In Vivo Assessment of Pulmonary Vascular Integrity in Experimental Pulmonary Edema

Brigham, Kenneth L.; Snell, James D.

doi:10.1172/jci107388

Cited by 16 publications

(6 citation statements)

References 43 publications

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“…We measured cardiac output and the indicator dilution quantity of water in the lung (idQwl) by injecting a mixture of [51Cr]erythrocytes, ['5I]human serum albumin, and tritiated water into the right atrium and taking samples at 1-s intervals from the aorta. We used both labeled erythrocytes and albumin as intravascular indicators, because in some circumstances in dogs, using albumin alone results in a large underestimate of extravascular lung water (4,11). We determined 5"Cr and "2I radioactivity in the in-1 A more detailed description of our surgical techniques will be published separately.…”

Section: Methodsmentioning

confidence: 99%

“…2Abbreviations used in this paper: dQl, dry weight of bloodless lung; idQwl, indicator dilution quantity of water in the lung; L/P, lymph-to-plasma; la, left atrial; my, (11), using hematocrit and whole blood and plasma water content measured gravimetrically in samples taken at the time of each study from the mean transit time of tritiated water, and multiplied this difference by cardiac output and fractional water content of whole blood (4,11).…”

Section: Methodsmentioning

confidence: 99%

“…When pulmonary edema occurs without heart failure, it is ascribed to increased permeability of lung exchanging vessels to plasma protein (1,2). Investigators studying increased permeability lung edema usually have produced fulminant, rapidly progressive edema with toxic chemicals such as alloxan (3,4), EDTA (5), or alphanapthylthiourea (6).…”

Section: Introductionmentioning

confidence: 99%

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Increased Sheep Lung Vascular Permeability Caused by Pseudomonas Bacteremia

Brigham¹,

Woolverton²,

Blake³

et al. 1974

J. Clin. Invest.

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404

122

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A B S T R A C T In awake sheep, we compared the responses of lung lymph flow and lymph and plasma protein concentrations to steady state elevations of pulmonary vascular pressures made by inflating a left atrial balloon with those after an intravenous infusion of 10W-10°Pseudomonas aeruginosa. Lymph flow increased when pressure was increased, but lymph-plasma protein concentration ratios always fell and lymph protein flow (lymph flow X lymph protein concentration) increased only slightly. After Pseudomonas, sheep had transient chills, fever, leukopenia, hypoxemia, increased pulmonary artery presssure and lymph flow and decreased left atrial pressure and lymph protein concentration. 3-5 h after Pseudomonas, when vascular pressures and lymph protein concentrations had returned to near base line, lymph flow increased further to 3-10 times base line and remained at a steady level for many hours. During this steady state period, lymph-plasma protein concentration ratios were similar to base line and lymph protein flow was higher than in the increased pressure studies. Two sheep died of pulmonary edema 7 and 9 h after Pseudomonas, but in 16 studies, five other sheep appeared well during the period of highest lymph flow and all variables returned to base line in 24-72 h. Six serial indicator dilution lung water studies in five sheep changed insignificantly from base line after Pseudomonas. Postmortem lung water was high in the two sheep dead of pulmonary edema and one other, but

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Increased Sheep Lung Vascular Permeability Caused by Pseudomonas Bacteremia

Brigham¹,

Woolverton²,

Blake³

et al. 1974

J. Clin. Invest.

Self Cite

404

122

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“…The sample was reweighed after 7 d to obtain the dry weight. The wet:dry ratio was then calculated as a surrogate measure of pulmonary edema (42). Data analysis.…”

Section: Vasopressin and Neonatal Resuscitationmentioning

confidence: 99%

Vasopressin improves survival compared with epinephrine in a neonatal piglet model of asphyxial cardiac arrest

