Lung Epithelial Fluid Transport and the Resolution of Pulmonary Edema

Matthay, Michael A.; Folkesson, Hans G.; Clérici, Christine

doi:10.1152/physrev.00003.2002

Cited by 610 publications

(671 citation statements)

References 369 publications

Supporting

Mentioning

649

Contrasting

Unclassified

Order By: Relevance

“…The cause of pulmonary edema in ARDS is unclear. It has been reported that pulmonary edema clearance is greatly affected by active sodium transport out of the alveoli rather than by reversal of the Starling forces (27)(28)(29). In a previous study, we showed that leptospirosis decreases protein expression of the ␣ subunit of the epithelial sodium channel (ENaC) in the lungs of hamsters.…”

Section: Discussionmentioning

confidence: 84%

Door-to-Dialysis Time and Daily Hemodialysis in Patients with Leptospirosis

Andrade

Cleto

Seguro

2007

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background: Leptospirosis is a public health problem, the severe form of which (Weil's disease) includes acute respiratory distress syndrome, typically accompanied by acute kidney injury (AKI), and is associated with high mortality rates. Recent evidence suggests that dialysis dosage affects outcomes in critically ill patients with sepsis-induced AKI. However, this population varies widely in terms of age, gender, and concomitant conditions, making it difficult to determine the appropriate timing (door-to-dialysis time) and dialysis dosage.Design, setting, participants, and measurements: It is logical to assume that increasing the dialysis dosage would minimize uremic complications and improve outcomes in such patients. Patients with Weil's disease constitute a homogeneous population and are typically free of comorbidities, therefore presenting an ideal model in which to test this assumption.Results Conclusions: On the basis of this result, it is believed that alternate-day hemodialysis is no longer appropriate for critically ill patients with Weil's disease.

show abstract

Section: Discussionmentioning

confidence: 84%

Door-to-Dialysis Time and Daily Hemodialysis in Patients with Leptospirosis

Andrade

Cleto

Seguro

2007

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…The rate of change in edema fluid protein concentration over time provides an indication of epithelial barrier function as it reflects the clearance of water from the alveolar space over time. Matthay et al 30 document maximal edema clearance rates of [ 14%Áhr -1 with hydrostatic edema. However, the majority of patients with ARDS have reported fluid clearance rates \ 3%Áhr -1 , 1 consistent with the results observed in the present study.…”

Section: Discussionmentioning

confidence: 99%

Resolution of pulmonary edema with variable mechanical ventilation in a porcine model of acute lung injury

Graham

Gulati

Kha

et al. 2011

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Objective Resolution of the acute respiratory distress syndrome (ARDS) requires clearance of pulmonary edema. Biologically variable ventilation (BVV) strategies that improve gas exchange, lung mechanics, and inflammatory mediators in ARDS may be beneficial in this regard. We used quantitative computed tomography (CT), a single indicator thermodilution system (PiCCOÒ) to determine extravascular lung water (EVLW), and the change in edema protein concentration over time to compare edema clearance with BVV vs conventional mechanical ventilation (CMV) in a porcine ARDS model. Methods Sixteen pigs with oleic acid lung injury were randomized to four hours of ventilation with either CMV (n = 8) or BVV (n = 8) at identical low tidal volume and minute ventilation over time. Hemodynamic variables, gas exchange, lung mechanics, and PiCCO derived EVLW were determined hourly. Computed tomography images and edema fluid samples were obtained at baseline lung injury and after four hours of ventilation. Wet and dry lung weights were determined postmortem.Results At four hours with BVV, peak airway pressure was decreased significantly and lung compliance improved compared with CMV (P = 0.003; P \ 0.001, respectively). Hemodynamic variables and gas exchange were not different between groups. Also at four hours, computed tomography revealed an increase in total gas volume (P = 0.001) and a decrease in total lung weight and global lung density (P = 0.005; P = 0.04 respectively) with BVV. These findings were associated with a significant increase in the gas volume of normally aerated lung regions (P \ 0.001) and a decrease in the poorly and non-aerated lung regions (P = 0.001). No change in any CT parameter occurred with CMV. The lung weights derived from computed tomography correlated well with postmortem wet weights (R 2 = 0.79; P \ 0.01). The decrease in PiCCO derived EVLW from injury to four hours did not differ significantly between BVV and CMV. Extravascular lung water showed no correlation with postmortem wet weights and significantly underestimated lung water. Average alveolar fluid clearance rates were positive (1.4%Áhr -1 (3%)) with BVV and negative with CMV (-2.0%Áhr -1 (4%)). Conclusions In a comparison between BVV and CMV, computed tomography evidence suggests that BVV facilitates enhanced clearance and/or redistribution of edema fluid with improved recruitment of atelectatic and poorly aerated lung regions; no such evidence was seen with either single thermodilution measurement of EVLW or edema clearance rates. The results of computed tomography provide further evidence of the benefit of BVV over conventional ventilation in ARDS. RésuméObjectif La re´solution d'un syndrome de de´tresse respiratoire aigue¨(SDRA) ne´cessite l'e´limination de

