Hyperbaric hyperoxemia as a risk factor for ventilator-acquired pneumonia?

The pathogenesis of ventilator-associated pneumonia: old and new mechanisms

INTRODUCTION

Ventilator-associated pneumonia (VAP), defined as a lung infection that occurs in patients after 48 hours on mechanical ventilation, is among the most frequently found nosocomial infections in intensive care units around the world and is associated with increased morbidity, mortality, and economic burden.

AREAS COVERED

We review the classical mechanisms of VAP development and explore more recent ones, such as dysbiosis, which has changed our view of the pathogenesis of the disease; whereas in the past the lower respiratory tract was classically considered a sterile organ, the use of new diagnostic techniques has shown that the lungs of healthy humans are inhabited by a large, dynamic ecosystem of microorganisms. Dysbiosis is the disruption of this ecosystem and is a key factor in the development of VAP. Recent findings have demonstrated that host immunity is microbiome-regulated and, consequently, is profoundly affected by dysbiosis. In this paper the significance of the microbiome-immunity crosstalk in the pathophysiology of VAP will be discussed.

EXPERT OPINION

A deeper understanding of mechanisms of VAP pathogenesis should help to devise new preventive, diagnostic and therapeutic strategies for reducing the incidence of this condition and for improving patient prognosis.

A novel cytoprotective organ perfusion platform for reconstructing homeostasis of DCD liver while alleviating IRI injury

Pump is a vital component for expelling the perfusate in small animal isolated organ normothermic machine perfusion (NMP) systems whose flexible structure and rhythmic contraction play a crucial role in maintaining perfusion system homeostasis. However, the continuous extrusion forming with the rigid stationary shaft of the peristaltic pumps can damage cells, leading to metabolic disorders and eventual dysfunction of transplanted organs. Here, we developed a novel biomimetic blood-gas system (BBGs) for preventing cell damage. This system mimics the cardiac cycle and features an adjustable inspiratory-to-expiratory (IE) ratio to mitigate acidosis caused by continuous oxygen inhalation. In our study, adipose stem cells (ADSCs) were cultured within the circulatory system for 10 min, 2, and 4 h. Compared to the peristaltic pump, the BBGs significantly reduced cell apoptosis and morphological injury while enhancing cell proliferation and adhesion. Additionally, when the supernatant from ADSCs was introduced to LPS-induced macrophages for 24 h, the BBGs group demonstrated a more pronounced anti-inflammatory effect, characterized by reduced M1 macrophage expression. Besides, with isolated rat livers from donation after circulatory death (DCD) perfusion with ADSCs for 6 h by the BBGs, we detected fewer apoptotic cells and a reduced inflammatory response, evidenced by down-regulated TNF-α expression. The development of BBGs demonstrates the feasibility of recreating physiological liquid-gas circulation in vitro, offering an alternative platform for isolated organ perfusion, especially for applications involving cell therapy.

Adverse Events During Hyperbaric Oxygen Therapy – Literature Review

As any other therapy method, hiperbaric oxygen therapy is connected with the risk of complications. The article is a review of the results of research on adverse events of hyperbaric oxygen therapy. The most common are: borotrauma of the middle ear, paranasal sinuses or lungs, oxygen toxicity can be pulmonary, ocular in extreme cases leading to cataracts, claustrophobia, pulmonary edema or hypoglycaemia. Research has shown that these events occur in the presence of high oxygen concentration or high pressure. Depending on the severity of complications, they are short-term not causing discontinuation of therapy or long-term excluding continuation of treatment. However adverse events connected with oxygen therapy are not common and are usually mild. This confirms that HBOT is an effective and safe method of treating decompression sickness, carbon monoxide poisoning, and the treatment of chronic wounds, delayed radiation injuries or necrotic soft tissue infections.