Top

BMC Anesthesiology

Published in:

Open Access 01-12-2015 | Research article

Reduced pulmonary blood flow in regions of injury 2 hours after acid aspiration in rats

Authors: Torsten Richter, Ralf Bergmann, Guido Musch, Jens Pietzsch, Thea Koch

Published in: BMC Anesthesiology | Issue 1/2015

Abstract

Background

Aspiration-induced lung injury can decrease gas exchange and increase mortality. Acute lung injury following acid aspiration is characterized by elevated pulmonary blood flow (PBF) in damaged lung areas in the early inflammation stage. Knowledge of PBF patterns after acid aspiration is important for targeting intravenous treatments. We examined PBF in an experimental model at a later stage (2 hours after injury).

Methods

Anesthetized Wistar-Unilever rats (n = 5) underwent unilateral endobronchial instillation of hydrochloric acid. The PBF distribution was compared between injured and uninjured sides and with that of untreated control animals (n = 6). Changes in lung density after injury were measured using computed tomography (CT). Regional PBF distribution was determined quantitatively in vivo 2 hours after acid instillation by measuring the concentration of [⁶⁸Ga]-radiolabeled microspheres using positron emission tomography.

Results

CT scans revealed increased lung density in areas of acid aspiration. Lung injury was accompanied by impaired gas exchange. Acid aspiration decreased the arterial pressure of oxygen from 157 mmHg [139;165] to 74 mmHg [67;86] at 20 minutes and tended toward restoration to 109 mmHg [69;114] at 110 minutes (P < 0.001). The PBF ratio of the middle region of the injured versus uninjured lungs of the aspiration group (0.86 [0.7;0.9], median [25%;75%]) was significantly lower than the PBF ratio in the left versus right lung of the control group (1.02 [1.0;1.05]; P = 0.016).

Conclusions

The PBF pattern 2 hours after aspiration-induced lung injury showed a redistribution of PBF away from injured regions that was likely responsible for the partial recovery from hypoxemia over time. Treatments given intravenously 2 hours after acid-induced lung injury may not preferentially reach the injured lung regions, contrary to what occurs during the first hour of inflammation.

Please see related article: http://dx.doi.org/10.1186/s12871-015-0014-z.

Knight PR, Rutter T, Tait AR, Coleman E, Johnson K. Pathogenesis of gastric particulate lung injury: a comparison and interaction with acidic pneumonitis. Anesth Analg. 1993;77(4):754–60.PubMedCrossRef

Raghavendran K, Nemzek J, Napolitano LM, Knight PR. Aspiration-induced lung injury. Crit Care Med. 2011;39(4):818–26.PubMedPubMedCentralCrossRef

Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344(9):665–71.PubMedCrossRef

Marrie TJ, Carriere KC, Jin Y, Johnson DH. Factors associated with death among adults <55 years of age hospitalized for community-acquired pneumonia. Clin Infect Dis. 2003;36(4):413–21.PubMedCrossRef

Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, et al. Incidence and outcomes of acute lung injury. N Engl J Med. 2005;353(16):1685–93.PubMedCrossRef

Dudley WR, Marshall BE. Steroid treatment for acid-aspiration pneumonitis. Anesthesiology. 1974;40(2):136–41.PubMedCrossRef

Safdar Z, Yiming M, Grunig G, Bhattacharya J. Inhibition of acid-induced lung injury by hyperosmolar sucrose in rats. Am J Respir Crit Care Med. 2005;172(8):1002–7.PubMedPubMedCentralCrossRef

Rabinovici R, Vernick J, Hillegas L, Neville LF. Hypertonic saline treatment of acid aspiration-induced lung injury. J Surg Res. 1996;60(1):176–80.PubMedCrossRef

Pawlik MT, Schreyer AG, Ittner KP, Selig C, Gruber M, Feuerbach S, et al. Early treatment with pentoxifylline reduces lung injury induced by acid aspiration in rats. Chest. 2005;127(2):613–21.PubMedCrossRef

10.

Grimbert FA, Parker JC, Taylor AE. Increased pulmonary vascular permeability following acid aspiration. J Appl Physiol. 1981;51(2):335–45.PubMed

11.

