Reducing atelectasis attenuates bacterial growth and translocation in experimental pneumonia
Reducing atelectasis attenuates bacterial growth and translocation in experimental pneumonia
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DOI：
10.1164/rccm.200312-1779oc
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发表时间：
2004-05-01
影响因子：
24.7
通讯作者：
Lachmann, B
中科院分区：
文献类型：
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作者：
van Kaam, AH;Lachmann, RA;Lachmann, B
肺不张除了是呼吸机引起的肺损伤的机制之一外，似乎还加重了实验性肺炎的病程。在这项研究中，我们研究了通过天然修饰的表面活性剂和/或开放肺通气降低肺不张程度对B组链球菌肺炎仔猪模型中细菌生长和移位的影响。在通过全肺灌洗造成表面活性剂缺乏后，细菌内滴注诱导了严重的肺炎，细菌移位到血流中，导致死亡率几乎达到80%。在滴注链球菌前用300 mg/kg外源性表面活性剂治疗可减弱细菌生长和移位，并防止临床恶化。通过开放肺通气逆转灌洗动物的肺不张也实现了这一目标。结合外源性表面活性剂和开放肺通气完全防止细菌移位，与B组链球菌滴入健康动物相当。我们的结论是，外源性表面活性剂和开放式肺通气减弱实验性肺炎中的细菌生长和易位，这种衰减至少部分介导的肺不张减少。这些发现表明，通过外源性表面活性剂和开放肺通气最大限度地减少肺泡萎陷可能会降低通气患者发生肺炎和随后败血症的风险。
Besides being one of the mechanisms responsible for ventilator-induced lung injury, atelectasis also seems to aggravate the course of experimental pneumonia. In this study, we examined the effect of reducing the degree of atelectasis by natural modified surfactant and/or open lung ventilation on bacterial growth and translocation in a piglet model of Group B streptococcal pneumonia. After creating surfactant deficiency by whole lung lavage, intratracheal instillation of bacteria induced severe pneumonia with bacterial translocation into the blood stream, resulting in a mortality rate of almost 80%. Treatment with 300 mg/kg of exogenous surfactant before instillation of streptococci attenuated both bacterial growth and translocation and prevented clinical deterioration. This goal was also achieved by reversing atelectasis in lavaged animals via open lung ventilation. Combining both exogenous surfactant and open lung ventilation prevented bacterial translocation completely, comparable to Group B streptococci instillation into healthy animals. We conclude that exogenous surfactant and open lung ventilation attenuate bacterial growth and translocation in experimental pneumonia and that this attenuation is at least in part mediated by a reduction in atelectasis. These findings suggest that minimizing alveolar collapse by exogenous surfactant and open lung ventilation may reduce the risk of pneumonia and subsequent sepsis in ventilated patients.