Neuroimmune Regulation of Ventilator-induced Lung Injury

Santos, Claudia C. dos; Shan, Yuexin; Akram, Ali; Slutsky, Arthur S.; Haitsma, Jack J.

doi:10.1164/rccm.201002-0314oc

Cited by 89 publications

(78 citation statements)

References 44 publications

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“…Massive brain injury increases susceptibility to lung injury (48). In preclinical studies, bilateral vagotomy exacerbated lung injury from ischemia-reperfusion and high VT, whereas vagal stimulation attenuated lung injury (49). ARDS is relatively common in brain-injured patients with respiratory failure, in whom high VT appears to be an independent risk factor for developing lung injury (50,51).…”

Section: Original Articlementioning

confidence: 99%

Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation after Cardiac Arrest

Beitler

Ghafouri

Jinadasa

et al. 2017

Am J Respir Crit Care Med

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Rationale: Neurocognitive outcome after out-of-hospital cardiac arrest (OHCA) is often poor, even when initial resuscitation succeeds. Lower tidal volumes (VTs) attenuate extrapulmonary organ injury in other disease states and are neuroprotective in preclinical models of critical illness.Objective: To evaluate the association between VT and neurocognitive outcome after OHCA.Methods: We performed a propensity-adjusted analysis of a twocenter retrospective cohort of patients experiencing OHCA who received mechanical ventilation for at least the first 48 hours of hospitalization. VT was calculated as the time-weighted average over the first 48 hours, in milliliters per kilogram of predicted body weight (PBW). The primary endpoint was favorable neurocognitive outcome (cerebral performance category of 1 or 2) at discharge.Measurements and Main Results: Of 256 included patients, 38% received time-weighted average VT greater than 8 ml/kg PBW during the first 48 hours. Lower VT was independently associated with favorable neurocognitive outcome in propensityadjusted analysis (odds ratio, 1.61; 95% confidence interval [CI], 1.13-2.28 per 1-ml/kg PBW decrease in VT; P = 0.008). This finding was robust to several sensitivity analyses. Lower VT also was associated with more ventilator-free days (b = 1.78; 95% CI, 0.39-3.16 per 1-ml/kg PBW decrease; P = 0.012) and shockfree days (b = 1.31; 95% CI, 0.10-2.51; P = 0.034). VT was not associated with hypercapnia (P = 1.00). Although the propensity score incorporated several biologically relevant covariates, only height, weight, and admitting hospital were independent predictors of VT less than or equal to 8 ml/kg PBW.Conclusions: Lower VT after OHCA is independently associated with favorable neurocognitive outcome, more ventilator-free days, and more shock-free days. These findings suggest a role for low-VT ventilation after cardiac arrest.

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Section: Original Articlementioning

confidence: 99%

Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation after Cardiac Arrest

Beitler

Ghafouri

Jinadasa

et al. 2017

Am J Respir Crit Care Med

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“…Indeed, it has been reported that vagus nerve stimulation was followed by inhibition of TNFα, IL1, IL6, IL8 and HMGB1 release [44] . dos Santos et al [45] supported the protective role of the cholinergic antinflammatory pathway, demonstrating that vagus nerve stimulation attenuated lung injury while in contrast vagotomy exacerbated VILI. Regardless of the responsible mechanisms, an injuri ous ventilatory strategy in the presence of an established inflammatory process may act as an additional stimulus that can aggravate lung damage.…”

Section: From the Brain To The Injury Of The Lungsmentioning

confidence: 95%

Respiratory mechanics in brain injury: A review

Koutsoukou

Katsiari

Orfanos

et al. 2016

WJCCM

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Several clinical and experimental studies have shown that lung injury occurs shortly after brain damage. The responsible mechanisms involve neurogenic pulmonary edema, inflammation, the harmful action of neurotransmitters, or autonomic system dysfunction. Mechanical ventilation, an essential component of life support in brain-damaged patients (BD), may be an additional traumatic factor to the already injured or susceptible to injury lungs of these patients thus worsening lung injury, in case that non lung protective ventilator settings are applied. Measurement of respiratory mechanics in BD patients, as well as assessment of their evolution during mechanical ventilation, may lead to preclinical lung injury detection early enough, allowing thus the selection of the appropriate ventilator settings to avoid ventilatorinduced lung injury. The aim of this review is to explore the mechanical properties of the respiratory system in BD patients along with the underlying mechanisms, and to translate the evidence of animal and clinical studies into therapeutic implications regarding the mechanical ventilation of these critically ill patients.

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“…Paraffin-embedded sections (4 mm) were stained with haematoxylin and eosin [20] for scoring of pulmonary inflammatory cell infiltration and alveolar wall thickening using a semiquantitative score (0e3) on blinded sections by two independent investigators [21].…”

Section: Histological Analysismentioning

confidence: 99%

Prevention and amelioration of rodent endotoxin-induced lung injury with administration of a novel therapeutic tripeptide feG

Elder¹,

Bersten²,

Saccone³

et al. 2013

Pulmonary Pharmacology & Therapeutics

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Neuroimmune Regulation of Ventilator-induced Lung Injury

Abstract: Stimulation of the cholinergic antiinflammatory reflex may represent a promising alternative for the treatment of VILI.

Cited by 89 publications

References 44 publications

Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation after Cardiac Arrest

Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation after Cardiac Arrest

Respiratory mechanics in brain injury: A review

Prevention and amelioration of rodent endotoxin-induced lung injury with administration of a novel therapeutic tripeptide feG

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