et al. 2014

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Background: Epinephrine is a component of all resuscitation algorithms. Vasopressin is a pulmonary vasodilator and systemic vasopressor. We investigated the effect of epinephrine vs. vasopressin on survival and hemodynamics after neonatal porcine cardiac arrest (CA). Methods: A 4-min asphyxial CA was induced, after which cardiopulmonary resuscitation (CPR) was commenced. Animals were randomized to low-(LDE: 0.01 mg/kg) or high-dose epinephrine (HDE: 0.03 mg/kg), low-(LDV: 0.2 U/kg) or high-dose vasopressin (HDV: 0.4 U/kg), or control (saline). Clinical and echocardiography indexes were monitored. results: Sixty-nine animals were randomized. Survival was greater in HDV (n = 8 (89%); P < 0.05 ANOVA) vs. control (n = 7 (43%)) and LDE (n = 5 (36%)) but not vs. HDE (n = 7 (64%)) or LDV (n = 6 (75%)). Animals resuscitated with LDE required more shocks (2.5 (interquartile range: 2-6); P < 0.05) and higher doses of energy (15 J (interquartile range: 10-20); P < 0.05). Left ventricular output was comparable between groups, but a greater increase in superior vena caval flow was seen after HDV (P < 0.001 vs. control, LDE, and HDE). Plasma troponin was greatest in the HDE group (P < 0.05 vs. control and HDV). conclusion: Vasopressin results in improved survival, lower postresuscitation troponin, and less hemodynamic compromise after CA in newborn piglets. Vasopressin may be a candidate for testing in human neonates. t he need for active neonatal resuscitation is common with an incidence of 5-10%, although there is likely to be regional variability (1). Guidelines for drug use in neonatal resuscitation guidelines are based on extrapolations from adult literature. Pressors, almost invariably epinephrine, are recommended as core therapy during cardiopulmonary resuscitation (CPR) in order to enhance systemic perfusion (especially cerebral and coronary perfusion) by maintaining vascular tone while forward flow is generated by chest compressions. Epinephrine, although an integral part of every published protocol for neonatal resuscitation, may be associated with adverse effects (2-6); similar concerns exist in pediatric and adult cardiac arrest (CA). However, because of concerns associated with epinephrine (2,7), vasopressin was studied in the setting of asystolic CA. Vasopressin is an intense systemic vasoconstrictor, which may explain why it increases cerebral (and systemic) perfusion during experimental cardiac massage, as well as increasing cerebral oxygenation, neurological outcome, and resuscitation success following experimental .Vasopressin was first proposed as a resuscitation agent after endogenous vasopressin levels were found to be higher in successfully resuscitated patients compared with those who died (13). Evidence from a large, adult, multicenter, randomized controlled trial suggests it to be superior to epinephrine, when the nature of the CA was primary asystole (14). For the following reasons, vasopressin may be a good candidate for pressor support during CPR. First, CA in neonates is almost always due to asphy...

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“…We measured cardiac output and extravascular water during steady-state base-line and experimental periods 10 times in four sheep receiving histamine alone and 21 times in seven sheep receiving diphenhydramine plus histamine according to the protocol described above under "Prevention studies." Measurements were made by indicator dilution techniques, with both ['Cr] -erythrocytes and l"I-albumin as intravascular indicators to avoid errors due to erythrocyte-plasma transit time differences (7,8). Each animal's erythrocytes were labeled by incubating a blood sample for 1 h with ['Cr]sodium chromate at room temperature and washing the cells three times with 0.89% NaCl solution.…”

Section: Experimental Protocolsmentioning

confidence: 99%

Effects of antihistamines on the lung vascular response to histamine in unanesthetized sheep. Diphenhydramine prevention of pulmonary edema and increased permeability.

Brigham¹,

Bowers²,

Owen³

1976

J. Clin. Invest.

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A B S T R A C T To see whether antihistamines could prevent and reverse histamine-induced pulmonary edema and increased lung vascular permeability, we compared the effects of a 4-h intravenous infusion of 4 /Ag/kg per min histamine phosphate on pulmonary hemodynamics, lung lymph flow, lymph and plasma protein content, arterial blood gases, hematocrit, and lung water with the effects of an identical histamine infusion given during an infusion of diphenhydramine or metiamide on the same variables in unanesthetized sheep. Histamine caused lymph flow to increase from 6.0±0.5 to 27.0±5.5 (SEM) ml/h (P <0.05), lymph: plasma globulin concentration ratio to increase from 0.62±0.01 to 0.67±0.02 (P < 0.05), left atrial pressure to fall from 1+1 to -3±1 cm H20 (P < 0.05), and lung lymph clearance of eight protein fractions ranging from 36 to 96 A molecular radius to increase significantly. Histamine also caused increases in lung water, pulmonary vascular resistance, arterial Pco2, pH, and hematocrit, and decreases in cardiac output and arterial Po2. Diphenhydramine (3 mg/kg before histamine followed by 1.5 mg/ kg per h intravenous infusion) completely prevented the histamine effect on hematocrit, lung lymph flow, lymph protein clearance, and lung water content, and reduced histamine effects on arterial blood gases and pH. 6 mg/kg diphenhydramine given at the peak histamine response caused lymph flow and lymph: plasma protein concentration ratios to fall. Metiamide (10 mg/ Description of the preparation We used an unanesthetized, chronic sheep preparation described previously (1-4). Each animal was prepared by a series of three staged thoracotomies during which nonpulmonary contributions to a large lymph node in the posterior mediastinum (caudal mediastinal node) were resected;

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In Vivo Assessment of Pulmonary Vascular Integrity in Experimental Pulmonary Edema

Cited by 16 publications

References 43 publications

Increased Sheep Lung Vascular Permeability Caused by Pseudomonas Bacteremia

Increased Sheep Lung Vascular Permeability Caused by Pseudomonas Bacteremia

Vasopressin improves survival compared with epinephrine in a neonatal piglet model of asphyxial cardiac arrest

Effects of antihistamines on the lung vascular response to histamine in unanesthetized sheep. Diphenhydramine prevention of pulmonary edema and increased permeability.

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