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Cai Z, Zhang H, Guo X, Song L. Resistive spontaneous breathing exacerbated lipopolysaccharide-induced lung injury in mice. Biochem Biophys Rep 2024; 38:101726. [PMID: 38766380 PMCID: PMC11098718 DOI: 10.1016/j.bbrep.2024.101726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 05/22/2024] Open
Abstract
Background Spontaneous respiratory mechanical force interacted with the primary lung injury and aggravated the progression of ARDS clinically. But the exact role and involved mechanism of it in the pathogenesis of ARDS animal model remained obscure. Aim This study was to investigate the effect of spontaneous respiratory mechanical force on lung injury of ARDS in mice. Methods Female C57BL/6 mice were subjected to resistive spontaneous breathing (RSB) by tracheal banding after 4-6 h of intranasal inhalation of LPS. Pulmonary function was examined by Buxco system, partial pressures of oxygen and carbon dioxide (PO2 and PCO2) were measured by a blood gas analyzer, and lung pathological changes were analyzed with hematoxylin and eosin staining. The levels of inflammatory markers were quantified by ELISA, total protein assay, and FACS analysis. The expression levels of mechanosensitive ion channels were detected by qRT-PCR and immunohistochemistry. Results The airway resistance (Raw) was increased and the tidal volume (TV) was decreased remarkedly in RSB group. RSB treatment did not affect PO2, PCO2, pathology and inflammation levels of lung in mice. The Raw increased and ventilatory indicators decreased in RSB + ARDS compared to ARDS significantly. Besides, RSB treatment deteriorated the changes of PO2, PCO2 and level of lactic acid induced by LPS. Meanwhile, RSB significantly promoted LPS-induced pulmonary histopathological injury, and elevated the levels of IL-1β, IL-6, TNF-α and total proteins, increased neutrophils infiltration. The expression level of Piezo1 in RSB + ARDS group was remarkably reduced compared to ARDS group and consistent with the severity of pulmonary damage. Conclusion RSB exacerbated LPS-induced ARDS hypoxemia and hypercapnia, inflammation and damage. The mechanosensitive protein Piezo1 expression decreased and may play an important role in the process.
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Affiliation(s)
- Zhigui Cai
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | | | - Xingxing Guo
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Liqiang Song
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
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Toumpanakis D, Glynos C, Schoini P, Vassilakopoulou V, Chatzianastasiou A, Dettoraki M, Mizi E, Tsoukalas D, Perlikos F, Magkou C, Papapetropoulos A, Vassilakopoulos T. Synergistic Effects of Resistive Breathing on Endotoxin-Induced Lung Injury in Mice. Int J Chron Obstruct Pulmon Dis 2023; 18:2321-2333. [PMID: 37876659 PMCID: PMC10591622 DOI: 10.2147/copd.s424560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Resistive breathing (RB) is characterized by forceful contractions of the inspiratory muscles, mainly the diaphragm, resulting in large negative intrathoracic pressure and mechanical stress imposed on the lung. We have shown that RB induces lung injury in healthy animals. Whether RB exerts additional injurious effects when added to pulmonary or extrapulmonary lung injury is unknown. Our aim was to study the synergistic effect of RB on lipopolysaccharide (LPS)-induced lung injury. Methods C57BL/6 mice inhaled an LPS aerosol (10mg/3mL) or received an intraperitoneal injection of LPS (10 mg/kg). Mice were then anaesthetized, the trachea was surgically exposed, and a nylon band of a specified length was sutured around the trachea, to provoke a reduction of the surface area at 50%. RB through tracheal banding was applied for 24 hours. Respiratory system mechanics were measured, BAL was performed, and lung sections were evaluated for histological features of lung injury. Results LPS inhalation increased BAL cellularity, mainly neutrophils (p < 0.001 to ctr), total protein and IL-6 in BAL (p < 0.001 and p < 0.001, respectively) and increased the lung injury score (p = 0.001). Lung mechanics were not altered. Adding RB to inhaled LPS further increased BAL cellularity (p < 0.001 to LPS inh.), total protein (p = 0.016), lung injury score (p = 0.001) and increased TNFa levels in BAL (p = 0.011). Intraperitoneal LPS increased BAL cellularity, mainly macrophages (p < 0.001 to ctr.), total protein levels (p = 0.017), decreased static compliance (p = 0.004) and increased lung injury score (p < 0.001). Adding RB further increased histological features of lung injury (p = 0.022 to LPS ip). Conclusion Resistive breathing exerts synergistic injurious effects when combined with inhalational LPS-induced lung injury, while the additive effect on extrapulmonary lung injury is less prominent.
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Affiliation(s)
- Dimitrios Toumpanakis
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Constantinos Glynos
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Pinelopi Schoini
- 4th Respiratory Clinic, “Sotiria” General Hospital for Thoracic Diseases of Athens, Athens, Greece
| | - Vyronia Vassilakopoulou
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Athanasia Chatzianastasiou
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Maria Dettoraki
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Eleftheria Mizi
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Dionysios Tsoukalas
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Fotis Perlikos
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | | | - Andreas Papapetropoulos
- Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- Division of Pharmaceutical Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Vassilakopoulos
- “Marianthi Simou” Applied Biomedical Research and Training Center, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Performance of Noninvasive Airway Occlusion Maneuvers to Assess Lung Stress and Diaphragm Effort in Mechanically Ventilated Critically Ill Patients. Anesthesiology 2023; 138:274-288. [PMID: 36520507 DOI: 10.1097/aln.0000000000004467] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Monitoring and controlling lung stress and diaphragm effort has been hypothesized to limit lung injury and diaphragm injury. The occluded inspiratory airway pressure (Pocc) and the airway occlusion pressure at 100 ms (P0.1) have been used as noninvasive methods to assess lung stress and respiratory muscle effort, but comparative performance of these measures and their correlation to diaphragm effort is unknown. The authors hypothesized that Pocc and P0.1 correlate with diaphragm effort and lung stress and would have strong discriminative performance in identifying extremes of lung stress and diaphragm effort. METHODS Change in transdiaphragmatic pressure and transpulmonary pressure was obtained with double-balloon nasogastric catheters in critically ill patients (n = 38). Pocc and P0.1 were measured every 1 to 3 h. Correlations between Pocc and P0.1 with change in transdiaphragmatic pressure and transpulmonary pressure were computed from patients from the first cohort. Accuracy of Pocc and P0.1 to identify patients with extremes of lung stress (change in transpulmonary pressure > 20 cm H2O) and diaphragm effort (change in transdiaphragmatic pressure < 3 cm H2O and >12 cm H2O) in the preceding hour was assessed with area under receiver operating characteristic curves. Cutoffs were validated in patients from the second cohort (n = 13). RESULTS Pocc and P0.1 correlate with change in transpulmonary pressure (R2 = 0.62 and 0.51, respectively) and change in transdiaphragmatic pressure (R2 = 0.53 and 0.22, respectively). Area under receiver operating characteristic curves to detect high lung stress is 0.90 (0.86 to 0.94) for Pocc and 0.88 (0.84 to 0.92) for P0.1. Area under receiver operating characteristic curves to detect low diaphragm effort is 0.97 (0.87 to 1.00) for Pocc and 0.93 (0.81 to 0.99) for P0.1. Area under receiver operating characteristic curves to detect high diaphragm effort is 0.86 (0.81 to 0.91) for Pocc and 0.73 (0.66 to 0.79) for P0.1. Performance was similar in the external dataset. CONCLUSIONS Pocc and P0.1 correlate with lung stress and diaphragm effort in the preceding hour. Diagnostic performance of Pocc and P0.1 to detect extremes in these parameters is reasonable to excellent. Pocc is more accurate in detecting high diaphragm effort. EDITOR’S PERSPECTIVE
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Pettenuzzo T, Sella N, Zarantonello F, De Cassai A, Geraldini F, Persona P, Pistollato E, Boscolo A, Navalesi P. How to recognize patients at risk of self-inflicted lung injury. Expert Rev Respir Med 2022; 16:963-971. [PMID: 36154791 DOI: 10.1080/17476348.2022.2128335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Patient self-inflicted lung injury (P-SILI) has been proposed as a form of lung injury caused by strong inspiratory efforts consequent to a high respiratory drive in patients with hypoxemic acute respiratory failure (hARF). Increased respiratory drive and effort may lead to variable combinations of deleterious phenomena, such as excessive transpulmonary pressure, pendelluft, intra-tidal recruitment, local lung volutrauma, and pulmonary edema. Gas exchange and respiratory mechanics derangements further increase respiratory drive and effort, thus inducing a vicious circle. Forms of partial ventilatory support may further add to the detrimental effects of P-SILI. Since P-SILI may worsen patient outcome, strategies aimed at identifying and preventing P-SILI would be of great importance. AREAS COVERED We systematically searched Pubmed since inception until 15 April 2022 to review the patho-physiological mechanisms of P-SILI and the strategies to identify those patients at risk of P-SILI. EXPERT OPINION Although the concept of P-SILI has been increasingly supported by experimental and clinical data, no study has insofar demonstrated the efficacy of any strategy to identify it in the clinical setting. Further research is thus needed to ascertain the detrimental effects of spontaneous breathing and identify patients with hARF at high risk of developing P-SILI.
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Affiliation(s)
- Tommaso Pettenuzzo
- Department of Surgery, Institute of Anesthesiology and Intensive Care, Padua University Hospital, Padua, Italy
| | - Nicolò Sella
- Department of Surgery, Institute of Anesthesiology and Intensive Care, Padua University Hospital, Padua, Italy
| | - Francesco Zarantonello
- Department of Surgery, Institute of Anesthesiology and Intensive Care, Padua University Hospital, Padua, Italy
| | - Alessandro De Cassai
- Department of Surgery, Institute of Anesthesiology and Intensive Care, Padua University Hospital, Padua, Italy
| | - Federico Geraldini
- Department of Surgery, Institute of Anesthesiology and Intensive Care, Padua University Hospital, Padua, Italy
| | - Paolo Persona
- Department of Surgery, Institute of Anesthesiology and Intensive Care, Padua University Hospital, Padua, Italy
| | - Elisa Pistollato
- Department of Surgery, Institute of Anesthesiology and Intensive Care, Padua University Hospital, Padua, Italy.,Department of Medicine, University of Padua, Padua, Italy
| | - Annalisa Boscolo
- Department of Surgery, Institute of Anesthesiology and Intensive Care, Padua University Hospital, Padua, Italy
| | - Paolo Navalesi
- Department of Surgery, Institute of Anesthesiology and Intensive Care, Padua University Hospital, Padua, Italy.,Department of Medicine, University of Padua, Padua, Italy
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Franz A, Mansur S. Unusual Case of Recurrent Pneumothorax in Granulomatosis With Polyangiitis. Cureus 2022; 14:e24165. [PMID: 35592215 PMCID: PMC9110043 DOI: 10.7759/cureus.24165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/09/2022] Open
Abstract
Granulomatosis with polyangiitis is a small vessel vasculitis that manifests as multisystemic inflammation predominantly affecting the lungs, upper respiratory tract, and the kidneys. Granulomatosis with polyangiitis commonly presents with elevated inflammatory markers and has a strong association with cytoplasmic antinuclear antibodies. Pulmonary manifestations of the disease include nodules, alveolar hemorrhage, and respiratory failure. The prevalence of pleural involvement is low, but can present as pleural effusion, wall thickening, and rarely pneumothorax. We describe the first report of recurrent pneumothorax secondary to presumed granulomatosis with polyangiitis.
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Toumpanakis D, Chatzianastasiou A, Vassilakopoulou V, Mizi E, Dettoraki M, Perlikos F, Giatra G, Mikos N, Theocharis S, Vassilakopoulos T. TRPV4 Inhibition Exerts Protective Effects Against Resistive Breathing Induced Lung Injury. Int J Chron Obstruct Pulmon Dis 2022; 17:343-353. [PMID: 35210764 PMCID: PMC8857953 DOI: 10.2147/copd.s336108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction TRPV4 channels are calcium channels, activated by mechanical stress, that have been implicated in the pathogenesis of pulmonary inflammation. During resistive breathing (RB), increased mechanical stress is imposed on the lung, inducing lung injury. The role of TRPV4 channels in RB-induced lung injury is unknown. Materials and Methods Spontaneously breathing adult male C57BL/6 mice were subjected to RB by tracheal banding. Following anaesthesia, mice were placed under a surgical microscope, the surface area of the trachea was measured and a nylon band was sutured around the trachea to reduce area to half. The specific TRPV4 inhibitor, HC-067047 (10 mg/kg ip), was administered either prior to RB and at 12 hrs following initiation of RB (preventive) or only at 12 hrs after the initiation of RB (therapeutic protocol). Lung injury was assessed at 24 hrs of RB, by measuring lung mechanics, total protein, BAL total and differential cell count, KC and IL-6 levels in BAL fluid, surfactant Protein (Sp)D in plasma and a lung injury score by histology. Results RB decreased static compliance (Cst), increased total protein in BAL (p < 0.001), total cell count due to increased number of both macrophages and neutrophils, increased KC and IL-6 in BAL (p < 0.001 and p = 0.01, respectively) and plasma SpD (p < 0.0001). Increased lung injury score was detected. Both preventive and therapeutic HC-067047 administration restored Cst and inhibited the increase in total protein, KC and IL-6 levels in BAL fluid, compared to RB. Preventive TRPV4 inhibition ameliorated the increase in BAL cellularity, while therapeutic TRPV4 inhibition exerted a partial effect. TRPV4 inhibition blunted the increase in plasma SpD (p < 0.001) after RB and the increase in lung injury score was also inhibited. Conclusion TRPV4 inhibition exerts protective effects against RB-induced lung injury.
