Ventilator-induced coagulopathy in experimental Streptococcus pneumoniae pneumonia

Haitsma, Jack J.; Schultz, Marcus J.; Hofstra, J–J.H.; Kuiper, Jan Willem; Juco, Jonathan; Vaschetto, Rosanna; Levi, Marcel; Zhang, H.; Slutsky, Arthur S.

doi:10.1183/09031936.00045908

Cited by 22 publications

(30 citation statements)

References 34 publications

(47 reference statements)

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“…Moreover, MV with higher tidal volume and PEEP was associated with higher levels of soluble TM, TF, TAT, fVIIa, and lower levels of APC in BALF, reflecting a procoagulant activity [43] . Haitsma et al [44] have shown, in an animal model of Streptococcus pneumonia, that the implementation of high tidal volume MV was associated with local activation of coagulation and attenuation of fibrinolysis in the lung, whereas the levels of IL-6 in BALF were increased. The abovementioned phenomenon was described as "ventilator-induced coagulopathy."…”

Section: Immunothrombosis In Ards Pathophysiologymentioning

confidence: 99%

Immunothrombosis in Acute Respiratory Distress Syndrome: Cross Talks between Inflammation and Coagulation

Frantzeskaki¹,

Armaganidis²,

Orfanos³

2016

Respiration

224

251

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Acute respiratory distress syndrome (ARDS) is defined as a syndrome of acute onset, with bilateral opacities on chest imaging and respiratory failure not caused by cardiac failure, leading to mild, moderate, or severe oxygenation impairment. The syndrome is most commonly a manifestation of sepsis-induced organ dysfunction, characterized by disruption of endothelial barrier integrity and diffuse lung damage. Imbalance between coagulation and inflammation is a predominant characteristic of ARDS, leading to extreme inflammatory response and diffuse fibrin deposition in vascular capillary bed and alveoli. Activated platelets, neutrophils, endothelial cells, neutrophil extracellular traps, microparticles, and coagulation proteases, participate in the complex process of immunothrombosis, which is a key event in ARDS pathophysiology. The present review is focused on the elucidation of immunothrombosis in ARDS and the potential therapeutic implications.

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Section: Immunothrombosis In Ards Pathophysiologymentioning

confidence: 99%

Immunothrombosis in Acute Respiratory Distress Syndrome: Cross Talks between Inflammation and Coagulation

Frantzeskaki¹,

Armaganidis²,

Orfanos³

2016

Respiration

224

251

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“…11 Haitsma and colleagues demonstrated that injurious ventilation settings increased pulmonary coagulopathy in an animal model of Streptococcus pneumoniae pneumonia, which resulted in a systemic coagulopathy. 12 Coagulation dysfunction with both defective inhibition of coagulation and attenuation of fibrinolysis could potentially contribute to the development of VTE in ventilated patients. 11,12 Review articles pressure of oxygen and possibly, release of mediators such as platelet-activating factor.…”

Section: Vte and Mechanical Ventilationmentioning

confidence: 99%

“…12 Coagulation dysfunction with both defective inhibition of coagulation and attenuation of fibrinolysis could potentially contribute to the development of VTE in ventilated patients. 11,12 Review articles pressure of oxygen and possibly, release of mediators such as platelet-activating factor. [15][16][17] In patients without pre-existing cardiopulmonary disease who are ventilated to near normal functional residual capacity without significant changes in lung volume and with positive end-expiratory pressure (PEEP) of less than 10 cm H 2 O, clinically important changes in RV afterload are uncommon.…”

Section: Vte and Mechanical Ventilationmentioning

confidence: 99%

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Pulmonary Embolism in the Mechanically-Ventilated Critically Ill Patient: Is it Different?

