, it has been observed that the negative effect on pulmonary hypertension due to the pulmonary vasoconstriction is dose dependent. In studies previously performed by our own institution pulmonary gas exchange in surfactant-depleted pigs has been shown to be improved by low-dose infusion of 1 mg kg ±1 min ±1 ALM but to be impaired with doses of 8 and 16 mg kg ±1 min ±1 [20,21]. Considering possible dose response effects of combined PLV and ALM, we administered increasing ALM doses assuming at least increasing plasma levels as well, but as we did not determine ALM concentrations in plasma we cannot exclude a cumulative effect due to the high plasma protein binding of ALM and a possible ALM-like activity of metabolites as previously described [37].…”

Section: Discussionmentioning

confidence: 99%

Effects of combined high-dose partial liquid ventilation and almitrine on pulmonary gas exchange and hemodynamics in an animal model of acute lung injury

et al. 2001

View full text Add to dashboard Cite

show abstract

“…(14,15). * P Ͻ 0.05 compared with ALI within the group; † P Ͻ 0.05 compared with V con ; ‡ P Ͻ 0.05 compared with V dec ; § P Ͻ 0.05 compared with V deco .…”

Section: Discussionmentioning

confidence: 99%

Erratum

&NA;

2004

Anesthesia & Analgesia

View full text Add to dashboard Cite

In acute lung injury (ALI), controlled mechanical ventilation with decelerating inspiratory flow (V dec ) has been suggested to improve oxygenation when compared with constant flow (V con ) by improving the distribution of ventilation and perfusion (V A /Q ). We performed the present study to test this hypothesis in an animal model of ALI. Furthermore, the effects of combined decelerating and constant flow (V deco ) were evaluated. Thus, 18 pigs with experimental ALI were randomized to receive mechanical ventilation with either V con , V dec or a fixed combination of both flow wave forms (V deco ) at the same tidal volume and positive end-expiratory pressure level for 6 h. Hemodynamics, gas exchange, and V A /Q distribution were determined. The results revealed an improvement of oxygenation resulting from a decrease of pulmonary shunt within each group (P Ͻ 0.05). However, blood flow to lung areas with a normal V A /Q distribution increased only during ventilation with V con (P Ͻ 0.05). Accordingly, Pao 2 was higher with V con than with V dec and V deco (P Ͻ 0.05). We conclude that contrary to the hypothesis, V con provides a more favorable V A /Q distribution, and hence better oxygenation, when compared with V dec and V deco in this model of ALI.(Anesth Analg 2004;98:211-9) I n acute lung injury (ALI), the efficiency of mechanical ventilation to provide adequate pulmonary gas exchange depends mainly on the homogeneity of alveolar ventilation distribution in lung areas with different alveolar opening pressures, thereby determining the ratio of ventilation and perfusion (V A /Q ). According to a mathematical lung model, decelerating inspiratory flow (V dec ) has been suggested to provide a more uniform distribution of inspired gas when compared with constant inspiratory flow (V con ) (1). These assumptions were confirmed by Abraham and Yoshihara (2) in a clinical study comparing volume-controlled mechanical ventilation (VCV) with V con and pressure-controlled mechanical ventilation (PCV) with V dec at equal tidal volumes (Vt) in patients with ALI. The authors demonstrated that changing from V con to V dec may be associated with increased oxygenation. In contrast, other clinical trials revealed a more homogeneous gas distribution but failed to prove an increase of oxygenation from V dec in ALI (3-8). However, previous studies evaluated hemodynamics and conventional gas exchange but did not determine changes of V A /Q distribution. Furthermore, most of them revealed short-term effects of 30 -60 min of experimental intervention (3,5-8). Thus, the potential benefits of PCV with V dec in ALI are still under debate (9). In particular, prolonged effects of different flow patterns on V A /Q distribution in ALI remain unclear.This study was performed to compare V A /Q distribution in experimental ALI in relation to V con during VCV, V dec during PCV and a fixed combination of both flow patterns (V deco ) provided by volume-assured pressure support (VAPS), a dual mode where pressure-controlled inspiration with V dec may be ...

show abstract

Dose-dependent effects of almitrine on hemodynamics and gas exchange in an animal model of acute lung injury

Abstract: In experimental ALI, effects of almitrine on oxygenation are dose-dependent. Almitrine is most effective when used at low doses known to mimic hypoxic pulmonary vasoconstriction.

Cited by 13 publications

References 40 publications

Hypoxic Pulmonary Vasoconstriction

Hypoxic Pulmonary Vasoconstriction

Effects of combined high-dose partial liquid ventilation and almitrine on pulmonary gas exchange and hemodynamics in an animal model of acute lung injury

Erratum

Contact Info

Product

Resources

About