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Affiliation(s)
- Dimitrios Toumpanakis
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Correspondence: Dimitrios Toumpanakis, Email
| | - Athanasia Chatzianastasiou
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vyronia Vassilakopoulou
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftheria Mizi
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dettoraki
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotis Perlikos
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Giatra
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 3 Department of Critical Care Medicine, Evgenideio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Mikos
- Allergology Department, Laiko General Hospital, Athens, Greece
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Vassilakopoulos
- “Marianthi Simou” Applied Biomedical Research and Training Center, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 3 Department of Critical Care Medicine, Evgenideio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Magliocca A, Rezoagli E, Zani D, Manfredi M, De Giorgio D, Olivari D, Fumagalli F, Langer T, Avalli L, Grasselli G, Latini R, Pesenti A, Bellani G, Ristagno G. Cardiopulmonary Resuscitation-associated Lung Edema (CRALE). A Translational Study. Am J Respir Crit Care Med 2021; 203:447-457. [PMID: 32897758 DOI: 10.1164/rccm.201912-2454oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Rationale: Cardiopulmonary resuscitation is the cornerstone of cardiac arrest (CA) treatment. However, lung injuries associated with it have been reported.Objectives: To assess 1) the presence and characteristics of lung abnormalities induced by cardiopulmonary resuscitation and 2) the role of mechanical and manual chest compression (CC) in its development.Methods: This translational study included 1) a porcine model of CA and cardiopulmonary resuscitation (n = 12) and 2) a multicenter cohort of patients with out-of-hospital CA undergoing mechanical or manual CC (n = 52). Lung computed tomography performed after resuscitation was assessed qualitatively and quantitatively along with respiratory mechanics and gas exchanges.Measurements and Main Results: The lung weight in the mechanical CC group was higher compared with the manual CC group in the experimental (431 ± 127 vs. 273 ± 66, P = 0.022) and clinical study (1,208 ± 630 vs. 837 ± 306, P = 0.006). The mechanical CC group showed significantly lower oxygenation (P = 0.043) and respiratory system compliance (P < 0.001) compared with the manual CC group in the experimental study. The variation of right atrial pressure was significantly higher in the mechanical compared with the manual CC group (54 ± 11 vs. 31 ± 6 mm Hg, P = 0.001) and significantly correlated with lung weight (r = 0.686, P = 0.026) and respiratory system compliance (r = -0.634, P = 0.027). Incidence of abnormal lung density was higher in patients treated with mechanical compared with manual CC (37% vs. 8%, P = 0.018).Conclusions: This study demonstrated the presence of cardiopulmonary resuscitation-associated lung edema in animals and in patients with out-of-hospital CA, which is more pronounced after mechanical as opposed to manual CC and correlates with higher swings of right atrial pressure during CC.
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Affiliation(s)
- Aurora Magliocca
- Dipartimento di Medicina Cardiovascolare, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Emanuele Rezoagli
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Davide Zani
- Department of Veterinary Medicine, University of Milan, Lodi, Italy
| | - Martina Manfredi
- Department of Veterinary Medicine, University of Milan, Lodi, Italy
| | - Daria De Giorgio
- Dipartimento di Medicina Cardiovascolare, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Davide Olivari
- Dipartimento di Medicina Cardiovascolare, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Francesca Fumagalli
- Dipartimento di Medicina Cardiovascolare, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Leonello Avalli
- Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy
| | - Giacomo Grasselli
- Department of Medical Physiopathology and Transplants, University of Milan, Milano, Italy; and.,Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Latini
- Dipartimento di Medicina Cardiovascolare, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Antonio Pesenti
- Department of Medical Physiopathology and Transplants, University of Milan, Milano, Italy; and.,Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Bellani
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Ristagno
- Department of Medical Physiopathology and Transplants, University of Milan, Milano, Italy; and.,Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
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8
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Khor YH, Ryerson CJ, Landry SA, Howard ME, Churchward TJ, Edwards BA, Hamilton GS, Joosten SA. Interstitial lung disease and obstructive sleep apnea. Sleep Med Rev 2021; 58:101442. [PMID: 33561604 DOI: 10.1016/j.smrv.2021.101442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/30/2020] [Accepted: 10/29/2020] [Indexed: 12/11/2022]
Abstract
Obstructive sleep apnea (OSA) is one of the most common comorbidities in patients with interstitial lung disease (ILD). Growing evidence highlights the significance of sleep disturbance on health outcomes in this population. The relationships between ILD and OSA are complex and possibly bidirectional, with multiple mechanisms postulated for the pathogenic and physiologic links. This review synthesizes current evidence and hypotheses regarding different aspects of the relationships between ILD and OSA, emphasizing the interactions between epidemiology, pathogenesis, and pathophysiology.
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Affiliation(s)
- Yet H Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg, Victoria, Australia; Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher J Ryerson
- Centre for Heart Lung Innovation, Providence Health Care, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shane A Landry
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Mark E Howard
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg, Victoria, Australia; Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Thomas J Churchward
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Bradley A Edwards
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Garun S Hamilton
- Monash Lung and Sleep, Victoria, Australia; School of Clinical Sciences, Monash University, Victoria, Australia
| | - Simon A Joosten
- Monash Lung and Sleep, Victoria, Australia; School of Clinical Sciences, Monash University, Victoria, Australia.
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Junqueira JJM, Lourenço JD, da Silva KR, Cervilha DADB, da Silveira LKR, Correia AT, Silva LEDF, Teodoro WR, Tibério IDFLC, Barbosa AP, Lopes FDTQDS. Decreased Bone Type I Collagen in the Early Stages of Chronic Obstructive Pulmonary Disease (COPD). COPD 2020; 17:575-586. [PMID: 32814449 DOI: 10.1080/15412555.2020.1808605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Smoking is the main risk factor for the development of chronic obstructive pulmonary disease (COPD) and is known to have deleterious effects on bone metabolism. However, the effects on bone collagen matrix during the development of COPD are unclear. The aim of this study was to evaluate the temporal effect of cigarette smoke exposure on bone type I collagen during COPD development in a cigarette smoke-induced model. C57BL/6 mice were allocated to three groups: control (C), animals exposed to filtered air for 1, 3 and 6 months; cigarette smoke (S), animals exposed to cigarette smoke for 1, 3 and 6 months; provisional smoking (PS), animals exposed to cigarette smoke for 3 months, followed by another 3 months of filtered air exposure. Evaluation of the respiratory mechanics and alveolar enlargement were performed. Femoral and tibial extraction was also performed to evaluate the type I collagen by immunofluorescence and COL1A1 gene expression. Exposure to cigarette smoke led to an alveolar enlargement and progressive reduction in lung tissue resistance and elastance, progressive reduction of type I collagen and reduction in COL1A1 gene expression. Although we did not observe any improvement in the functional and histological parameters in the provisional smoking group, we detected an increase in COL1A1 gene expression. A worsening in bone collagen matrix is part of the initial physiopathological events during COPD development and the smoking cessation induced an evident recovery of COL1A1 expression, possibly to attempt at tissue repair.
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Affiliation(s)
- Jader Joel Machado Junqueira
- Department of Medicine, Laboratory of Experimental Therapeutics (LIM-20), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Juliana Dias Lourenço
- Department of Medicine, Laboratory of Experimental Therapeutics (LIM-20), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Kaique Rodrigues da Silva
- Department of Medicine, Laboratory of Experimental Therapeutics (LIM-20), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Daniela Aparecida de Brito Cervilha
- Department of Medicine, Laboratory of Experimental Therapeutics (LIM-20), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Aristides Tadeu Correia
- Department of Medicine, Laboratory of Experimental Therapeutics (LIM-20), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Larissa Emidio de França Silva
- Department of Medicine, Laboratory of Experimental Therapeutics (LIM-20), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Walcy Rosolia Teodoro
- Rheumatology Division (LIM-17), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Alexandre Póvoa Barbosa
- Department of Medicine, Laboratory of Experimental Therapeutics (LIM-20), School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Toumpanakis D, Mizi E, Vassilakopoulou V, Dettoraki M, Chatzianastasiou A, Perlikos F, Giatra G, Moscholaki M, Theocharis S, Vassilakopoulos T. Spontaneous Breathing Through Increased Airway Resistance Augments Elastase-Induced Pulmonary Emphysema. Int J Chron Obstruct Pulmon Dis 2020; 15:1679-1688. [PMID: 32764913 PMCID: PMC7367735 DOI: 10.2147/copd.s256750] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/02/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Resistive breathing (RB), the pathophysiologic hallmark of chronic obstructive pulmonary disease (COPD), especially during exacerbations, is associated with significant inflammation and mechanical stress on the lung. Mechanical forces are implicated in the progression of emphysema that is a major pathologic feature of COPD. We hypothesized that resistive breathing exacerbates emphysema. Methods C57BL/6 mice were exposed to 0.75 units of pancreatic porcine elastase intratracheally to develop emphysema. Resistive breathing was applied by suturing a nylon band around the trachea to reduce surface area to half for the last 24 or 72 hours of a 21-day time period after elastase treatment in total. Following RB (24 or 72 hours), lung mechanics were measured and bronchoalveolar lavage (BAL) was performed. Emphysema was quantified by the mean linear intercept (Lm) and the destructive index (DI) in lung tissue sections. Results Following 21 days of intratracheal elastase exposure, Lm and DI increased in lung tissue sections [Lm (μm), control 39.09±0.76, elastase 62.05±2.19, p=0.003 and DI, ctr 30.95±2.75, elastase 73.12±1.75, p<0.001]. RB for 72 hours further increased Lm by 64% and DI by 19%, compared to elastase alone (p<0.001 and p=0.02, respectively). RB induced BAL neutrophilia in elastase-treated mice. Static compliance (Cst) increased in elastase-treated mice [Cst (mL/cmH2O), control 0.067±0.001, elastase 0.109±0.006, p<0.001], but superimposed RB decreased Cst, compared to elastase alone [Cst (mL/cmH2O), elastase+RB24h 0.090±0.004, p=0.006 to elastase, elastase+RB72h 0.090±0.005, p=0.006 to elastase]. Conclusion Resistive breathing augments pulmonary inflammation and emphysema in an elastase-induced emphysema mouse model.
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Affiliation(s)
- Dimitrios Toumpanakis
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece.,3rd Department of Critical Care Medicine, Evgenideio Hospital, Medical School, University of Athens, Athens, Greece
| | - Eleftheria Mizi
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece
| | - Vyronia Vassilakopoulou
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece
| | - Maria Dettoraki
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece
| | - Athanasia Chatzianastasiou
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece
| | - Fotis Perlikos
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece
| | - Georgia Giatra
- 3rd Department of Critical Care Medicine, Evgenideio Hospital, Medical School, University of Athens, Athens, Greece
| | - Marina Moscholaki
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece
| | | | - Theodoros Vassilakopoulos
- "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, Evangelismos Hospital, Athens, Greece.,3rd Department of Critical Care Medicine, Evgenideio Hospital, Medical School, University of Athens, Athens, Greece
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11
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Briskey DR, Vogel K, Johnson MA, Sharpe GR, Coombes JS, Mills DE. Inspiratory flow-resistive breathing, respiratory muscle-induced systemic oxidative stress, and diaphragm fatigue in healthy humans. J Appl Physiol (1985) 2020; 129:185-193. [PMID: 32552433 DOI: 10.1152/japplphysiol.00091.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We questioned whether the respiratory muscles of humans contribute to systemic oxidative stress following inspiratory flow-resistive breathing, whether the amount of oxidative stress is influenced by the level of resistive load, and whether the amount of oxidative stress is related to the degree of diaphragm fatigue incurred. Eight young and healthy participants attended the laboratory for four visits on separate days. During the first visit, height, body mass, lung function, and maximal inspiratory mouth and transdiaphragmatic pressure (Pdimax) were assessed. During visits 2-4, participants undertook inspiratory flow-resistive breathing with either no resistance (control) or resistive loads equivalent to 50 and 70% of their Pdimax (Pdimax50% and Pdimax70%) for 30 min. Participants undertook one resistive load per visit, and the order in which they undertook the loads was randomized. Inspiratory muscle pressures were higher (P < 0.05) during the 5th and Final min of Pdimax50% and Pdimax70% compared with control. Plasma F2-isoprostanes increased (P < 0.05) following inspiratory flow-resistive breathing at Pdimax70%. There were no increases in plasma protein carbonyls or total antioxidant capacity. Furthermore, although we evidenced small reductions in transdiapragmaic twitch pressures (PdiTW) after inspiratory flow-resistive breathing at Pdimax50% and Pdimax70%, this was not related to the increase in plasma F2-isoprostanes. Our novel data suggest that it is only when sufficiently strenuous that inspiratory flow-resistive breathing in humans elicits systemic oxidative stress evidenced by elevated plasma F2-isoprostanes, and based on our data, this is not related to a reduction in PdiTW.NEW & NOTEWORTHY We examined whether the respiratory muscles of humans contribute to systemic oxidative stress following inspiratory flow-resistive breathing, whether the amount of oxidative stress is influenced by the level of resistive load, and whether the amount of oxidative stress is related to the degree of diaphragm fatigue incurred. It is only when sufficiently strenuous that inspiratory flow-resistive breathing elevates plasma F2-isoprostanes, and our novel data show that this is not related to a reduction in transdiaphragmatic twitch pressure.