show abstract

“…This highlights lack of understanding of the pathways operative in sepsis and the necessity for improved therapies. Impairment of pulmonary vascular integrity is a key feature in multiple pathological conditions, including acute lung injury (ALI), sepsis, lung inflammation, and ventilator-induced lung injury, each of which result in pulmonary edema (1,(5)(6)(7). Sepsis is a complex, serious medical condition consequent to an overwhelming immune response to infection.…”

Section: Introductionmentioning

confidence: 99%

Blockade of NOX2 and STIM1 signaling limits lipopolysaccharide-induced vascular inflammation

Gandhirajan¹,

Meng²,

et al. 2013

View full text Add to dashboard Cite

During sepsis, acute lung injury (ALI) results from activation of innate immune cells and endothelial cells by endotoxins, leading to systemic inflammation through proinflammatory cytokine overproduction, oxidative stress, and intracellular Ca 2+ overload. Despite considerable investigation, the underlying molecular mechanism(s) leading to LPS-induced ALI remain elusive. To determine whether stromal interaction molecule 1-dependent (STIM1-dependent) signaling drives endothelial dysfunction in response to LPS, we investigated oxidative and STIM1 signaling of EC-specific Stim1-knockout mice. Here we report that LPSmediated Ca 2+ oscillations are ablated in ECs deficient in Nox2, Stim1, and type II inositol triphosphate receptor (Itpr2). LPS-induced nuclear factor of activated T cells (NFAT) nuclear accumulation was abrogated by either antioxidant supplementation or Ca 2+ chelation. Moreover, ECs lacking either Nox2 or Stim1 failed to trigger store-operated Ca 2+ entry (SOCe) and NFAT nuclear accumulation. LPS-induced vascular permeability changes were reduced in EC-specific Stim1 -/-mice, despite elevation of systemic cytokine levels. Additionally, inhibition of STIM1 signaling prevented receptor-interacting protein 3-dependent (RIP3-dependent) EC death. Remarkably, BTP2, a small-molecule calcium release-activated calcium (CRAC) channel blocker administered after insult, halted LPS-induced vascular leakage and pulmonary edema. These results indicate that ROS-driven Ca 2+ signaling promotes vascular barrier dysfunction and that the SOCe machinery may provide crucial therapeutic targets to limit sepsis-induced ALI.

show abstract

Lung Epithelial Fluid Transport and the Resolution of Pulmonary Edema

Cited by 610 publications

References 369 publications

Door-to-Dialysis Time and Daily Hemodialysis in Patients with Leptospirosis

Door-to-Dialysis Time and Daily Hemodialysis in Patients with Leptospirosis

Resolution of pulmonary edema with variable mechanical ventilation in a porcine model of acute lung injury

Blockade of NOX2 and STIM1 signaling limits lipopolysaccharide-induced vascular inflammation

Contact Info

Product

Resources

About