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Critical Care
Published in: Critical Care 3/2010

Open Access 01-06-2010 | Research

Hypervolemia induces and potentiates lung damage after recruitment maneuver in a model of sepsis-induced acute lung injury

Authors: Pedro L Silva, Fernanda F Cruz, Livia C Fujisaki, Gisele P Oliveira, Cynthia S Samary, Debora S Ornellas, Tatiana Maron-Gutierrez, Nazareth N Rocha, Regina Goldenberg, Cristiane SNB Garcia, Marcelo M Morales, Vera L Capelozzi, Marcelo Gama de Abreu, Paolo Pelosi, Patricia RM Rocco

Published in: Critical Care | Issue 3/2010

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Abstract

Introduction

Recruitment maneuvers (RMs) seem to be more effective in extrapulmonary acute lung injury (ALI), caused mainly by sepsis, than in pulmonary ALI. Nevertheless, the maintenance of adequate volemic status is particularly challenging in sepsis. Since the interaction between volemic status and RMs is not well established, we investigated the effects of RMs on lung and distal organs in the presence of hypovolemia, normovolemia, and hypervolemia in a model of extrapulmonary lung injury induced by sepsis.

Methods

ALI was induced by cecal ligation and puncture surgery in 66 Wistar rats. After 48 h, animals were anesthetized, mechanically ventilated and randomly assigned to 3 volemic status (n = 22/group): 1) hypovolemia induced by blood drainage at mean arterial pressure (MAP)≈70 mmHg; 2) normovolemia (MAP≈100 mmHg), and 3) hypervolemia with colloid administration to achieve a MAP≈130 mmHg. In each group, animals were further randomized to be recruited (CPAP = 40 cm H2O for 40 s) or not (NR) (n = 11/group), followed by 1 h of protective mechanical ventilation. Echocardiography, arterial blood gases, static lung elastance (Est,L), histology (light and electron microscopy), lung wet-to-dry (W/D) ratio, interleukin (IL)-6, IL-1β, caspase-3, type III procollagen (PCIII), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) mRNA expressions in lung tissue, as well as lung and distal organ epithelial cell apoptosis were analyzed.

Results

We observed that: 1) hypervolemia increased lung W/D ratio with impairment of oxygenation and Est,L, and was associated with alveolar and endothelial cell damage and increased IL-6, VCAM-1, and ICAM-1 mRNA expressions; and 2) RM reduced alveolar collapse independent of volemic status. In hypervolemic animals, RM improved oxygenation above the levels observed with the use of positive-end expiratory pressure (PEEP), but increased lung injury and led to higher inflammatory and fibrogenetic responses.

Conclusions

Volemic status should be taken into account during RMs, since in this sepsis-induced ALI model hypervolemia promoted and potentiated lung injury compared to hypo- and normovolemia.
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Metadata
Title
Hypervolemia induces and potentiates lung damage after recruitment maneuver in a model of sepsis-induced acute lung injury
Authors
Pedro L Silva
Fernanda F Cruz
Livia C Fujisaki
Gisele P Oliveira
Cynthia S Samary
Debora S Ornellas
Tatiana Maron-Gutierrez
Nazareth N Rocha
Regina Goldenberg
Cristiane SNB Garcia
Marcelo M Morales
Vera L Capelozzi
Marcelo Gama de Abreu
Paolo Pelosi
Patricia RM Rocco
Publication date
01-06-2010
Publisher
BioMed Central
Published in
Critical Care / Issue 3/2010
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc9063

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