Methods Rats were challenged by acid instillation or 24 h of sepsis induced by cecal ligation and puncture, followed by mechanical ventilation (MV) with either a low tidal volume (Vt) of 6 mL/kg and 5 cm H 2O positive end-expiratory pressure (PEEP; LVt acid, LVt sepsis) or with a high Vt of 15 mL/kg and no PEEP (HVt acid, HVt sepsis). Rats sacrificed immediately after acid instillation and non-ventilated septic animals served as controls. World Views Classic And Contemporary Readings Sixth Edition Interactions. Hemodynamic and respiratory variables were monitored.
After 4 h, lung wet to dry (W/D) weight ratios, histological lung injury and plasma mediator concentrations were measured. Results Oxygenation and lung compliance decreased after acid instillation as compared to sepsis. Additionally, W/D weight ratios and histological lung injury scores increased after acid instillation as compared to sepsis. MV increased W/D weight ratio and lung injury score, however this effect was mainly attributable to HVt ventilation after acid instillation.
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Similarly, effects of HVt on oxygenation were only observed after acid instillation. HVt during sepsis did not further affect oxygenation, compliance, W/D weight ratio or lung injury score. Plasma interleukin-6 and tumour necrosis factor-α concentrations were increased after acid instillation as compared to sepsis, but plasma intercellular adhesion molecule-1 concentration increased during sepsis only. Descarca Gratis Cel Mai Bun Program De Descarcat Muzica. In contrast to lung injury parameters, no additional effects of HVt MV after acid instillation on plasma mediator concentrations were observed. Background Acute lung injury and its most severe manifestation, the acute respiratory distress syndrome (ARDS), result from direct or indirect pulmonary insults. Nuovo Cinema Paradiso Italian Torrent there. A direct, primary or pulmonary insult directly affects the lung parenchyma.
In contrast, an indirect, secondary or extrapulmonary insult follows from an acute systemic inflammatory response []. In a clinical study, involving patients suffering from pneumonia, peritonitis or polytrauma, these types of injury differed in terms of respiratory mechanics and response to positive end-expiratory pressure []. Animal experiments showed additional differences in the pulmonary inflammatory response, ultra-structural characteristics, apoptosis and respiratory mechanics [-]. The distinction between these insults may have therapeutic implications regarding ventilator settings [-]. For example, predominant consolidation of the lung in direct injury as opposed to oedema and alveolar collapse in indirect injury might imply the potential for greater ventilator-lung induced injury (VILI) in the former since alveolar recruitability would be less and overdistension greater for a given tidal volume [,,]. However, this concept is highly controversial [-].