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Affiliation(s)
- David R Briskey
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia.,RDC Clinical, Brisbane, Queensland, Australia
| | - Kurt Vogel
- Respiratory and Exercise Physiology Research Group, School of Health and Wellbeing, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Michael A Johnson
- Exercise and Health Research Group, Sport, Health, and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, Nottinghamshire, United Kingdom
| | - Graham R Sharpe
- Exercise and Health Research Group, Sport, Health, and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, Nottinghamshire, United Kingdom
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Dean E Mills
- Respiratory and Exercise Physiology Research Group, School of Health and Wellbeing, University of Southern Queensland, Ipswich, Queensland, Australia.,Centre for Health, Informatics, and Economic Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
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12
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Bellani G, Grassi A, Sosio S, Gatti S, Kavanagh BP, Pesenti A, Foti G. Driving Pressure Is Associated with Outcome during Assisted Ventilation in Acute Respiratory Distress Syndrome. Anesthesiology 2020; 131:594-604. [PMID: 31335543 DOI: 10.1097/aln.0000000000002846] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC Higher driving pressure during controlled mechanical ventilation is known to be associated with increased mortality in patients with acute respiratory distress syndrome.Whereas patients with acute respiratory distress syndrome are initially managed with controlled mechanical ventilation, as they improve, they are transitioned to assisted ventilation. Whether higher driving pressure assessed during pressure support (assisted) ventilation can be reliably assessed and whether higher driving pressure is associated with worse outcomes in patients with acute respiratory distress syndrome has not been well studied. WHAT THIS ARTICLE TELLS US THAT IS NEW This study shows that in the majority of adult patients with acute respiratory distress syndrome, both driving pressure and respiratory system compliance can be reliably measured during pressure support (assisted) ventilation.Higher driving pressure measured during pressure support (assisted) ventilation significantly associates with increased intensive care unit mortality, whereas peak inspiratory pressure does not.Lower respiratory system compliance also significantly associates with increased intensive care unit mortality. BACKGROUND Driving pressure, the difference between plateau pressure and positive end-expiratory pressure (PEEP), is closely associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). Although this relationship has been demonstrated during controlled mechanical ventilation, plateau pressure is often not measured during spontaneous breathing because of concerns about validity. The objective of the present study is to verify whether driving pressure and respiratory system compliance are independently associated with increased mortality during assisted ventilation (i.e., pressure support ventilation). METHODS This is a retrospective cohort study conducted on 154 patients with ARDS in whom plateau pressure during the first three days of assisted ventilation was available. Associations between driving pressure, respiratory system compliance, and survival were assessed by univariable and multivariable analysis. In patients who underwent a computed tomography scan (n = 23) during the stage of assisted ventilation, the quantity of aerated lung was compared with respiratory system compliance measured on the same date. RESULTS In contrast to controlled mechanical ventilation, plateau pressure during assisted ventilation was higher than the sum of PEEP and pressure support (peak pressure). Driving pressure was higher (11 [9-14] vs. 10 [8-11] cm H2O; P = 0.004); compliance was lower (40 [30-50] vs. 51 [42-61] ml · cm H2O; P < 0.001); and peak pressure was similar, in nonsurvivors versus survivors. Lower respiratory system compliance (odds ratio, 0.92 [0.88-0.96]) and higher driving pressure (odds ratio, 1.34 [1.12-1.61]) were each independently associated with increased risk of death. Respiratory system compliance was correlated with the aerated lung volume (n = 23, r = 0.69, P < 0.0001). CONCLUSIONS In patients with ARDS, plateau pressure, driving pressure, and respiratory system compliance can be measured during assisted ventilation, and both higher driving pressure and lower compliance are associated with increased mortality.
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Affiliation(s)
- Giacomo Bellani
- From the Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy (G.B., A.G., S.S., S.G., G.F.) Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy (G.B., A.G., S.S., S.G., G.F.) Departments of Critical Care Medicine and Anesthesia, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (B.P.K.) Department of Anesthesia, Critical Care and Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (A.P.)
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13
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Lalgudi Ganesan S, Jayashree M, Chandra Singhi S, Bansal A. Airway Pressure Release Ventilation in Pediatric Acute Respiratory Distress Syndrome. A Randomized Controlled Trial. Am J Respir Crit Care Med 2019; 198:1199-1207. [PMID: 29641221 DOI: 10.1164/rccm.201705-0989oc] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Although case series describe benefits of airway pressure release ventilation (APRV), this mode of ventilation has not been evaluated against the conventional low-tidal volume ventilation (LoTV) in children with acute respiratory distress syndrome (ARDS). OBJECTIVES To compare the effect of APRV and conventional LoTV on ventilator-free days in children with ARDS. METHODS This open-label, parallel-design randomized controlled trial was conducted in a 15-bed ICU. Children aged 1 month to 12 years satisfying the modified Berlin definition were included. We excluded children with air leaks, increased intracranial pressure, poor spontaneous breathing efforts, chronic lung disease, and beyond 24 hours of ARDS diagnosis or 72 hours of ventilation. Children were randomized using unstratified, variable-sized block technique. A priori interim analysis was planned at 50% enrollment. All enrolled children were followed up until 180 days after enrollment or death, whichever was earlier. MEASUREMENTS AND MAIN RESULTS The trial was terminated after 50% enrollment (52 children) when analysis revealed higher mortality in the intervention arm. Ventilator-free days were statistically similar in both arms (P = 0.23). The 28-day all-cause mortality was 53.8% in APRV as compared with 26.9% among control subjects (risk ratio, 2.0; 95% confidence interval, 0.97-4.1; Fisher exact P = 0.089). The multivariate-adjusted risk ratio of death for APRV compared with LoTV was 2.02 (95% confidence interval, 0.99-4.12; P = 0.05). Higher mean airway pressures, greater spontaneous breathing, and early improvement in oxygenation were seen in the intervention arm. CONCLUSIONS APRV, as a primary ventilation strategy in children with ARDS, was associated with a trend toward higher mortality compared with the conventional LoTV. Limitations should be considered while interpreting these results. Clinical trial registered with www.clinicaltrials.gov (NCT02167698) and Clinical Trials Registry of India (CTRI/2014/06/004677).
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Affiliation(s)
- Saptharishi Lalgudi Ganesan
- 1 Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India; and
| | - Muralidharan Jayashree
- 1 Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India; and
| | - Sunit Chandra Singhi
- 1 Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India; and.,2 Division of Pediatrics, Medanta, The Medicity, Gurugram, National Capital Region, India
| | - Arun Bansal
- 1 Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India; and
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14
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Sosio S, Bellani G, Villa S, Lupieri E, Mauri T, Foti G. A Calibration Technique for the Estimation of Lung Volumes in Nonintubated Subjects by Electrical Impedance Tomography. Respiration 2019; 98:189-197. [PMID: 31195395 DOI: 10.1159/000499159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 02/26/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Electrical impedance tomography (EIT) is a bedside monitoring technique of the respiratory system that measures impedance changes within the thorax. The close correlation between variations in impedance (ΔZ) and lung volumes (Vt) is known. Unless Vt is measured by an external reference (e.g., spirometry), its absolute value (in milliliters) cannot be determined; however, measurement of Vt would be useful in nonintubated subjects. OBJECTIVE To validate a simplified and feasible calibration method of EIT, which allows estimation of Vt in nonintubated subjects. MATERIALS AND METHODS We performed a prospective study on 13 healthy volunteers. Subjects breathed 10 times in a nonexpandable "calibration balloon" with a known volume while wearing the EIT belt. The relationship between ΔZ and the balloon volume was calculated (ΔZ/Vt). Subsequently, subjects were connected to a mechanical ventilator by a mouthpiece under different settings. Vt was calculated from EIT measurements (VtEIT) by means of the ΔZ/Vt coefficient and compared with the value obtained from the ventilator (Vtflow). RESULTS There was a close correlation between Vtflow and VtEIT (r2 = 0.89). The fit equation was VtEIT = 0.9 × Vtflow +10.1. The highest correlation was found at positive endexpiratory pressure (PEEP) 0 (mean: VtEIT = 0.93 × Vtflow) versus PEEP 8 (mean: VtEIT = 0.8 × Vtflow), p = 0.01. No differences in the fit equation were found between pressure support ventilation (PSV) 0 and PSV 8, p = 0.50. Further analysis showed no statistically significant differences between sex, height, and BMI. CONCLUSION A simple and fast EIT calibration technique enables reliable, noninvasive monitoring of Vt in nonintubated subjects.
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Affiliation(s)
- Simone Sosio
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Giacomo Bellani
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy, .,Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy,
| | - Silvia Villa
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Ermes Lupieri
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care, and Emergency, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giuseppe Foti
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.,Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy
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15
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Giannakopoulou CE, Sotiriou A, Dettoraki M, Yang M, Perlikos F, Toumpanakis D, Prezerakos G, Koutsourelakis I, Kastis GA, Vassilakopoulou V, Mizi E, Papalois A, Greer JJ, Vassilakopoulos T. Regulation of breathing pattern by IL-10. Am J Physiol Regul Integr Comp Physiol 2019; 317:R190-R202. [PMID: 31091151 DOI: 10.1152/ajpregu.00065.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Proinflammatory cytokines like interleukin-1β (IL-1β) affect the control of breathing. Our aim is to determine the effect of the anti-inflammatory cytokine IL-10 οn the control of breathing. IL-10 knockout mice (IL-10-/-, n = 10) and wild-type mice (IL-10+/+, n = 10) were exposed to the following test gases: hyperoxic hypercapnia 7% CO2-93% O2, normoxic hypercapnia 7% CO2-21% O2, hypoxic hypercapnia 7% CO2-10% O2, and hypoxic normocapnia 3% CO2-10% O2. The ventilatory function was assessed using whole body plethysmography. Recombinant mouse IL-10 (rIL-10; 10 μg/kg) was administered intraperitoneally to wild-type mice (n = 10) 30 min before the onset of gas challenge. IL-10 was administered in neonatal medullary slices (10-30 ng/ml, n = 8). We found that IL-10-/- mice exhibited consistently increased frequency and reduced tidal volume compared with IL-10+/+ mice during room air breathing and in all test gases (by 23.62 to 33.2%, P < 0.05 and -36.23 to -41.69%, P < 0.05, respectively). In all inspired gases, the minute ventilation of IL-10-/- mice was lower than IL-10+/+ (by -15.67 to -22.74%, P < 0.05). The rapid shallow breathing index was higher in IL-10-/- mice compared with IL-10+/+ mice in all inspired gases (by 50.25 to 57.5%, P < 0.05). The intraperitoneal injection of rIL-10 caused reduction of the respiratory rate and augmentation of the tidal volume in room air and also in all inspired gases (by -12.22 to -29.53 and 32.18 to 45.11%, P < 0.05, respectively). IL-10 administration in neonatal rat (n = 8) in vitro rhythmically active medullary slice preparations did not affect either rhythmicity or peak amplitude of hypoglossal nerve discharge. In conclusion, IL-10 may induce a slower and deeper pattern of breathing.
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Affiliation(s)
- Charoula Eleni Giannakopoulou
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Adamantia Sotiriou
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Maria Dettoraki
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Michael Yang
- Experimental Research Center, ELPEN Pharmaceuticals, Attica, Greece
| | - Fotis Perlikos
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Dimitrios Toumpanakis
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Georgios Prezerakos
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Ioannis Koutsourelakis
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Georgios A Kastis
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Vyronia Vassilakopoulou
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | - Eleftheria Mizi
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
| | | | - John J Greer
- Department of Physiology, Neuroscience and Mental Health Institute, Women and Children's Health Research Institute, Faculty of Medicine and Dentistry, University of Alberta , Edmonton, Alberta , Canada
| | - Theodoros Vassilakopoulos
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, University of Athens Medical School , Athens , Greece
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Chiang SR, Lin CY, Chen DY, Tsai HF, Lin XC, Hsu TC, Tzang BS. The effects of human parvovirus VP1 unique region in a mouse model of allergic asthma. PLoS One 2019; 14:e0216799. [PMID: 31086415 PMCID: PMC6516678 DOI: 10.1371/journal.pone.0216799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/29/2019] [Indexed: 01/22/2023] Open
Abstract
Evidence has indicated that viral infection increases the risk of developing asthma. Although the association of human parvovirus B19 (B19V) or human bocavirus (HBoV) with respiratory diseases has been reported, little is known about the influence of the B19V-VP1u and HBoV-VP1u proteins on the symptoms of asthma. Herein, we investigated the systemic influence of subcutaneously injected B19V-VP1u and HBoV-VP1u recombinant proteins in an OVA-sensitized asthmatic mouse model. A significantly higher Penh ratio and IgE level were detected in the serum, bronchoalveolar lavage fluid (BALF) and the supernatant of a lymphocyte culture from mice treated with HBoV-VP1u or B19V-VP1u than in a lymphocyte culture from OVA-sensitized mice. Significantly higher levels of serum and BALF IgE, total IgG, IgG1, OVA-specific IgE and OVA-specific IgG1 were detected in mice treated with HBoV-VP1u or B19V-VP1u than in OVA-sensitized mice. Conversely, a significantly lower IgG2a level was detected in mice from the HBoV-VP1u or B19V-VP1u groups than in mice from the OVA group. The mice treated with HBoV-VP1u or B19V-VP1u exhibited more significant lung inflammatory indices, including elevated serum and BALF IL-4, IL-5, IL-10 and IL-13 levels; BALF lymphocyte, neutrophil and eosinophil counts, MMP-9 and MMP-2 activity; and the amount of lymphocyte infiltration, relative to those in the control mice or in those sensitized with OVA. These findings demonstrate that the subcutaneous injection of HBoV-VP1u or B19V-VP1u proteins in OVA-sensitized mice result in elevated asthmatic indices and suggest that human parvoviruses may increase the risk of developing airway inflammation in a mouse model of asthma.
