Low Respiratory Rate Plus Minimally Invasive Extracorporeal Co2 Removal Decreases Systemic and Pulmonary Inflammatory Mediators in Experimental Acute Respiratory Distress Syndrome*

Grasso, Salvatore; Stripoli, Tania; Mazzone, Palma; Pezzuto, Marco; Lacitignola, Luca; Centonze, Paola; Guarracino, Alessandro; Esposito, Cosimo; Herrmann, Peter; Quintel, Michael; Trerotoli, Paolo; Bruno, Francesco; Crovace, Antonio; Staffieri, Francesco

doi:10.1097/ccm.0000000000000312

Cited by 56 publications

(38 citation statements)

References 50 publications

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“…Low tidal volume is the only method that has been proven to reduce mortality in ARDS patients under mechanical ventilation . This strategy was found to alleviate harmful lung stretch and release of inflammatory mediators , such as IL‐6 and IL‐8 in the lung and plasma which are known to be important mediators of severe pulmonary injury and their level correlates with the severity of ARDS . Our result illustrated that low tidal volume was also practical and safe for total liquid ventilation.…”

Section: Discussionmentioning

confidence: 62%

Low Tidal Volume Reduces Lung Inflammation Induced by Liquid Ventilation in Piglets With Severe Lung Injury

et al. 2016

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Total liquid ventilation (TLV) is an alternative treatment for severe lung injury. High tidal volume is usually required for TLV to maintain adequate CO clearance. However, high tidal volume may cause alveolar barotrauma. We aim to investigate the effect of low tidal volume on pulmonary inflammation in piglets with lung injury and under TLV. After the establishment of acute lung injury model by infusing lipopolysaccharide, 12 piglets were randomly divided into two groups, TLV with high tidal volume (25 mL/kg) or with low tidal volume (6 mL/kg) for 240 min, respectively. Extracorporeal CO removal was applied in low tidal volume group to improve CO clearance and in high tidal volume group as sham control. Gas exchange and hemodynamic status were monitored every 30 min during TLV. At the end of the study, pulmonary mRNA expression and plasmatic concentration of interleukin-6 (IL-6) and interleukin-8 (IL-8) were measured by collecting lung tissue and blood samples from piglets. Arterial blood pressure, PaO , and PaCO showed no remarkable difference between groups during the observation period. Compared with high tidal volume strategy, low tidal volume resulted in 76% reduction of minute volume and over 80% reduction in peak inspiratory pressure during TLV. In addition, low tidal volume significantly diminished pulmonary mRNA expression and plasmatic level of IL-6 and IL-8. We conclude that during TLV, low tidal volume reduces lung inflammation in piglets with acute lung injury without compromising gas exchange.

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Section: Discussionmentioning

confidence: 62%

Low Tidal Volume Reduces Lung Inflammation Induced by Liquid Ventilation in Piglets With Severe Lung Injury

et al. 2016

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“…Prospective ARDS studies suggest that there may not be a safe upper limit of tidal volume or plateau airway pressure (53). In addition, recent reports highlight the role of respiratory rate as a contributor to ventilatorassociated lung injury (55,56) and that lower respiratory rates (e.g., lower than 10 breaths per minute) should be considered. Analysis of pooled data of patients managed with mechanical ventilation alone for ARDS and those managed with venovenous ECMO have also suggested that driving pressure (plateau airway pressure minus positive end-expiratory pressure) is independently associated with increased mortality; while this relationship has not been validated in a prospective or randomized fashion, perhaps targeting a lower driving pressure could also be beneficial (57,58).…”

Section: Ventilator Strategiesmentioning

confidence: 99%

Extracorporeal techniques in acute respiratory distress syndrome

2017

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Extracorporeal membrane oxygenation (ECMO) was first introduced for patients with acute respiratory distress syndrome (ARDS) in the 1970s. However, enthusiasm was tempered due to the high mortality seen at that time. The use of ECMO has grown considerably in recent years due to technological advances and the evidence suggesting potential benefit. While the efficacy of ECMO has yet to be rigorously demonstrated with high-quality evidence, it has the potential not only to have a substantial impact on outcomes, including mortality, but also to change the paradigm of ARDS management.

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“…This may be aimed at reducing aggressiveness of invasive ventilation in patients with ARDS. Recently Grasso et al [6] showed that the use of ECCO 2 R permitted to reduce respiratory rate from 30 to 14 breaths/min while removing 39% of CO 2 production. Interestingly some cytokines (interleukin-6 and tumor necrosis factor-a) concentrations were significantly lower in plasma and in bronchoalveolar lavage, suggesting that ECCO 2 R is also capable to limit biotrauma.…”

mentioning

confidence: 98%

“…This has led to the attempt of this technique in patients presenting with acute hypercapnic respiratory failure (COPD patients, bridge to transplant lung patients) [2]. ECCO 2 R systems are now proposed to reduce invasiveness of mechanical ventilation and, therefore, VILI in ARDS patients [3][4][5][6][7].…”

mentioning

confidence: 99%