Non-lobar atelectasis generates inflammation and structural alveolar injury in the surrounding healthy tissue during mechanical ventilation.
Non-lobar atelectasis generates inflammation and structural alveolar injury in the surrounding healthy tissue during mechanical ventilation.
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DOI：
10.1186/s13054-014-0505-1
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发表时间：
2014-09-09
期刊：
影响因子：
--
通讯作者：
Bruhn A
中科院分区：
文献类型：
--
作者：
Retamal J;Bergamini BC;Carvalho AR;Bozza FA;Borzone G;Borges JB;Larsson A;Hedenstierna G;Bugedo G;Bruhn A
当肺泡塌陷时，相邻的扩张单元施加在其壁上的牵引力可能增加并集中。这些力可以促进其再膨胀，代价是在收缩单元和膨胀单元之间的界面处的潜在有害应力。我们开发了一个实验模型来检验这一假设，即局部非肺叶肺不张可以作为应力集中器，在机械通气过程中促进周围健康肺组织的炎症和结构性肺泡损伤。共35只大鼠被麻醉，麻痹和机械通气。通过支气管阻断诱导肺不张：在FIO 2 = 1.0的情况下稳定和预充氧5分钟后，将硅圆柱体阻断器楔入末端支气管树中。然后，将动物随机分为两组：1）潮气量（VT）= 10 ml/kg和呼气末正压（PEEP）= 3 cm H2O（VT 10/PEEP 3）; 2）VT = 20 ml/kg和PEEP = 0 cm H2O（VT 20/零呼气末压（ZEEP））。然后在180分钟内对动物进行通气。进行三个系列的实验：组织学（n = 12）;组织细胞因子（n = 12）;和显微计算机断层扫描（microCT; n = 2）。另外6只未通气的健康动物用作对照。在29只动物中的26只动物的肺基底区成功诱导肺不张。两只动物的microCT显示肺不张体积为0.12和0.21 cm 3。两组肺不张周围区域的肺泡破裂和嗜中性粒细胞浸润均多于相应的对侧肺（对照）。VT 20/ZEEP组肺不张周围区域的水肿高于VT 10/PEEP 3组的相应对侧肺（对照）。两组中肺不张周围区域的体积-表面比均高于相应的对侧肺（对照）。我们没有发现组织中白细胞介素-1 β和尼古丁诱导的中性粒细胞趋化因子-1在不同地区之间存在统计学差异。目前的研究结果表明，局部非肺叶肺不张作为一个应力集中，产生结构性肺泡损伤和炎症周围的肺组织。
When alveoli collapse the traction forces exerted on their walls by adjacent expanded units may increase and concentrate. These forces may promote its re-expansion at the expense of potentially injurious stresses at the interface between the collapsed and the expanded units. We developed an experimental model to test the hypothesis that a local non-lobar atelectasis can act as a stress concentrator, contributing to inflammation and structural alveolar injury in the surrounding healthy lung tissue during mechanical ventilation. A total of 35 rats were anesthetized, paralyzed and mechanically ventilated. Atelectasis was induced by bronchial blocking: after five minutes of stabilization and pre-oxygenation with FIO2 = 1.0, a silicon cylinder blocker was wedged in the terminal bronchial tree. Afterwards, the animals were randomized between two groups: 1) Tidal volume (VT) = 10 ml/kg and positive end-expiratory pressure (PEEP) = 3 cmH2O (VT10/PEEP3); and 2) VT = 20 ml/kg and PEEP = 0 cmH2O (VT20/zero end-expiratory pressure (ZEEP)). The animals were then ventilated during 180 minutes. Three series of experiments were performed: histological (n = 12); tissue cytokines (n = 12); and micro-computed tomography (microCT; n = 2). An additional six, non-ventilated, healthy animals were used as controls. Atelectasis was successfully induced in the basal region of the lung of 26 out of 29 animals. The microCT of two animals revealed that the volume of the atelectasis was 0.12 and 0.21 cm3. There were more alveolar disruption and neutrophilic infiltration in the peri-atelectasis region than the corresponding contralateral lung (control) in both groups. Edema was higher in the peri-atelectasis region than the corresponding contralateral lung (control) in the VT20/ZEEP than VT10/PEEP3 group. The volume-to-surface ratio was higher in the peri-atelectasis region than the corresponding contralateral lung (control) in both groups. We did not find statistical difference in tissue interleukin-1β and cytokine-induced neutrophil chemoattractant-1 between regions. The present findings suggest that a local non-lobar atelectasis acts as a stress concentrator, generating structural alveolar injury and inflammation in the surrounding lung tissue.
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DOI：
10.1164/ajrccm.149.5.8173774
发表时间：
1994-05-01
影响因子：
24.7
作者：
MUSCEDERE, JG;MULLEN, JBM;SLUTSKY, AS
通讯作者：
SLUTSKY, AS
影响因子：
15.9
作者：
Tremblay, L;Valenza, F;Slutsky, AS
通讯作者：
Slutsky, AS
影响因子：
8.8
作者：
Cereda, Maurizio;Emami, Kiarash;Rizi, Rahim R.
通讯作者：
Rizi, Rahim R.
DOI：
10.1164/rccm.201109-1667pp
发表时间：
2012-04-01
影响因子：
24.7
作者：
Albert, Richard K.
通讯作者：
Albert, Richard K.
DOI：
10.1164/rccm.201308-1567oc
发表时间：
2014-01-15
影响因子：
24.7
作者：
Cressoni, Massimo;Cadringher, Paolo;Gattinoni, Luciano
通讯作者：
Gattinoni, Luciano