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Affiliation(s)
- Shyh-Ren Chiang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan, R.O.C
- Department of General Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan, R.O.C
| | - Chia-Yun Lin
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan, R.O.C
| | - Der-Yuan Chen
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan, R.O.C
- Rheumatic Diseases Research Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, R.O.C
- School of Medicine, China Medical University, Taichung, Taiwan, R.O.C
| | - Hui-Fang Tsai
- Department of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taiwan, R.O.C
| | - Xin-Ci Lin
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan, R.O.C
| | - Tsai-Ching Hsu
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan, R.O.C
- Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan, R.O.C
- Immunology Research Center, Chung Shan Medical University, Taichung, Taiwan, R.O.C
- * E-mail: (BST); (TCH)
| | - Bor-Show Tzang
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan, R.O.C
- Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan, R.O.C
- Immunology Research Center, Chung Shan Medical University, Taichung, Taiwan, R.O.C
- Department of Biochemistry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C
- * E-mail: (BST); (TCH)
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Ito JT, Cervilha DADB, Lourenço JD, Gonçalves NG, Volpini RA, Caldini EG, Landman G, Lin CJ, Velosa APP, Teodoro WPR, Tibério IDFLC, Mauad T, Martins MDA, Macchione M, Lopes FDTQDS. Th17/Treg imbalance in COPD progression: A temporal analysis using a CS-induced model. PLoS One 2019; 14:e0209351. [PMID: 30629626 PMCID: PMC6328193 DOI: 10.1371/journal.pone.0209351] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/04/2018] [Indexed: 01/10/2023] Open
Abstract
Background The imbalance between pro- and anti-inflammatory immune responses plays a pivotal role in chronic obstructive pulmonary disease (COPD) development and progression. To clarify the pathophysiological mechanisms of this disease, we performed a temporal analysis of immune response-mediated inflammatory progression in a cigarette smoke (CS)-induced mouse model with a focus on the balance between Th17 and Treg responses. Methods C57BL/6 mice were exposed to CS for 1, 3 or 6 months to induce COPD, and the control groups were maintained under filtered air conditions for the same time intervals. We then performed functional (respiratory mechanics) and structural (alveolar enlargement) analyses. We also quantified the NF-κB, TNF-α, CD4, CD8, CD20, IL-17, IL-6, FOXP3, IL-10, or TGF-β positive cells in peribronchovascular areas and assessed FOXP3 and IL-10 expression through double-label immunofluorescence. Additionally, we evaluated the gene expression of NF-κB and TNF in bronchiolar epithelial cells. Results Our CS-induced COPD model exhibited an increased proinflammatory immune response (increased expression of the NF-κB, TNF-α, CD4, CD8, CD20, IL-17, and IL-6 markers) with a concomitantly decreased anti-inflammatory immune response (FOXP3, IL-10, and TGF-β markers) compared with the control mice. These changes in the immune responses were associated with increased alveolar enlargement and impaired lung function starting on the first month and third month of CS exposure, respectively, compared with the control mice. Conclusion Our results showed that the microenvironmental stimuli produced by the release of cytokines during COPD progression lead to a Th17/Treg imbalance.
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Affiliation(s)
- Juliana Tiyaki Ito
- Department of Clinical Medicine, Laboratory of Experimental Therapeutics, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- * E-mail:
| | | | - Juliana Dias Lourenço
- Department of Clinical Medicine, Laboratory of Experimental Therapeutics, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Natália Gomes Gonçalves
- Department of Pathology, Laboratory of Molecular Pathology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Rildo Aparecido Volpini
- Department of Clinical Medicine, Basic Research Laboratory on Kidney Diseases, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Elia Garcia Caldini
- Department of Pathology, Laboratory of Cell Biology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Gilles Landman
- Department of Pathology, Multi-purpose Laboratory of Molecular Pathology, Federal University of São Paulo, São Paulo, Brazil
| | - Chin Jia Lin
- Department of Pathology, Laboratory of Molecular Pathology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Ana Paula Pereira Velosa
- Department of Clinical Medicine, Laboratory of Extracellular Matrix, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Walcy Paganelli Rosolia Teodoro
- Department of Clinical Medicine, Laboratory of Extracellular Matrix, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Thais Mauad
- Department of Pathology, Experimental Air Pollution Laboratory, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Milton de Arruda Martins
- Department of Clinical Medicine, Laboratory of Experimental Therapeutics, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Mariangela Macchione
- Department of Pathology, Experimental Air Pollution Laboratory, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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p38 Inhibition Ameliorates Inspiratory Resistive Breathing-Induced Pulmonary Inflammation. Inflammation 2019; 41:1873-1887. [PMID: 29974374 DOI: 10.1007/s10753-018-0831-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Inspiratory resistive breathing (IRB), a hallmark of obstructive airway diseases, is associated with strenuous contractions of the inspiratory muscles and increased negative intrathoracic pressures that act as an injurious stimulus to the lung. We have shown that IRB induces pulmonary inflammation in healthy animals. p38 kinase is activated in the lung under stress. We hypothesized that p38 is activated during IRB and contributes to IRB-induced pulmonary inflammation. Anesthetized, tracheostomized rats breathed spontaneously through a two-way valve. Resistance was connected to the inspiratory port to provoke a peak tidal inspiratory pressure 50% of maximum. Following 3 and 6 h of IRB, respiratory system mechanics were measured and bronchoalveolar lavage (BAL) was performed. Phosphorylated p38, TNF-α, and MIP-2α were detected in lung tissue. Lung injury was estimated histologically. SB203580 (p38 inhibitor) was administered prior to IRB (1 mg kg-1). Six hours of IRB increased phosphorylated p38 in the lung, compared with quietly breathing controls (p = 0.001). Six hours of IRB increased the numbers of macrophages and neutrophils (p = 0.01 and p = 0.005) in BAL fluid. BAL protein levels and lung elasticity increased after both 3 and 6 h IRB. TNF-α and MIP-2α increased after 6 h of IRB (p = 0.01 and p < 0.001, respectively). Increased lung injury score was detected at 6 h IRB. SB203580 administration blocked the increase of neutrophils and macrophages at 6 h IRB (p = 0.01 and p = 0.005 to 6 h IRB) but not the increase in BAL protein and elasticity. TNF-α, MIP-2α, and injury score at 6 h IRB returned to control. p38 activation contributes to IRB-induced pulmonary inflammation.
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Glynos C, Bibli SI, Katsaounou P, Pavlidou A, Magkou C, Karavana V, Topouzis S, Kalomenidis I, Zakynthinos S, Papapetropoulos A. Comparison of the effects of e-cigarette vapor with cigarette smoke on lung function and inflammation in mice. Am J Physiol Lung Cell Mol Physiol 2018; 315:L662-L672. [PMID: 30091379 DOI: 10.1152/ajplung.00389.2017] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Electronic cigarettes (e-cigs) are advertised as a less harmful nicotine delivery system or as a new smoking cessation tool. We aimed to assess the in vivo effects of e-cig vapor in the lung and to compare them to those of cigarette smoke (CS). We exposed C57BL/6 mice for either 3 days or 4 wk to ambient air, CS, or e-cig vapor containing 1) propylene glycol/vegetable glycerol (PG:VG-Sol; 1:1), 2) PG:VG with nicotine (G:VG-N), or 3) PG:VG with nicotine and flavor (PG:VG-N+F) and determined oxidative stress, inflammation, and pulmonary mechanics. E-cig vapors, especially PG:VG-N+F, increased bronchoalveolar lavage fluid (BALF) cellularity, Muc5ac production, as well as BALF and lung oxidative stress markers at least comparably and in many cases more than CS. BALF protein content at both time points studied was only elevated in the PG:VG-N+F group. After 3 days, PG:VG-Sol altered tissue elasticity, static compliance, and airway resistance, whereas after 4 wk CS was the only treatment adversely affecting these parameters. Airway hyperresponsiveness in response to methacholine was increased similarly in the CS and PG:VG-N+F groups. Our findings suggest that exposure to e-cig vapor can trigger inflammatory responses and adversely affect respiratory system mechanics. In many cases, the added flavor in e-cigs exacerbated the detrimental effects of e-cig vapor. We conclude that both e-cig vaping and conventional cigarette smoking negatively impact lung biology.
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Affiliation(s)
- Constantinos Glynos
- George P. Livanos and Marianthi Simou Laboratories, Evangelismos Hospital, 1st Department of Pulmonary and Critical Care, National and Kapodistrian University of Athens Medical School , Greece
| | - Sofia-Iris Bibli
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens , Athens , Greece.,Institute for Vascular Signaling, Centre for Molecular Medicine, Goethe University , Frankfurt am Main , Germany
| | - Paraskevi Katsaounou
- George P. Livanos and Marianthi Simou Laboratories, Evangelismos Hospital, 1st Department of Pulmonary and Critical Care, National and Kapodistrian University of Athens Medical School , Greece
| | - Athanasia Pavlidou
- George P. Livanos and Marianthi Simou Laboratories, Evangelismos Hospital, 1st Department of Pulmonary and Critical Care, National and Kapodistrian University of Athens Medical School , Greece.,Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens , Athens , Greece
| | - Christina Magkou
- Department of Histopathology, Evangelismos Hospital , Athens , Greece
| | - Vassiliki Karavana
- George P. Livanos and Marianthi Simou Laboratories, Evangelismos Hospital, 1st Department of Pulmonary and Critical Care, National and Kapodistrian University of Athens Medical School , Greece
| | - Stavros Topouzis
- Laboratory of Molecular Pharmacology, Department of Pharmacy, University of Patras , Patras , Greece
| | - Ioannis Kalomenidis
- George P. Livanos and Marianthi Simou Laboratories, Evangelismos Hospital, 1st Department of Pulmonary and Critical Care, National and Kapodistrian University of Athens Medical School , Greece
| | - Spyros Zakynthinos
- George P. Livanos and Marianthi Simou Laboratories, Evangelismos Hospital, 1st Department of Pulmonary and Critical Care, National and Kapodistrian University of Athens Medical School , Greece
| | - Andreas Papapetropoulos
- George P. Livanos and Marianthi Simou Laboratories, Evangelismos Hospital, 1st Department of Pulmonary and Critical Care, National and Kapodistrian University of Athens Medical School , Greece.,Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens , Athens , Greece
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Obstructive Sleep Apnea and Subclinical Interstitial Lung Disease in the Multi-Ethnic Study of Atherosclerosis (MESA). Ann Am Thorac Soc 2018; 14:1786-1795. [PMID: 28613935 DOI: 10.1513/annalsats.201701-091oc] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Obstructive sleep apnea (OSA) has been postulated to contribute to idiopathic pulmonary fibrosis by promoting alveolar epithelial injury via tractional forces and intermittent hypoxia. OBJECTIVES To determine whether OSA is associated with subclinical interstitial lung disease (ILD) and with biomarkers of alveolar epithelial injury and remodeling. METHODS We performed cross-sectional analyses of 1,690 community-dwelling adults who underwent 15-channel in-home polysomnography and thoracic computed tomographic imaging in the Multi-Ethnic Study of Atherosclerosis. We measured the obstructive apnea-hypopnea index (oAHI) by polysomnography and high-attenuation areas (HAAs) and interstitial lung abnormalities (ILAs) by computed tomography. Serum matrix metalloproteinase-7 (MMP-7) and surfactant protein-A (SP-A) were measured by ELISA in 99 participants. We used generalized linear models to adjust for potential confounders. RESULTS The mean age was 68 years, and the mean forced vital capacity was 97% predicted. The median oAHI was 8.4 events/h, and 32% had an oAHI greater than 15. After adjusting for demographics, smoking, and center, an oAHI greater than 15 was associated with a 4.0% HAA increment (95% confidence interval [CI], 1.4-6.8%; P = 0.003) and 35% increased odds of ILA (95% CI, 13-61%; P = 0.001). However, there was evidence that these associations varied by body mass index (BMI) (P for interaction = 0.08 and 0.04, respectively). Among those with a BMI less than 25 kg/m2, an oAHI greater than 15 was associated with a 6.1% HAA increment (95% CI, 0.5-12%; P = 0.03) and 2.3-fold increased odds of ILA (95% CI, 1.3-4.1; P = 0.005). Among those with a BMI greater than 30 kg/m2, an oAHI greater than 15 was associated with 1.8-fold greater odds of ILA (95% CI, 1.1-2.9; P = 0.01) but was not associated with HAA. There were no meaningful associations detected among those with a BMI of 25-30 kg/m2. Greater oAHI was associated higher serum SP-A and MMP-7 levels, particularly among those with a BMI less than 25 kg/m2. CONCLUSIONS Moderate to severe OSA is associated with subclinical ILD and with evidence of alveolar epithelial injury and extracellular matrix remodeling in community-dwelling adults, an association that is strongest among normal-weight individuals. These findings support the hypothesis that OSA might contribute to early ILD.
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Petitjeans F, Leroy S, Pichot C, Geloen A, Ghignone M, Quintin L. Hypothesis: Fever control, a niche for alpha-2 agonists in the setting of septic shock and severe acute respiratory distress syndrome? Temperature (Austin) 2018; 5:224-256. [PMID: 30393754 PMCID: PMC6209424 DOI: 10.1080/23328940.2018.1453771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 03/11/2018] [Indexed: 12/12/2022] Open
Abstract
During severe septic shock and/or severe acute respiratory distress syndrome (ARDS) patients present with a limited cardio-ventilatory reserve (low cardiac output and blood pressure, low mixed venous saturation, increased lactate, low PaO2/FiO2 ratio, etc.), especially when elderly patients or co-morbidities are considered. Rescue therapies (low dose steroids, adding vasopressin to noradrenaline, proning, almitrine, NO, extracorporeal membrane oxygenation, etc.) are complex. Fever, above 38.5-39.5°C, increases both the ventilatory (high respiratory drive: large tidal volume, high respiratory rate) and the metabolic (increased O2 consumption) demands, further limiting the cardio-ventilatory reserve. Some data (case reports, uncontrolled trial, small randomized prospective trials) suggest that control of elevated body temperature ("fever control") leading to normothermia (35.5-37°C) will lower both the ventilatory and metabolic demands: fever control should simplify critical care management when limited cardio-ventilatory reserve is at stake. Usually fever control is generated by a combination of general anesthesia ("analgo-sedation", light total intravenous anesthesia), antipyretics and cooling. However general anesthesia suppresses spontaneous ventilation, making the management more complex. At variance, alpha-2 agonists (clonidine, dexmedetomidine) administered immediately following tracheal intubation and controlled mandatory ventilation, with prior optimization of volemia and atrio-ventricular conduction, will reduce metabolic demand and facilitate normothermia. Furthermore, after a rigorous control of systemic acidosis, alpha-2 agonists will allow for accelerated emergence without delirium, early spontaneous ventilation, improved cardiac output and micro-circulation, lowered vasopressor requirements and inflammation. Rigorous prospective randomized trials are needed in subsets of patients with a high fever and spiraling toward refractory septic shock and/or presenting with severe ARDS.