Zochios

Keeshan

2013

Journal of the Intensive Care Society

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Acute PE results in increased right ventricular (RV) afterload. If the afterload is severely increased, RV enlargement, hypokinesis, ischaemia and RV failure may ensue. 13,14 The concomitant release of vasoactive and bronchoactive humoral factors such as serotonin from platelets, thrombin from plasma and histamine from tissue, have all been implicated in both pulmonary oedema and the ventilation-perfusion mismatch seen. 15 Experimental data suggest that the main mechanisms involved in hypoxaemia and the increase in the alveolararterial oxygen tension gradient are shunt, low ventilationperfusion ratio (V/Q), decrease in the mixed venous partial Pulmonary embolism in the mechanicallyventilated critically ill patient: is it different? 2C03, 3C00VA Zochios, A Keeshan Pulmonary embolism (PE) confers significant in-hospital morbidity and mortality, and critically ill patients remain at risk for venous thromboembolism despite thromboprophylaxis. Recognition of the clinical manifestations and immediate management of PE are of paramount importance. Despite diagnostic advances, PE is often undiagnosed and untreated in patients receiving mechanical ventilation, as these patients do not exhibit the common clinical features of the condition, making the diagnosis very challenging. Computed tomographic pulmonary angiography is probably the reference standard for the diagnosis of acute PE in the haemodynamically stable, ventilated patient. In the setting of circulatory collapse, bedside echocardiography may be used to risk stratify these patients, based on the presence or absence of right ventricular dysfunction, and guide further management. Treatment options include anticoagulation alone, anticoagulation plus thrombolysis, surgical or catheter embolectomy. Inotropes, vasopressors and pulmonary artery vasodilators may be considered after initial resuscitation of the right ventricle. Few studies have focused on estimating the prevalence of PE among mechanically-ventilated intensive care unit (ICU) patients and there is notable lack of data assessing predictive factors, prevention, diagnostic strategy and management of PE in the ICU setting.

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“…Mechanical and inflammatory processes most likely interact: a mechanically stressed lung may produce an inflammatory reaction. Conversely, inflammation renders the lung susceptible to mechanical stress [12]. …”

Section: Introductionmentioning

confidence: 99%

The Potential of Heliox as a Therapy for Acute Respiratory Distress Syndrome in Adults and Children: A Descriptive Review

et al. 2015

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Background: In neonatal respiratory distress syndrome (RDS) and acute RDS (ARDS) mechanical ventilation is often necessary to manage hypoxia, whilst protecting the lungs through lower volume ventilation and permissive hypercapnia. Mechanical ventilation can, however, induce or aggravate the lung injury caused by the respiratory distress. Helium, in a gas mixture with oxygen (heliox), has a low density and can reduce the flow in narrow airways and allow for lower driving pressures. Objectives: The aim of this study was to review preclinical and clinical studies of the use of heliox ventilation in acute lung injury associated with respiratory failure. Methods: A systematic search was executed in the PubMed and EMBASE databases, with search terms referring to ARDS or an acute lung injury condition associated with respiratory failure and the corresponding intervention. Results: A total of 576 papers were retrieved. After the majority had been excluded 20 papers remained, of which 6 articles described animal models (3 paediatric; 3 adult animal models) and 14 were clinical studies, of which 12 described paediatric patient populations and 2 adult patient populations. In both paediatric and adult animal models, heliox improved gas exchange while allowing for less invasive ventilation in a wide variety of models using different ventilation modes. Clinical studies show a reduction in the work of breathing during heliox ventilation, with a concomitant increase in pH and decrease in PaCO₂ levels compared to oxygen ventilation. Conclusions: Although evidence so far is limited, there may be a rationale for heliox ventilation in ARDS as an intervention to improve ventilation and reduce the work of breathing.

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Ventilator-induced coagulopathy in experimental Streptococcus pneumoniae pneumonia

Cited by 22 publications

References 34 publications

Immunothrombosis in Acute Respiratory Distress Syndrome: Cross Talks between Inflammation and Coagulation

Immunothrombosis in Acute Respiratory Distress Syndrome: Cross Talks between Inflammation and Coagulation

Pulmonary Embolism in the Mechanically-Ventilated Critically Ill Patient: Is it Different?

The Potential of Heliox as a Therapy for Acute Respiratory Distress Syndrome in Adults and Children: A Descriptive Review

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