Open lung approach with low tidal volume mechanical ventilation attenuates lung injury in rats with massive brain damage

Krebs, Joerg; Tsagogiorgas, Charalambos; Pelosi, Paolo; Rocco, Patricia R. M.; Hottenrott, Maximilia; Sticht, Carsten; Yard, Benito A.; Luecke, Thomas

doi:10.1186/cc13813

Cited by 21 publications

(15 citation statements)

References 48 publications

(66 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous guidelines recommended the use of liberal tidal volumes [10-15 mL/ kg of predicted body weight (PBW)] [27] with positive end expiratory pressure (PEEP) of at least 5 cmH 2 O to treat NPE. However, ventilator-induced lung injury is common in organ donors [28], and recent experimental evidence shows that protective ventilation attenuates the severity of lung injury [29]. A protective ventilator strategy bundle (using 6-8 mL/kg of PBW, PEEP equal to 8-10 cmH 2 O, a closed circuit for tracheal suction, alveolar recruitment manoeuvres after any disconnection, [8], an approach similar to the management of acute lung injury patients [31,32].…”

Section: Respiratory Managementmentioning

confidence: 99%

Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality

et al. 2019

View full text Add to dashboard Cite

To provide a practical overview of the management of the potential organ donor in the intensive care unit. Methods: Seven areas of donor management were considered for this review: hemodynamic management; fluids and electrolytes; respiratory management; endocrine management; temperature management; anaemia and coagulation; infection management. For each subchapter, a narrative review was conducted. Results and conclusions: Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagulation. Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopressin, intravenously. Temperature management of the donor is an area of uncertainty, but it appears reasonable to strive for a core temperature of > 35 °C. The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. The potential donor should be assessed clinically for infections, and screening tests for specific infections are an essential part of donor management. Although the rate of infection transmission from donor to receptor is low, certain infections are still a formal contraindication to organ donation. However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.

show abstract

Section: Respiratory Managementmentioning

confidence: 99%

Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality

et al. 2019

View full text Add to dashboard Cite

show abstract

“…We first performed a systematic search of NIH GEO and ArrayExpress for studies of either type. There were 21 animal lung tissue datasets (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) with diverse lung injury mechanisms, including ventilator-induced injury (n = 14), ozone (n = 3), intratracheal LPS (n = 3), and a hemorrhagic trauma model (n = 1) (total controls = 83, cases = 141; Table 1). No human ALI whole-lung samples were available, so we used three human experimental datasets (39-41) that studied LPS or ozone exposure via BAL (total microarrays: controls = 107, cases = 110; Table 2).…”

Section: Multicohort Gene Expression Analysesmentioning

confidence: 99%

Gene Expression Analysis to Assess the Relevance of Rodent Models to Human Lung Injury

Sweeney

Lofgren

Khatri

et al. 2017

Am J Respir Cell Mol Biol

View full text Add to dashboard Cite

The relevance of animal models to human diseases is an area of intense scientific debate. The degree to which mouse models of lung injury recapitulate human lung injury has never been assessed. Integrating data from both human and animal expression studies allows for increased statistical power and identification of conserved differential gene expression across organisms and conditions. We sought comprehensive integration of gene expression data in experimental acute lung injury (ALI) in rodents compared with humans. We performed two separate gene expression multicohort analyses to determine differential gene expression in experimental animal and human lung injury. We used correlational and pathway analyses combined with external in vitro gene expression data to identify both potential drivers of underlying inflammation and therapeutic drug candidates. We identified 21 animal lung tissue datasets and three human lung injury bronchoalveolar lavage datasets. We show that the metasignatures of animal and human experimental ALI are significantly correlated despite these widely varying experimental conditions. The gene expression changes among mice and rats across diverse injury models (ozone, ventilator-induced lung injury, LPS) are significantly correlated with human models of lung injury (Pearson r = 0.33-0.45, P < 1E). Neutrophil signatures are enriched in both animal and human lung injury. Predicted therapeutic targets, peptide ligand signatures, and pathway analyses are also all highly overlapping. Gene expression changes are similar in animal and human experimental ALI, and provide several physiologic and therapeutic insights to the disease.

show abstract

“…A consensus has been formed that it is also suitable for patients with healthy lungs in operating room [9,10]. An animal experiment showed that small VT ventilation could more effectively promote the oxygenation of rats with brain injury than large VT ventilation [11]. Furthermore, large VT ventilation in TBI patients might be associated with the occurrence of ARDS, and its incidence increased to some extent with the VT [12].…”

Section: Discussionmentioning

confidence: 99%

Effects of Intraoperative Lung-Protective Ventilation on Clinical Outcomes in Patients With Traumatic Brain Injury: A Randomized Controlled Trial

Jiang

Zhang

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Secondary lung injury is the most common non-neurological complication after traumatic brain injury (TBI). Lung-protective ventilation (LPV) has been proven to improve perioperative oxygenation and lung compliance in some critical patients. This study aimed to investigate whether intraoperative LPV could improve respiratory function and prevent postoperative complications in emergency TBI patients.Methods: Ninety TBI patients were randomly allocated to three groups (1:1:1): Group A, conventional mechanical ventilation [tidal volume (VT) 10mL/kg only]; Group B, small VT (8mL/kg) + positive end-expiratory pressure (PEEP) (5cmH2O); Group C, small VT (8mL/kg) + PEEP (5cmH2O) + recruitment maneuvers (RMs). Primary outcomes were intraoperative respiratory mechanics parameters and incidences of postoperative pulmonary complications; Secondary outcomes were serum levels of brain injury markers and incidences of postoperative neurological complications.Results: Seventy-nine patients completed final analysis. Intraoperative PaO2 and dynamic pulmonary compliance of Group B and C were higher than those of Group A (P=0.028; P=0.005), while their airway peak pressure and plateau pressure were lower than those of group A (P=0.004; P=0.005). Compared to Group A, postoperative 30-day incidences of hypoxemia, pulmonary infection and atelectasis of the other two groups significantly decreased (52.0% vs. 14.3% vs. 19.2%, P=0.005; 84.0% vs. 50.0% vs. 42.3%, P=0.006; 24.0% vs. 3.6% vs. 0.0%, P=0.004). Moreover, intraoperative hypotension in Group C was more frequent than that in Group A and B (P=0.007). At the end of surgery, serum levels of glial fibrillary acidic protein and ubiquitin carboxyl-terminal hydrolase isozyme L1 in Group B were lower than those in group A and C (P=0.002; P<0.001). Postoperative incidences of neurological complications among three groups were comparable. Conclusions: Intraoperative continuous administration of small VT + PEEP is beneficial to TBI patients. Additional RMs with caution can be performed to prevent the disturbance of the stability of cerebral hemodynamics.Trial registration: Chinese Clinical Trial Registry (ChiCTR2000038314), retrospectively registered on September 17, 2020.

show abstract

Open lung approach with low tidal volume mechanical ventilation attenuates lung injury in rats with massive brain damage

Cited by 21 publications

References 48 publications

Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality

Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality

Gene Expression Analysis to Assess the Relevance of Rodent Models to Human Lung Injury

Effects of Intraoperative Lung-Protective Ventilation on Clinical Outcomes in Patients With Traumatic Brain Injury: A Randomized Controlled Trial

Contact Info

Product

Resources

About