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Affiliation(s)
- F. Petitjeans
- Critical Care, Hôpital d'Instruction des Armées Desgenettes, Lyon, France
| | - S. Leroy
- Pediatric Emergency Medicine, Hôpital Avicenne, Paris-Bobigny, France
| | - C. Pichot
- Critical Care, Hôpital d'Instruction des Armées Desgenettes, Lyon, France
| | - A. Geloen
- Physiology, INSA de Lyon (CARMeN, INSERM U 1060), Lyon-Villeurbanne, France
| | - M. Ghignone
- Critical Care, JF Kennedy Hospital North Campus, WPalm Beach, Fl, USA
| | - L. Quintin
- Critical Care, Hôpital d'Instruction des Armées Desgenettes, Lyon, France
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Crotti S, Bottino N, Spinelli E. Spontaneous breathing during veno-venous extracorporeal membrane oxygenation. J Thorac Dis 2018; 10:S661-S669. [PMID: 29732184 DOI: 10.21037/jtd.2017.10.27] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Veno-venous extracorporeal membrane oxygenation (VV ECMO) has started to be applied in awake spontaneously breathing patients as an alternative to invasive mechanical ventilation. As the physiologic cardiorespiratory variability is increased in this condition, the dynamic interaction between patient respiratory activity and extracorporeal system function affects the clinical management. The effect of extracorporeal CO2 removal on patient respiratory drive is variable and not always predictable, with some patients responding to CO2 removal with a decrease in respiratory rate and effort and other patients demonstrating a persistently high work of breathing independent on CO2 unload. While the pathophysiological mechanisms of this different interactions are still to be clarified, improved monitoring ability is needed both to titrate the support in responders and to avoid the risk of ventilation injury in non-responders. Acute changes in patient respiratory patterns may also occur during spontaneous breathing, making it difficult to maintain constant levels of extracorporeal respiratory support, also because changes in the distribution of venous blood volume due to lung-heart interactions affect extracorporeal blood flow. Assessment of native lung function and of its evolution over time is challenging while respiratory gas exchanges are provided by the extracorporeal system, since both oxygenation and decarboxylation capabilities can be fully evaluated only when alveolar ventilation is restored reducing extracorporeal CO2 removal. The rationale for using "awake ECMO" varies across different types of acute respiratory failure: the pathophysiological mechanisms of the underlying disease affect the patient-ECMO interaction and the goal of support. In this review we discuss the pathophysiology, technical challenges and monitoring issues of the use of ECMO in awake spontaneously breathing patients with acute respiratory failure of different etiologies.
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Affiliation(s)
- Stefania Crotti
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Bottino
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Spinelli
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Asimakos A, Toumpanakis D, Karatza MH, Vasileiou S, Katsaounou P, Mastora Z, Vassilakopoulos T. Immune cell response to strenuous resistive breathing: comparison with whole body exercise and the effects of antioxidants. Int J Chron Obstruct Pulmon Dis 2018; 13:529-545. [PMID: 29445271 PMCID: PMC5808692 DOI: 10.2147/copd.s154533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background/hypothesis Whole body exercise (WBE) changes lymphocyte subset percentages in peripheral blood. Resistive breathing, a hallmark of diseases of airway obstruction, is a form of exercise for the inspiratory muscles. Strenuous muscle contractions induce oxidative stress that may mediate immune alterations following exercise. We hypothesized that inspiratory resistive breathing (IRB) alters peripheral blood lymphocyte subsets and that oxidative stress mediates lymphocyte subpopulation alterations following both WBE and IRB. Patients and methods Six healthy nonathletes performed two WBE and two IRB sessions for 45 minutes at 70% of VO2 maximum and 70% of maximum inspiratory pressure (Pimax), respectively, before and after the administration of antioxidants (vitamins E, A, and C for 75 days, allopurinol for 30 days, and N-acetylcysteine for 3 days). Blood was drawn at baseline, at the end of each session, and 2 hours into recovery. Lymphocyte subsets were determined by flow cytometry. Results Before antioxidant supplementation at both WBE end and IRB end, the natural killer cell percentage increased, the T helper cell (CD3+ CD4+) percentage was reduced, and the CD4/CD8 ratio was depressed, a response which was abolished by antioxidants only after IRB. Furthermore, at IRB end, antioxidants promoted CD8+ CD38+ and blunted cytotoxic T-cell percentage increase. CD8+ CD45RA+ cell percentage changes were blunted after antioxidant supplementation in both WBE and IRB. Conclusion We conclude that IRB produces (as WBE) changes in peripheral blood lymphocyte subsets and that oxidative stress is a major stimulus predominantly for IRB-induced lymphocyte subset alterations.
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Affiliation(s)
- Andreas Asimakos
- GP Livanos and M Simou Laboratories, Thorax Foundation.,Critical Care Department and Pulmonary Unit, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens
| | - Dimitrios Toumpanakis
- GP Livanos and M Simou Laboratories, Thorax Foundation.,Critical Care Department and Pulmonary Unit, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens
| | | | | | - Paraskevi Katsaounou
- GP Livanos and M Simou Laboratories, Thorax Foundation.,Critical Care Department and Pulmonary Unit, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens
| | - Zafeiria Mastora
- GP Livanos and M Simou Laboratories, Thorax Foundation.,Critical Care Department and Pulmonary Unit, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens
| | - Theodoros Vassilakopoulos
- GP Livanos and M Simou Laboratories, Thorax Foundation.,Critical Care Department and Pulmonary Unit, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens.,3rd Department of Critical Care Medicine, Evgenideion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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24
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Toumpanakis D, Vassilakopoulou V, Sigala I, Zacharatos P, Vraila I, Karavana V, Theocharis S, Vassilakopoulos T. The role of Src & ERK1/2 kinases in inspiratory resistive breathing induced acute lung injury and inflammation. Respir Res 2017; 18:209. [PMID: 29237457 PMCID: PMC5729404 DOI: 10.1186/s12931-017-0694-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/05/2017] [Indexed: 01/08/2023] Open
Abstract
Background Inspiratory resistive breathing (IRB), a hallmark of obstructive airway diseases, is associated with large negative intrathoracic pressures, due to strenuous contractions of the inspiratory muscles. IRB is shown to induce lung injury in previously healthy animals. Src is a multifunctional kinase that is activated in the lung by mechanical stress. ERK1/2 kinase is a downstream target of Src. We hypothesized that Src is activated in the lung during IRB, mediates ERK1/2 activation and IRB-induced lung injury. Methods Anaesthetized, tracheostomized adult rats breathed spontaneously through a 2-way non-rebreathing valve. Resistance was added to the inspiratory port to provide a peak tidal inspiratory pressure of 50% of maximum (inspiratory resistive breathing). Activation of Src and ERK1/2 in the lung was estimated during IRB. Following 6 h of IRB, respiratory system mechanics were measured by the forced oscillation technique and bronchoalveolar lavage (BAL) was performed to measure total and differential cell count and total protein levels. IL-1b and MIP-2a protein levels were measured in lung tissue samples. Wet lung weight to total body weight was measured and Evans blue dye extravasation was estimated to measure lung permeability. Lung injury was evaluated by histology. The Src inhibitor, PP-2 or the inhibitor of ERK1/2 activation, PD98059 was administrated 30 min prior to IRB. Results Src kinase was activated 30 min after the initiation of IRB. Src inhibition ameliorated the increase in BAL cellularity after 6 h IRB, but not the increase of IL-1β and MIP-2a in the lung. The increase in BAL total protein and lung injury score were not affected. The increase in tissue elasticity was partly inhibited. Src inhibition blocked ERK1/2 activation at 3 but not at 6 h of IRB. ERK1/2 inhibition ameliorated the increase in BAL cellularity after 6 h of IRB, blocked the increase of IL-1β and returned Evans blue extravasation and wet lung weight to control values. BAL total protein and the increase in elasticity were partially affected. ERK1/2 inhibition did not significantly change total lung injury score compared to 6 h IRB. Conclusions Src and ERK1/2 are activated in the lung following IRB and participate in IRB-induced lung injury.
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Affiliation(s)
- Dimitrios Toumpanakis
- 1st Department of Critical Care and Pulmonary Medicine and "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, 45-47 Ispilandou str, 10676, Athens, Greece
| | - Vyronia Vassilakopoulou
- 1st Department of Critical Care and Pulmonary Medicine and "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, 45-47 Ispilandou str, 10676, Athens, Greece
| | - Ioanna Sigala
- 1st Department of Critical Care and Pulmonary Medicine and "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, 45-47 Ispilandou str, 10676, Athens, Greece
| | - Panagiotis Zacharatos
- 1st Department of Critical Care and Pulmonary Medicine and "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, 45-47 Ispilandou str, 10676, Athens, Greece
| | - Ioanna Vraila
- 1st Department of Critical Care and Pulmonary Medicine and "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, 45-47 Ispilandou str, 10676, Athens, Greece
| | - Vassiliki Karavana
- 1st Department of Critical Care and Pulmonary Medicine and "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, 45-47 Ispilandou str, 10676, Athens, Greece
| | | | - Theodoros Vassilakopoulos
- 1st Department of Critical Care and Pulmonary Medicine and "Marianthi Simou" Applied Biomedical Research and Training Center, Medical School, University of Athens, 45-47 Ispilandou str, 10676, Athens, Greece.
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Mehani SHM. Immunomodulatory effects of two different physical therapy modalities in patients with chronic obstructive pulmonary disease. J Phys Ther Sci 2017; 29:1527-1533. [PMID: 28931981 PMCID: PMC5599814 DOI: 10.1589/jpts.29.1527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/05/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Counteracting the systemic cytokine release and its inflammatory effects by
improving respiratory muscle strength and controlling lung inflammation may be important
for improving immune system in patients with chronic obstructive pulmonary disease, So the
aim of the present study was to evaluate the effect of low level laser therapy and
inspiratory muscle training on interleukin-6 (IL-6) as a marker of inflammation and
CD4+/CD8+ ratio as a marker for T Lymphocytes in these patients. [Subjects and Methods]
Forty male patients with stable COPD participated in the study, their ages ranged between
55−65 years. They were randomly divided into group (A) who received inspiratory muscle
training and group (B) who received low level laser (LLL) acupuncture stimulation for
about 8 week. [Results] There was a reduction in the concentration of plasma IL-6
associated with an increase in CD4+/CD8+ ratio in both groups, but laser was superior to
inspiratory muscle training. IL-6 and CD4+/CD8+ were negatively correlated. [Conclusion]
Both inspiratory muscle training and low level laser therapy are effective physical
therapy modalities in promoting immune disturbances. The results also supported the
superior role of LLLT over IMT in managing immune disturbances.
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Affiliation(s)
- Sherin Hassan M Mehani
- Department of Physical Therapy for Internal Medicine, Faculty of Physical Therapy, Beni-Suef University: Benisuef Elgadata, Street no.18, Benisuef governorate, Egypt
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Brochard L, Slutsky A, Pesenti A. Mechanical Ventilation to Minimize Progression of Lung Injury in Acute Respiratory Failure. Am J Respir Crit Care Med 2017; 195:438-442. [PMID: 27626833 DOI: 10.1164/rccm.201605-1081cp] [Citation(s) in RCA: 685] [Impact Index Per Article: 97.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Mechanical ventilation is used to sustain life in patients with acute respiratory failure. A major concern in mechanically ventilated patients is the risk of ventilator-induced lung injury, which is partially prevented by lung-protective ventilation. Spontaneously breathing, nonintubated patients with acute respiratory failure may have a high respiratory drive and breathe with large tidal volumes and potentially injurious transpulmonary pressure swings. In patients with existing lung injury, regional forces generated by the respiratory muscles may lead to injurious effects on a regional level. In addition, the increase in transmural pulmonary vascular pressure swings caused by inspiratory effort may worsen vascular leakage. Recent data suggest that these patients may develop lung injury that is similar to the ventilator-induced lung injury observed in mechanically ventilated patients. As such, we argue that application of a lung-protective ventilation, today best applied with sedation and endotracheal intubation, might be considered a prophylactic therapy, rather than just a supportive therapy, to minimize the progression of lung injury from a form of patient self-inflicted lung injury. This has important implications for the management of these patients.
