Aydra Mendes Almeida Bianchi1,2, Maycon Moura Reboredo1,2, Leda Marília Fonseca Lucinda1,2, Fernando Fonseca Reis1,2, Manfrinni Vinícius Alves Silva1,2, Maria Aparecida Esteves Rabelo1, Marcelo Alcantara Holanda3, Júlio César Abreu Oliveira1, José Ángel Lorente4,5,6, Bruno do Valle Pinheiro7,8. 1. Pulmonary Research Laboratory, Hospital Universitário da Universidade Federal de Juiz de Fora, Av. Eugênio do Nascimento - s/nº, Dom Bosco, Juiz de Fora, MG, 36038-330, Brazil. 2. Center of Reproductive Biology, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil. 3. Laboratory of Respiration, Department of Internal Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil. 4. Hospital Universitario de Getafe, Madrid, Spain. 5. CIBER de Enfermedades Respiratorias, Madrid, Spain. 6. Universidad Europea, Madrid, Spain. 7. Pulmonary Research Laboratory, Hospital Universitário da Universidade Federal de Juiz de Fora, Av. Eugênio do Nascimento - s/nº, Dom Bosco, Juiz de Fora, MG, 36038-330, Brazil. bvallepinheiro@gmail.com. 8. Center of Reproductive Biology, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil. bvallepinheiro@gmail.com.
Abstract
INTRODUCTION: The benefits of prone position ventilation are well demonstrated in the severe forms of acute respiratory distress syndrome, but not in the milder forms. We investigated the effects of prone position on arterial blood gases, lung inflammation, and histology in an experimental mild acute lung injury (ALI) model. METHODS: ALI was induced in Wistar rats by intraperitoneal Escherichia coli lipopolysaccharide (LPS, 5 mg/kg). After 24 h, the animals with PaO2/FIO2 between 200 and 300 mmHg were randomized into 2 groups: prone position (n = 6) and supine position (n = 6). Both groups were compared with a control group (n = 5) that was ventilated in the supine position. All of the groups were ventilated for 1 h with volume-controlled ventilation mode (tidal volume = 6 ml/kg, respiratory rate = 80 breaths/min, positive end-expiratory pressure = 5 cmH2O, inspired oxygen fraction = 1) RESULTS: Significantly higher lung injury scores were observed in the LPS-supine group compared to the LPS-prone and control groups (0.32 ± 0.03; 0.17 ± 0.03 and 0.13 ± 0.04, respectively) (p < 0.001), mainly due to a higher neutrophil infiltration level in the interstitial space and more proteinaceous debris that filled the airspaces. Similar differences were observed when the gravity-dependent lung regions and non-dependent lung regions were analyzed separately (p < 0.05). The BAL neutrophil content was also higher in the LPS-supine group compared to the LPS-prone and control groups (p < 0.05). There were no significant differences in the wet/dry ratio and gas exchange levels. CONCLUSIONS: In this experimental extrapulmonary mild ALI model, prone position ventilation for 1 h, when compared with supine position ventilation, was associated with lower lung inflammation and injury.
INTRODUCTION: The benefits of prone position ventilation are well demonstrated in the severe forms of acute respiratory distress syndrome, but not in the milder forms. We investigated the effects of prone position on arterial blood gases, lung inflammation, and histology in an experimental mild acute lung injury (ALI) model. METHODS: ALI was induced in Wistar rats by intraperitoneal Escherichia colilipopolysaccharide (LPS, 5 mg/kg). After 24 h, the animals with PaO2/FIO2 between 200 and 300 mmHg were randomized into 2 groups: prone position (n = 6) and supine position (n = 6). Both groups were compared with a control group (n = 5) that was ventilated in the supine position. All of the groups were ventilated for 1 h with volume-controlled ventilation mode (tidal volume = 6 ml/kg, respiratory rate = 80 breaths/min, positive end-expiratory pressure = 5 cmH2O, inspired oxygen fraction = 1) RESULTS: Significantly higher lung injury scores were observed in the LPS-supine group compared to the LPS-prone and control groups (0.32 ± 0.03; 0.17 ± 0.03 and 0.13 ± 0.04, respectively) (p < 0.001), mainly due to a higher neutrophil infiltration level in the interstitial space and more proteinaceous debris that filled the airspaces. Similar differences were observed when the gravity-dependent lung regions and non-dependent lung regions were analyzed separately (p < 0.05). The BAL neutrophil content was also higher in the LPS-supine group compared to the LPS-prone and control groups (p < 0.05). There were no significant differences in the wet/dry ratio and gas exchange levels. CONCLUSIONS: In this experimental extrapulmonary mild ALI model, prone position ventilation for 1 h, when compared with supine position ventilation, was associated with lower lung inflammation and injury.
Authors: Gustavo Matute-Bello; Gregory Downey; Bethany B Moore; Steve D Groshong; Michael A Matthay; Arthur S Slutsky; Wolfgang M Kuebler Journal: Am J Respir Cell Mol Biol Date: 2011-05 Impact factor: 6.914
Authors: Sachin Sud; Jan O Friedrich; Paolo Taccone; Federico Polli; Neill K J Adhikari; Roberto Latini; Antonio Pesenti; Claude Guérin; Jordi Mancebo; Martha A Q Curley; Rafael Fernandez; Ming-Cheng Chan; Pascal Beuret; Gregor Voggenreiter; Maneesh Sud; Gianni Tognoni; Luciano Gattinoni Journal: Intensive Care Med Date: 2010-02-04 Impact factor: 17.440
Authors: Antoine Vieillard-Baron; Cyril Charron; Vincent Caille; Guillaume Belliard; Bernard Page; François Jardin Journal: Chest Date: 2007-10-09 Impact factor: 9.410
Authors: Maria Cristina E Santana; Cristiane S N B Garcia; Débora G Xisto; Lilian K S Nagato; Roberta M Lassance; Luiz Felipe M Prota; Felipe M Ornellas; Vera L Capelozzi; Marcelo M Morales; Walter A Zin; Paolo Pelosi; Patricia R M Rocco Journal: Respir Physiol Neurobiol Date: 2009-04-14 Impact factor: 1.931