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Affiliation(s)
- Laurent Brochard
- 1 Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada.,2 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arthur Slutsky
- 1 Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada.,2 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Pesenti
- 3 Department of Anesthesia, Critical Care, and Emergency, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; and.,4 Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milan, Milan, Italy
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27
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Toumpanakis D, Loverdos K, Tzouda V, Vassilakopoulou V, Litsiou E, Magkou C, Karavana V, Pieper M, Vassilakopoulos T. Tiotropium bromide exerts anti-inflammatory effects during resistive breathing, an experimental model of severe airway obstruction. Int J Chron Obstruct Pulmon Dis 2017; 12:2207-2220. [PMID: 28814849 PMCID: PMC5546183 DOI: 10.2147/copd.s137587] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Resistive breathing (RB), a hallmark of obstructive airway diseases, is characterized by strenuous contractions of the inspiratory muscles that impose increased mechanical stress on the lung. RB is shown to induce pulmonary inflammation in previous healthy animals. Tiotropium bromide, an anticholinergic bronchodilator, is also shown to exert anti-inflammatory effects. The effect of tiotropium on RB-induced pulmonary inflammation is unknown. Methods Adult rats were anesthetized, tracheostomized and breathed spontaneously through a two-way non-rebreathing valve. Resistances were connected to the inspiratory and/or expiratory port, to produce inspiratory resistive breathing (IRB) of 40% or 50% Pi/Pi,max (40% and 50% IRB), expiratory resistive breathing (ERB) of 60% Pe/Pe,max (60% ERB) or combined resistive breathing (CRB) of both 40% Pi/Pi,max and 60% Pe/Pe,max (40%/60% CRB). Tiotropium aerosol was inhaled prior to RB. After 6 h of RB, mechanical parameters of the respiratory system were measured and bronchoalveolar lavage (BAL) was performed. IL-1β and IL-6 protein levels were measured in lung tissue. Lung injury was estimated histologically. Results In all, 40% and 50% IRB increased macrophage and neutrophil counts in BAL and raised IL-1β and IL-6 lung levels, tissue elasticity, BAL total protein levels and lung injury score. Tiotropium attenuated BAL neutrophil number, IL-1β, IL-6 levels and lung injury score increase at both 40% and 50% IRB. The increase in macrophage count and protein in BAL was only reversed at 40% IRB, while tissue elasticity was not affected. In all, 60% ERB raised BAL neutrophil count and total protein and reduced macrophage count. IL-1β and IL-6 levels and lung injury score were increased. Tiotropium attenuated these alterations, except for the decrease in macrophage count and the increase in total protein level. In all, 40%/60% CRB increased macrophage and neutrophil count in BAL, IL-1β and IL-6 levels, tissue elasticity, total protein in BAL and histological injury score. Tiotropium attenuated the aforementioned alterations. Conclusion Tiotropium inhalation attenuates RB-induced pulmonary inflammation.
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Affiliation(s)
- Dimitrios Toumpanakis
- First Critical Care Department, Pulmonary Unit, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital.,George P. Livanos and Marianthi Simou Laboratories, Thorax Foundation
| | - Konstantinos Loverdos
- First Critical Care Department, Pulmonary Unit, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital.,George P. Livanos and Marianthi Simou Laboratories, Thorax Foundation
| | - Vassiliki Tzouda
- First Critical Care Department, Pulmonary Unit, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital.,George P. Livanos and Marianthi Simou Laboratories, Thorax Foundation
| | - Vyronia Vassilakopoulou
- First Critical Care Department, Pulmonary Unit, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital.,George P. Livanos and Marianthi Simou Laboratories, Thorax Foundation
| | - Eleni Litsiou
- First Critical Care Department, Pulmonary Unit, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital.,George P. Livanos and Marianthi Simou Laboratories, Thorax Foundation
| | - Christina Magkou
- Department of Pathology, Evangelismos General Hospital, Athens, Greece
| | - Vassiliki Karavana
- First Critical Care Department, Pulmonary Unit, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital.,George P. Livanos and Marianthi Simou Laboratories, Thorax Foundation
| | - Michael Pieper
- Boehringer Ingelheim Pharma GmbH & Co. KG Div. Research Germany, Biberach, Germany
| | - Theodoros Vassilakopoulos
- First Critical Care Department, Pulmonary Unit, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital.,George P. Livanos and Marianthi Simou Laboratories, Thorax Foundation
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Spontaneous Breathing during Extracorporeal Membrane Oxygenation in Acute Respiratory Failure. Anesthesiology 2017; 126:678-687. [PMID: 28212205 DOI: 10.1097/aln.0000000000001546] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND We evaluate the clinical feasibility of spontaneous breathing on extracorporeal membrane oxygenation and the interactions between artificial and native lungs in patients bridged to lung transplant or with acute exacerbation of chronic obstructive pulmonary disease (COPD) or acute respiratory distress syndrome. METHODS The clinical course of a total of 48 patients was analyzed. Twenty-three of 48 patients were enrolled in the prospective study (nine bridged to lung transplant, six COPD, and eight acute respiratory distress syndrome). The response to the carbon dioxide removal was evaluated in terms of respiratory rate and esophageal pressure swings by increasing ("relief" threshold) and decreasing ("distress" threshold) the extracorporeal membrane oxygenation gas flow, starting from baseline condition. RESULTS Considering all 48 patients, spontaneous breathing extracorporeal membrane oxygenation was performed in 100% bridge to lung transplant (9 of 9 extubated), 86% COPD (5 of 6 extubated), but 27% acute respiratory distress syndrome patients (6 of 8 extubated; P < 0.001) and was maintained for 92, 69, and 38% of the extracorporeal membrane oxygenation days (P = 0.021), respectively. In all the 23 patients enrolled in the study, gas flow increase (from 2.3 ± 2.2 to 9.2 ± 3.2 l/min) determined a decrease of both respiratory rate (from 29 ± 6 to 8 ± 9 breaths/min) and esophageal pressure swings (from 20 ± 9 to 4 ± 4 cm H2O; P < 0.001 for all). All COPD and bridge to lung transplant patients were responders (reached the relief threshold), while 50% of acute respiratory distress syndrome patients were nonresponders. CONCLUSIONS Carbon dioxide removal through extracorporeal membrane oxygenation relieves work of breathing and permits extubation in many patients, mainly bridge to lung transplant and COPD. Only few patients with acute respiratory distress syndrome were able to perform the spontaneous breathing trial, and in about 50% of these, removal of large amount of patient's carbon dioxide production was not sufficient to prevent potentially harmful spontaneous respiratory effort.
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Abstract
Although the lungs are a critical component of exercise performance, their response to exercise and other environmental stresses is often overlooked when evaluating pulmonary performance during high workloads. Exercise can produce capillary leakage, particularly when left atrial pressure increases related to left ventricular (LV) systolic or diastolic failure. Diastolic LV dysfunction that results in elevated left atrial pressure during exercise is particularly likely to result in pulmonary edema and capillary hemorrhage. Data from race horses, endurance athletes, and triathletes support the concept that the lungs can react to exercise and immersion stress with pulmonary edema and pulmonary hemorrhage. Immersion in water by swimmers and divers can also increase stress on pulmonary capillaries and result in pulmonary edema. Swimming-induced pulmonary edema and immersion pulmonary edema in scuba divers are well-documented events caused by the fluid shifts that occur with immersion, elevated pulmonary venous pressure during extreme exercise, and negative alveolar pressure due to inhalation resistance. Prevention strategies include avoiding extreme exercise, avoiding over hydration, and assuring that inspiratory resistance is minimized.
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Affiliation(s)
- Alfred A Bove
- Temple University School of Medicine, Philadelphia, Pennsylvania
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30
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Knudsen L, Ruppert C, Ochs M. Tissue remodelling in pulmonary fibrosis. Cell Tissue Res 2016; 367:607-626. [PMID: 27981380 DOI: 10.1007/s00441-016-2543-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/19/2016] [Indexed: 12/16/2022]
Abstract
Many lung diseases result in fibrotic remodelling. Fibrotic lung disorders can be divided into diseases with known and unknown aetiology. Among those with unknown aetiology, idiopathic pulmonary fibrosis (IPF) is a common diagnosis. Because of its progressive character leading to a rapid decline in lung function, it is a fatal disease with poor prognosis and limited therapeutic options. Thus, IPF has motivated many studies in the last few decades in order to increase our mechanistic understanding of the pathogenesis of the disease. The current concept suggests an ongoing injury of the alveolar epithelium, an impaired regeneration capacity, alveolar collapse and, finally, a fibroproliferative response. The origin of lung injury remains elusive but a diversity of factors, which will be discussed in this article, has been shown to be associated with IPF. Alveolar epithelial type II (AE2) cells play a key role in lung fibrosis and their crucial role for epithelial regeneration, stabilisation of alveoli and interaction with fibroblasts, all known to be responsible for collagen deposition, will be illustrated. Whereas mechanisms of collagen deposition and fibroproliferation are the focus of many studies in the field, the awareness of other mechanisms in this disease is currently limited to biochemical and imaging studies including quantitative assessments of lung structure in IPF and animal models assigning alveolar collapse and collapse induration crucial roles for the degradation of the lung resulting in de-aeration and loss of surface area. Dysfunctional AE2 cells, instable alveoli and mechanical stress trigger remodelling that consists of collapsed alveoli absorbed by fibrotic tissue (i.e., collapse induration).
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Affiliation(s)
- Lars Knudsen
- Institute of Functional and Applied Anatomy, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany. .,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany. .,REBIRTH, Cluster of Excellence, Hannover Medical School, Hannover, Germany.
| | - Clemens Ruppert
- Department of Internal Medicine, Justus-Liebig-University Giessen, Giessen, Germany.,Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Universities of Giessen and Marburg, Giessen, Germany
| | - Matthias Ochs
- Institute of Functional and Applied Anatomy, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany.,REBIRTH, Cluster of Excellence, Hannover Medical School, Hannover, Germany
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31
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Vassilakopoulos T, Toumpanakis D. Can resistive breathing injure the lung? Implications for COPD exacerbations. Int J Chron Obstruct Pulmon Dis 2016; 11:2377-2384. [PMID: 27713628 PMCID: PMC5044984 DOI: 10.2147/copd.s113877] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In obstructive lung diseases, airway inflammation leads to bronchospasm and thus resistive breathing, especially during exacerbations. This commentary discusses experimental evidence that resistive breathing per se (the mechanical stimulus) in the absence of underlying airway inflammation leads to lung injury and inflammation (mechanotransduction). The potential implications of resistive breathing-induced mechanotrasduction in COPD exacerbations are presented along with the available clinical evidence.
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Affiliation(s)
- Theodoros Vassilakopoulos
- Pulmonary and Critical Care Medicine, Medical School, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Toumpanakis
- Pulmonary and Critical Care Medicine, Medical School, National and Kapodistrian University of Athens, Greece
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Loverdos K, Toumpanakis D, Litsiou E, Karavana V, Glynos C, Magkou C, Theocharis S, Vassilakopoulos T. The differential effects of inspiratory, expiratory, and combined resistive breathing on healthy lung. Int J Chron Obstruct Pulmon Dis 2016; 11:1623-38. [PMID: 27499619 PMCID: PMC4959591 DOI: 10.2147/copd.s106337] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Combined resistive breathing (CRB) is the hallmark of obstructive airway disease pathophysiology. We have previously shown that severe inspiratory resistive breathing (IRB) induces acute lung injury in healthy rats. The role of expiratory resistance is unknown. The possibility of a load-dependent type of resistive breathing-induced lung injury also remains elusive. Our aim was to investigate the differential effects of IRB, expiratory resistive breathing (ERB), and CRB on healthy rat lung and establish the lowest loads required to induce injury. Anesthetized tracheostomized rats breathed through a two-way valve. Varying resistances were connected to the inspiratory, expiratory, or both ports, so that the peak inspiratory pressure (IRB) was 20%-40% or peak expiratory (ERB) was 40%-70% of maximum. CRB was assessed in inspiratory/expiratory pressures of 30%/50%, 40%/50%, and 40%/60% of maximum. Quietly breathing animals served as controls. At 6 hours, respiratory system mechanics were measured, and bronchoalveolar lavage was performed for measurement of cell and protein concentration. Lung tissue interleukin-6 and interleukin-1β levels were estimated, and a lung injury histological score was determined. ERB produced significant, load-independent neutrophilia, without mechanical or permeability derangements. IRB 30% was the lowest inspiratory load that provoked lung injury. CRB increased tissue elasticity, bronchoalveolar lavage total cell, macrophage and neutrophil counts, protein and cytokine levels, and lung injury score in a dose-dependent manner. In conclusion, CRB load dependently deranges mechanics, increases permeability, and induces inflammation in healthy rats. ERB is a putative inflammatory stimulus for the lung.
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Affiliation(s)
- Konstantinos Loverdos
- Department of Critical Care, Pulmonary Unit and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos General Hospital, University of Athens Medical School
| | - Dimitrios Toumpanakis
- Department of Critical Care, Pulmonary Unit and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos General Hospital, University of Athens Medical School
| | - Eleni Litsiou
- Department of Critical Care, Pulmonary Unit and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos General Hospital, University of Athens Medical School
| | - Vassiliki Karavana
- Department of Critical Care, Pulmonary Unit and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos General Hospital, University of Athens Medical School
| | - Constantinos Glynos
- Department of Critical Care, Pulmonary Unit and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos General Hospital, University of Athens Medical School
| | | | - Stamatios Theocharis
- 1st Department of Pathology, University of Athens Medical School, Athens, Greece
| | - Theodoros Vassilakopoulos
- Department of Critical Care, Pulmonary Unit and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos General Hospital, University of Athens Medical School
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Langer T, Santini A, Bottino N, Crotti S, Batchinsky AI, Pesenti A, Gattinoni L. "Awake" extracorporeal membrane oxygenation (ECMO): pathophysiology, technical considerations, and clinical pioneering. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:150. [PMID: 27357690 PMCID: PMC4928342 DOI: 10.1186/s13054-016-1329-y] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/27/2016] [Indexed: 12/14/2022]
Abstract
Venovenous extracorporeal membrane oxygenation (vv-ECMO) has been classically employed as a rescue therapy for patients with respiratory failure not treatable with conventional mechanical ventilation alone. In recent years, however, the timing of ECMO initiation has been readdressed and ECMO is often started earlier in the time course of respiratory failure. Furthermore, some centers are starting to use ECMO as a first line of treatment, i.e., as an alternative to invasive mechanical ventilation in awake, non-intubated, spontaneously breathing patients with respiratory failure ("awake" ECMO). There is a strong rationale for this type of respiratory support as it avoids several side effects related to sedation, intubation, and mechanical ventilation. However, the complexity of the patient-ECMO interactions, the difficulties related to respiratory monitoring, and the management of an awake patient on extracorporeal support together pose a major challenge for the intensive care unit staff. Here, we review the use of vv-ECMO in awake, spontaneously breathing patients with respiratory failure, highlighting the pros and cons of this approach, analyzing the pathophysiology of patient-ECMO interactions, detailing some of the technical aspects, and summarizing the initial clinical experience gained over the past years.
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Affiliation(s)
- Thomas Langer
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
| | - Alessandro Santini
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Nicola Bottino
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Stefania Crotti
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Andriy I Batchinsky
- The Geneva Foundation, Tacoma, WA, USA.,Multi Organ Support and Preservation Task Area, U.S. Army Institute of Surgical Research (USAISR), Ft. Sam Houston, Texas, USA
| | - Antonio Pesenti
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Luciano Gattinoni
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
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Bellani G, Grasselli G, Teggia-Droghi M, Mauri T, Coppadoro A, Brochard L, Pesenti A. Do spontaneous and mechanical breathing have similar effects on average transpulmonary and alveolar pressure? A clinical crossover study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:142. [PMID: 27160458 PMCID: PMC4862136 DOI: 10.1186/s13054-016-1290-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/08/2016] [Indexed: 01/27/2023]
Abstract
Background Preservation of spontaneous breathing (SB) is sometimes debated because it has potentially both negative and positive effects on lung injury in comparison with fully controlled mechanical ventilation (CMV). We wanted (1) to verify in mechanically ventilated patients if the change in transpulmonary pressure was similar between pressure support ventilation (PSV) and CMV for a similar tidal volume, (2) to estimate the influence of SB on alveolar pressure (Palv), and (3) to determine whether a reliable plateau pressure could be measured during pressure support ventilation (PSV). Methods We studied ten patients equipped with esophageal catheters undergoing three levels of PSV followed by a phase of CMV. For each condition, we calculated the maximal and mean transpulmonary (ΔPL) swings and Palv. Results Overall, ΔPL was similar between CMV and PSV, but only loosely correlated. The differences in ΔPL between CMV and PSV were explained largely by different inspiratory flows, indicating that the resistive pressure drop caused this difference. By contrast, the Palv profile was very different between CMV and SB; SB led to progressively more negative Palv during inspiration, and Palv became lower than the set positive end-expiratory pressure in nine of ten patients at low PSV. Finally, inspiratory occlusion holds performed during PSV led to plateau and Δ PL pressures comparable with those measured during CMV. Conclusions Under similar conditions of flow and volume, transpulmonary pressure change is similar between CMV and PSV. SB during mechanical ventilation can cause remarkably negative swings in Palv, a mechanism by which SB might potentially induce lung injury. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1290-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giacomo Bellani
- Department of Health Science, University of Milan-Bicocca, Via Cadore, 48 20900, Monza, Italy. .,Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.
| | - Giacomo Grasselli
- Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Maddalena Teggia-Droghi
- Department of Health Science, University of Milan-Bicocca, Via Cadore, 48 20900, Monza, Italy.,Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Coppadoro
- Department of Emergency and Intensive Care, A. Manzoni Hospital, Lecco, Italy
| | - Laurent Brochard
- Keenan Research Centre, St. Michael's Hospital, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Antonio Pesenti
- Department of Health Science, University of Milan-Bicocca, Via Cadore, 48 20900, Monza, Italy.,Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
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35
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Hillas G, Perlikos F, Toumpanakis D, Litsiou E, Nikolakopoulou S, Sagris K, Vassilakopoulos T. Controlled Mechanical Ventilation Attenuates the Systemic Inflammation of Severe Chronic Obstructive Pulmonary Disease Exacerbations. Am J Respir Crit Care Med 2016; 193:696-8. [DOI: 10.1164/rccm.201508-1700le] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Takeuchi M, Tachibana K. Mechanical ventilation for ARDS patients--for a better understanding of the 2012 Surviving Sepsis Campaign Guidelines. Cardiovasc Hematol Disord Drug Targets 2015; 15:41-5. [PMID: 25567337 PMCID: PMC4428140 DOI: 10.2174/1871529x15666150108113853] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 09/20/2014] [Accepted: 10/10/2014] [Indexed: 12/29/2022]
Abstract
The mortality rate among patients suffering acute respiratory distress syndrome (ARDS) remains high despite implementation at clinical centers of the lung protective ventilatory strategies recommended by the International Guidelines for Management of Severe Sepsis and Septic Shock, 2012. This suggests that such strategies are still sub-optimal for some ARDS patients. For these patients, tailored use of ventilator settings should be considered, including: further reduction of tidal volumes, administration of neuromuscular blocking agents if the patient’s spontaneous breathing is incompatible with mechanical ventilation, and adjusting positive end-expiratory pressure (PEEP) settings based on transpulmonary pressure levels.
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Affiliation(s)
| | - Kazuya Tachibana
- Department of Intensive Care Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodocho, Izumi, Osaka, 594-1101, Japan.
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Effects of Sigh on Regional Lung Strain and Ventilation Heterogeneity in Acute Respiratory Failure Patients Undergoing Assisted Mechanical Ventilation*. Crit Care Med 2015; 43:1823-31. [DOI: 10.1097/ccm.0000000000001083] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Glynos C, Toumpanakis D, Loverdos K, Karavana V, Zhou Z, Magkou C, Dettoraki M, Perlikos F, Pavlidou A, Kotsikoris V, Topouzis S, Theocharis SE, Brouckaert P, Giannis A, Papapetropoulos A, Vassilakopoulos T. Guanylyl cyclase activation reverses resistive breathing-induced lung injury and inflammation. Am J Respir Cell Mol Biol 2015; 52:762-71. [PMID: 25353067 DOI: 10.1165/rcmb.2014-0092oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Inspiratory resistive breathing (RB), encountered in obstructive lung diseases, induces lung injury. The soluble guanylyl cyclase (sGC)/cyclic guanosine monophosphate (cGMP) pathway is down-regulated in chronic and acute animal models of RB, such as asthma, chronic obstructive pulmonary disease, and in endotoxin-induced acute lung injury. Our objectives were to: (1) characterize the effects of increased concurrent inspiratory and expiratory resistance in mice via tracheal banding; and (2) investigate the contribution of the sGC/cGMP pathway in RB-induced lung injury. Anesthetized C57BL/6 mice underwent RB achieved by restricting tracheal surface area to 50% (tracheal banding). RB for 24 hours resulted in increased bronchoalveolar lavage fluid cellularity and protein content, marked leukocyte infiltration in the lungs, and perturbed respiratory mechanics (increased tissue resistance and elasticity, shifted static pressure-volume curve right and downwards, decreased static compliance), consistent with the presence of acute lung injury. RB down-regulated sGC expression in the lung. All manifestations of lung injury caused by RB were exacerbated by the administration of the sGC inhibitor, 1H-[1,2,4]oxodiazolo[4,3-]quinoxalin-l-one, or when RB was performed using sGCα1 knockout mice. Conversely, restoration of sGC signaling by prior administration of the sGC activator BAY 58-2667 (Bayer, Leverkusen, Germany) prevented RB-induced lung injury. Strikingly, direct pharmacological activation of sGC with BAY 58-2667 24 hours after RB reversed, within 6 hours, the established lung injury. These findings raise the possibility that pharmacological targeting of the sGC-cGMP axis could be used to ameliorate lung dysfunction in obstructive lung diseases.
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Affiliation(s)
- Constantinos Glynos
- 1 George P. Livanos and Marianthi Simou Laboratories, Evangelismos Hospital, First Department of Pulmonary and Critical Care, and
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Abdeyrim A, Zhang Y, Li N, Zhao M, Wang Y, Yao X, Keyoumu Y, Yin T. Impact of obstructive sleep apnea on lung volumes and mechanical properties of the respiratory system in overweight and obese individuals. BMC Pulm Med 2015; 15:76. [PMID: 26209328 PMCID: PMC4513967 DOI: 10.1186/s12890-015-0063-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/23/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Even through narrowing of the upper-airway plays an important role in the generation of obstructive sleep apnea (OSA), the peripheral airways is implicated in pre-obese and obese OSA patients, as a result of decreased lung volume and increased lung elastic recoil pressure, which, in turn, may aggravate upper-airway collapsibility. METHODS A total of 263 male (n = 193) and female (n = 70) subjects who were obese to various degrees without a history of lung diseases and an expiratory flow limitation, but troubled with snoring or suspicion of OSA were included in this cross-sectional study. According to nocturnal-polysomnography the subjects were distributed into OSA and non-OSA groups, and were further sub-grouped by gender because of differences between males and females, in term of, lung volume size, airway resistance, and the prevalence of OSA among genders. Lung volume and respiratory mechanical properties at different-frequencies were evaluated by plethysmograph and an impulse oscillation system, respectively. RESULTS Functional residual capacity (FRC) and expiratory reserve volume were significantly decreased in the OSA group compared to the non-OSA group among males and females. As weight and BMI in males in the OSA group were greater than in the non-OSA group (90 ± 14.8 kg vs. 82 ± 10.4 kg, p < 0.001; 30.5 ± 4.2 kg/m(2) vs. 28.0 ± 3.0 kg/m(2), p < 0.001), multiple regression analysis was required to adjust for BMI or weight and demonstrated that these lung volumes decreases were independent from BMI and associated with the severity of OSA. This result was further confirmed by the female cohort. Significant increases in total respiratory resistance and decreases in respiratory conductance (Grs) were observed with increasing severity of OSA, as defined by the apnea-hypopnea index (AHI) in both genders. The specific Grs (sGrs) stayed relatively constant between the two groups in woman, and there was only a weak association between AHI and sGrs among man. Multiple-stepwise-regression showed that reactance at 5 Hz was highly correlated with AHI in males and females or hypopnea index in females, independently-highly correlated with peripheral-airway resistance and significantly associated with decreasing FRC. CONCLUSIONS Total respiratory resistance and peripheral airway resistance significantly increase, and its inverse Grs decrease, in obese patients with OSA in comparison with those without OSA, and are independently associated with OSA severity. These results might be attributed to the abnormally increased lung elasticity recoil pressure on exhalation, due to increase in lung elasticity and decreased lung volume in obese OSA.
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Affiliation(s)
- Arikin Abdeyrim
- Postgraduate college of Xinjiang Medical University, Urumqi, China.
- The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China.
| | - Yongping Zhang
- Postgraduate college of Xinjiang Medical University, Urumqi, China.
- The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China.
| | - Nanfang Li
- Postgraduate college of Xinjiang Medical University, Urumqi, China.
- The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China.
| | - Minghua Zhao
- Department of Pulmonary function test, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Yinchun Wang
- Laboratory of sleep study, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Xiaoguang Yao
- The Center of Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Youledusi Keyoumu
- Department of Otorhinolaryngology Head and Neck Surgery, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Ting Yin
- Laboratory of sleep study, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
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Abstract
PURPOSE OF REVIEW Spontaneous breathing has been shown to induce both positive and negative effects on the function and on injury of lungs and diaphragm during critical illness; thus, monitoring of the breathing effort generated by the patient might be valuable for a better understanding of the mechanisms of disease and to set properly ventilation. The purpose of this review is to summarize the recent findings on the different techniques available to measure the patient's breathing effort, mainly during spontaneous assisted ventilation. RECENT FINDINGS Although esophageal pressure measurement remains the solid reference technique to quantitate the breathing effort, other tools have been developed and tested. These include the diaphragmatic electromyogram, whose voltage is linearly related to the pressure generated by the diaphragm, ultrasound, which relies on the measurement of diaphragmatic displacement or thickening, and other approaches, which derive breathing effort solely from the airway flow and pressure tracings. SUMMARY The development of measurement techniques and their introduction in clinical practice will allow us to understand the role of spontaneous breathing effort in the pathophysiology of lung injury and weaning failure, and how to adjust the breathing workload in an individual patient.
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Liu XW, Ma T, Qu B, Liu Z. Effects of noninvasive positive pressure ventilation on oxygenation status and prognosis in patients with acute paraquat-induced lung injury. Clin Ther 2015; 37:654-9. [PMID: 25655533 DOI: 10.1016/j.clinthera.2014.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 12/08/2014] [Accepted: 12/21/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effects of noninvasive positive pressure ventilation (NIPPV) on oxygenation status and prognosis in patients with acute lung injury induced by paraquat (PQ) poisoning. METHODS Patients with acute PQ-induced lung injury treated with NIPPV were admitted to an emergency intensive care unit. Changes in oxygenation status (respiratory rate and the partial pressure of alveolar O2 and CO2 [PaO2 and PaCO2, respectively]) after initial NIPPV were observed. Differences in inspiratory pressure (PI) between nonsurvivors and survivors were compared. The relationship between PI and the prognosis of patients with acute PQ-induced lung injury was evaluated. FINDINGS A total of 86 patients (47 women, 39 men; mean age, 33.5 [24.5] years [range, 22-61 years]) were included. There were significant differences in respiratory rate, PaO2, and PaCO2 from before to after initial NIPPV (respiratory rate, 35 [14] vs 26 [16] min(-1) [P = 0.037]; PaO2, 61.8 [19.6] vs 73.5 [26.8] mm Hg [P = 0.046]; and PaCO2, 27.7 [16.4] vs 34.6 [19.2] mm Hg [P = 0.039]). The overall mortality rate was 75.6% (65/86) during a 28-day follow-up period. We observed a significant difference in initial PI (PIinit) between nonsurvivors and survivors (8.2 [4.3] vs 6.6 [3.8] cm H2O; P = 0.043). Furthermore, nonsurvivors had a greater maximal PI (PImax) than did survivors (21.6 [9.8] vs 15.4 [8.5] cm H2O; P = 0.022). Correlation analysis revealed that both PIinit and PImax were associated with a poor prognosis in patients with acute PQ-induced lung injury (PIinit, r = -0.29 [P = 0.038]; PImax, r = -0.31 [P = 0.042]). IMPLICATIONS NIPPV may effectively improve oxygenation status in patients with acute PQ-induced lung injury, thereby relieving dyspnea and promoting the recovery of pulmonary function. PIinit and PImax may be important determinants of prognosis in acute PQ-induced lung injury. These findings need further verification in a large-scale, multicenter, randomized controlled study that combines other factors with a relatively long-term follow-up.
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Affiliation(s)
- Xiao-Wei Liu
- Department of Emergency, First Affiliated Hospital, China Medical University, Liaoning, People's Republic of China
| | - Tao Ma
- Department of Emergency, First Affiliated Hospital, China Medical University, Liaoning, People's Republic of China
| | - Bo Qu
- Department of Biostatistics, School of Public Health, China Medical University, Liaoning, People's Republic of China
| | - Zhi Liu
- Department of Emergency, First Affiliated Hospital, China Medical University, Liaoning, People's Republic of China.
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Toumpanakis D, Noussia O, Sigala I, Litsiou E, Loverdos K, Zacharatos P, Karavana V, Michailidou T, Magkou C, Zhou Z, Theocharis S, Vassilakopoulos T. Inspiratory resistive breathing induces MMP-9 and MMP-12 expression in the lung. Am J Physiol Lung Cell Mol Physiol 2015; 308:L683-92. [PMID: 25595645 DOI: 10.1152/ajplung.00133.2014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 01/06/2015] [Indexed: 01/27/2023] Open
Abstract
Inspiratory resistive breathing (IRB) is characterized by large negative intrathoracic pressures and was shown to induce pulmonary inflammation in previously healthy rats. Matrix metalloproteinases (MMP)-9 and -12 are induced by inflammation and mechanical stress in the lung. We hypothesized that IRB induces MMP-9 and -12 in the lung. Anesthetized, tracheostomized rats breathed spontaneously through a two-way valve, connected to an inspiratory resistance, with the tidal inspiratory tracheal pressure set at 50% of the maximum. Quietly breathing animals served as controls. After 3 and 6 h of IRB, respiratory mechanics were measured, bronchoalveolar lavage (BAL) was performed, lung injury score was estimated, and lung MMP-9 was estimated by zymography and ELISA. MMP-9 and MMP-12 immunohistochemistry was performed. Isolated normal alveolar macrophages were incubated with BAL from rats that underwent IRB. After 18 h, MMP-9 and -12 levels were measured in supernatants, and immunocytochemistry was performed. Macrophages were treated with IL-1β, IL-6, or TNF-α, and MMP-9 in supernatants was measured. After 6 h of IRB, leukocytes in BAL increased, and IL-1β and IL-6 levels were elevated. Elasticity and injury score were increased after 3 and 6 h of IRB. Lung MMP-9 levels increased after 6 h of IRB. MMP-9 and MMP-12 were detected in alveolar macrophages and epithelial (bronchial/alveolar) cells after 3 and 6 h of IRB. MMP-9 and MMP-12 were found in supernatants after treatment with 6 h of IRB BAL. Cytosolic immunostaining was detected after treatment with 3 and 6 h of IRB BAL. All cytokines induced MMP-9 in culture supernatants. In conclusion, IRB induces MMP-9 and -12 in the lung of previously healthy rats.
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Affiliation(s)
- Dimitrios Toumpanakis
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos Hospital, University of Athens, Medical School, Athens, Greece
| | - Olga Noussia
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos Hospital, University of Athens, Medical School, Athens, Greece
| | - Ioanna Sigala
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos Hospital, University of Athens, Medical School, Athens, Greece
| | - Eleni Litsiou
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos Hospital, University of Athens, Medical School, Athens, Greece
| | - Konstantinos Loverdos
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos Hospital, University of Athens, Medical School, Athens, Greece
| | - Panagiotis Zacharatos
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos Hospital, University of Athens, Medical School, Athens, Greece
| | - Vassiliki Karavana
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos Hospital, University of Athens, Medical School, Athens, Greece
| | - Tatiana Michailidou
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos Hospital, University of Athens, Medical School, Athens, Greece
| | - Christina Magkou
- Department of Pathology, General Hospital "Evangelismos", Athens, Greece
| | - Zongmin Zhou
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos Hospital, University of Athens, Medical School, Athens, Greece
| | - Stamatios Theocharis
- First Department of Pathology, University of Athens, Medical School, Athens, Greece
| | - Theodoros Vassilakopoulos
- Department of Critical Care and Pulmonary Services and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos Hospital, University of Athens, Medical School, Athens, Greece;
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Ahluwalia N, Shea BS, Tager AM. New therapeutic targets in idiopathic pulmonary fibrosis. Aiming to rein in runaway wound-healing responses. Am J Respir Crit Care Med 2014; 190:867-78. [PMID: 25090037 DOI: 10.1164/rccm.201403-0509pp] [Citation(s) in RCA: 183] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a devastating disease, with a median survival as short as 3 years from the time of diagnosis and no pharmacological therapies yet approved by the U.S. Food and Drug Administration. To address the great unmet need for effective IPF therapy, a number of new drugs have recently been, or are now being, evaluated in clinical trials. The rationales for most of these therapeutic candidates are based on the current paradigm of IPF pathogenesis, in which recurrent injury to the alveolar epithelium is believed to drive aberrant wound healing responses, resulting in fibrosis rather than repair. Here we discuss drugs in recently completed or currently ongoing phase II and III IPF clinical trials in the context of their putative mechanisms of action and the aberrant repair processes they are believed to target: innate immune activation and polarization, fibroblast accumulation and myofibroblast differentiation, or extracellular matrix deposition and stiffening. Placed in this context, the positive results of recently completed trials of pirfenidone and nintedanib, and results that will come from ongoing trials of other agents, should provide valuable insights into the still-enigmatic pathogenesis of this disease, in addition to providing benefits to patients with IPF.
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Affiliation(s)
- Neil Ahluwalia
- Pulmonary and Critical Care Unit and Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Mills DE, Johnson MA, McPhilimey MJ, Williams NC, Gonzalez JT, Barnett YA, Sharpe GR. The effects of inspiratory muscle training on plasma interleukin-6 concentration during cycling exercise and a volitional mimic of the exercise hyperpnea. J Appl Physiol (1985) 2013; 115:1163-72. [DOI: 10.1152/japplphysiol.00272.2013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
It is unknown whether the respiratory muscles contribute to exercise-induced increases in plasma interleukin-6 (IL-6) concentration, if this is related to diaphragm fatigue, and whether inspiratory muscle training (IMT) attenuates the plasma IL-6 response to whole body exercise and/or a volitional mimic of the exercise hyperpnea. Twelve healthy males were divided equally into an IMT or placebo (PLA) group, and before and after a 6-wk intervention they undertook, on separate days, 1 h of 1) passive rest, 2) cycling exercise at estimated maximal lactate steady state power (EX), and 3) volitional hyperpnea at rest, which mimicked the breathing and respiratory muscle recruitment patterns achieved during EX (HYPEX). Plasma IL-6 concentration remained unchanged during passive rest. The plasma IL-6 response to EX was reduced following IMT (main effect of intervention, P = 0.039) but not PLA ( P = 0.272). Plasma IL-6 concentration increased during HYPEX (main effect of time, P < 0.01) and was unchanged postintervention. There was no evidence of diaphragm fatigue (measured by phrenic nerve stimulation) following each trial. In conclusion, plasma IL-6 concentration is increased during EX and HYPEX and this occurred in the absence of diaphragm fatigue. Furthermore, IMT reduced the plasma IL-6 response to EX but not HYPEX. These findings suggest that the respiratory muscles contribute to exercise-induced increases in plasma IL-6 concentration in the absence of diaphragm fatigue and that IMT can reduce the magnitude of the response to exercise but not a volitional mimic of the exercise hyperpnea.
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Affiliation(s)
- Dean E. Mills
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - Michael A. Johnson
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - Martin J. McPhilimey
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - Neil C. Williams
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - Javier T. Gonzalez
- School of Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Yvonne A. Barnett
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - Graham R. Sharpe
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
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Kastis GA, Toumpanakis D, Loverdos K, Anaplioti A, Samartzis A, Argyriou P, Loudos G, Karavana V, Tzouda V, Datseris I, Rontogianni D, Roussos C, Theocharis SE, Vassilakopoulos T. Dose- and time-dependent effects of lipopolysaccharide on technetium-99-m-labeled diethylene-triamine pentaacetatic acid clearance, respiratory system mechanics and pulmonary inflammation. Exp Biol Med (Maywood) 2013; 238:209-22. [PMID: 23576803 DOI: 10.1258/ebm.2012.012313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Intratracheal administration of lipopolysaccharide (LPS) in animals is a commonly used model of acute lung injury, characterized by increased alveolar-capillary membrane permeability causing protein-rich edema, inflammation, deterioration of lung mechanical function and impaired gas exchange. Technetium-99-m-labeled diethylene-triamine pentaacetatic acid ((99m)Tc-DTPA) scintigraphy is a non-invasive technique to assess lung epithelial permeability. We hypothesize that the longer the exposure and the higher the dose of LPS the greater the derangement of the various indices of lung injury. After 3, 6 and 24 h of 5 or 40 μg LPS intratracheally administration, (99m)Tc-DTPA was instilled in the lung. Images were acquired for 90 min with a γ-camera and the radiotracer clearance was estimated. In another subgroup, the mechanical properties of the respiratory system were estimated with the forced oscillation technique and static pressure-volume curves, 4.5, 7.5 and 25.5 h post-LPS (iso-times with the end of (99m)Tc-DTPA scintigraphy). Bronchoalveolar lavage (BAL) was performed and a lung injury score was estimated by histology. Lung myeloperoxidase (MPO) activity was measured. (99m)Tc-DTPA clearance increased in all LPS challenged groups compared with control. DTPA clearance presented a U-shape time course at the lower dose, while LPS had a declining effect over time at the larger dose. At 7.5 and 25.5 h post-LPS, tissue elasticity was increased and static compliance decreased at both doses. Total protein in the BAL fluid increased at both doses only at 4.5 h Total lung injury score and MPO activity were elevated in all LPS-treated groups. There is differential time- and dose-dependency of the various indices of lung injury after intratracheally LPS instillation in rats.
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Affiliation(s)
- George A Kastis
- Department of Critical Care and Pulmonary Services, G.P. Livanos, M. Simou and Experimental Surgery Laboratories, University of Athens, Medical School, Evangelismos Hospital, Athens, Greece
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Abstract
Negative pressure pulmonary edema (NPPE), or acute postobstructive pulmonary edema, is caused by negative intrathoracic pressure against an obstructed upper airway. Although NPPE is generally a benign condition, several fatal cases attributed to the delay in diagnosis have been reported. We report a case of NPPE experienced during Dumon stent placement. In a 39-year-old man, unilateral NPPE developed upon relief from a right main bronchial obstruction caused by a blood clot within the Dumon. The incident indicates that the "increased preload theory" is unable by itself to explain the pathophysiology of NPPE. Although we preferred spontaneous assisted ventilation for interventional rigid bronchoscopy, the potential risk of NPPE during Dumon stent placement, especially in spontaneously breathing young, healthy patients, needs to be considered.
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Sigala I, Zacharatos P, Boulia S, Toumpanakis D, Michailidou T, Parthenis D, Roussos C, Papapetropoulos A, Hussain SN, Vassilakopoulos T. Nitric oxide regulates cytokine induction in the diaphragm in response to inspiratory resistive breathing. J Appl Physiol (1985) 2012; 113:1594-603. [PMID: 22961265 DOI: 10.1152/japplphysiol.00233.2012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Resistive breathing (encountered in chronic obstructive pulmonary disease and asthma) results in cytokine upregulation and decreased nitric oxide (NO) levels in the strenuously contracting diaphragm. NO can regulate gene expression. We hypothesized that endogenously produced NO downregulates cytokine production triggered by strenuous diaphragmatic contraction. Wistar rats treated with vehicle, the nonselective NO synthase inhibitor NG-nitro-l-arginine-methylester (l-NAME), or the NO donor diethylenetriamine-NONOate (DETA) were subjected to inspiratory resistive breathing (IRB; 50% of maximal inspiratory pressure) for 6 h or sham operation. Additional groups of rats were subjected to IRB for 6 h with concurrent administration of l-NAME and inhibitors of NF-κB (BAY-11-7082), ERK1/2 (PD98059), or P38 (SB203580). Inhibition of NO production (with l-NAME) resulted in upregulation of IRB-induced diaphragmatic IL-6, IL-10, IL-2, TNF-α, and IL-1β levels by 50%, 53%, 60%, 47%, and 45%, respectively. In contrast, the NO donor (DETA) attenuated the IRB-induced cytokine upregulation to levels characteristic of quietly breathing animals. l-NAME augmented IRB-induced activation of MAPKs (P38 and ERK1/2) and NF-κB, whereas DETA triggered the opposite effect. NF-κB and ERK1/2 inhibition in l-NAME-treated animals blunted the l-NAME-induced cytokine upregulation except IL-6, whereas P38 inhibition blunted all (including IL-6) cytokine upregulation. NO downregulates IRB-induced cytokine production in the strenuously contracting diaphragm through its action on MAPKs and NF-κB.
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Affiliation(s)
- Ioanna Sigala
- Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, 45-47 Ipsilandou Str., Athens, Greece
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LEDERER DAVIDJ, JELIC SANJA, BASNER ROBERTC, BHATTACHARYA JAHAR. Is obstructive sleep apnea a cause of idiopathic pulmonary fibrosis? Arch Pathol Lab Med 2012; 136:470; author reply 470. [PMID: 22540293 PMCID: PMC7213593 DOI: 10.5858/arpa.2011-0650-le] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- DAVID J. LEDERER
- Department of Medicine, College of Physicians and Surgeons,
Columbia University, New York, NY 10032,Department of Epidemiology, Mailman School of Public Health,
Columbia University, New York, NY 10032
| | - SANJA JELIC
- Department of Medicine, College of Physicians and Surgeons,
Columbia University, New York, NY 10032
| | - ROBERT C. BASNER
- Department of Medicine, College of Physicians and Surgeons,
Columbia University, New York, NY 10032
| | - JAHAR BHATTACHARYA
- Department of Medicine, College of Physicians and Surgeons,
Columbia University, New York, NY 10032
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