Richter T, Bergmann R, Knels L, Hofheinz F, Kasper M, Deile M, et al. Pulmonary blood flow increases in damaged regions directly after acid aspiration in rats. Anesthesiology. 2013;119(4):890–900.PubMedCrossRef

12.

Richter T, Bergmann R, Pietzsch J, Mueller MP, Koch T. Effects of pulmonary acid aspiration on the regional pulmonary blood flow within the first hour after injury: an observational study in rats. Clin Hemorheol Microcirc. 2014. doi:10.3233/CH-141867.

13.

Kennedy TP, Johnson KJ, Kunkel RG, Ward PA, Knight PR, Finch JS. Acute acid aspiration lung injury in the rat: biphasic pathogenesis. Anesth Analg. 1989;69(1):87–92.PubMed

14.

Nanjo S, Bhattacharya J, Staub NC. Concentrated albumin does not affect lung edema formation after acid instillation in the dog. Am Rev Respir Dis. 1983;128(5):884–9.PubMed

15.

Richter T, Bergmann R, Pietzsch J, Kozle I, Hofheinz F, Schiller E, et al. Effects of posture on regional pulmonary blood flow in rats as measured by PET. J Appl Physiol. 2010;108(2):422–9.PubMedCrossRef

16.

Vieira SR, Puybasset L, Richecoeur J, Lu Q, Cluzel P, Gusman PB, et al. A lung computed tomographic assessment of positive end-expiratory pressure-induced lung overdistension. Am J Respir Crit Care Med. 1998;158(5 Pt 1):1571–7.PubMedCrossRef

17.

James CF, Modell JH, Gibbs CP, Kuck EJ, Ruiz BC. Pulmonary aspiration–effects of volume and pH in the rat. Anesth Analg. 1984;63(7):665–8.PubMedCrossRef

18.

Westphalen K, Monma E, Islam MN, Bhattacharya J. Acid contact in the rodent pulmonary alveolus causes proinflammatory signaling by membrane pore formation. Am J Physiol Lung Cell Mol Physiol. 2012;303(2):107–16.CrossRef

19.

Matute-Bello G, Frevert CW, Martin TR. Animal models of acute lung injury. Am J Physiol Lung Cell Mol Physiol. 2008;295(3):379–99.CrossRef

20.

Lim YS, Chung MH, Park SH, Kim HY, Choi BG, Lim HW, et al. Acute and repeated inhalation lung injury by 3-methoxybutyl chloroformate in rats: CT-pathologic correlation. Eur J Radiol. 2007;62(2):227–34.PubMedCrossRef

21.

Routly JJ, Puybasset L, Nieszkowska A, Lu Q. Acute respiratory distress syndrome: Lessons from computed tomography of the whole lung. Crit Care Med. 2003;31(4):S285–95.

22.

Carlile PV, Hagan SF, Gray BA. Perfusion distribution and lung thermal volume in canine hydrochloric acid aspiration. J Appl Physiol. 1988;65(2):750–9.PubMed

23.

Melsom MN, Flatebo T, Nicolaysen G. Hypoxia and hyperoxia both transiently affect distribution of pulmonary perfusion but not ventilation in awake sheep. Acta Physiol Scand. 1999;166(2):151–8.PubMedCrossRef

24.

Hlastala MP, Lamm WJ, Karp A, Polissar NL, Starr IR, Glenny RW. Spatial distribution of hypoxic pulmonary vasoconstriction in the supine pig. J Appl Physiol. 2004;96(5):1589–99.PubMedCrossRef

25.

Lamm WJ, Starr IR, Neradilek B, Polissar NL, Glenny RW, Hlastala MP. Hypoxic pulmonary vasoconstriction is heterogeneously distributed in the prone dog. Respir Physiol Neurobiol. 2004;144(2–3):281–94.PubMedCrossRef

26.

Starr IR, Lamm WJ, Neradilek B, Polissar N, Glenny RW, Hlastala MP. Regional hypoxic pulmonary vasoconstriction in prone pigs. J Appl Physiol. 2005;99(1):363–70.PubMedCrossRef

27.

Schuster DP, Anderson C, Kozlowski J, Lange N. Regional pulmonary perfusion in patients with acute pulmonary edema. J Nucl Med. 2002;43(7):863–70.PubMed

28.

Brashers VL, Peach MJ, Rose Jr CE. Augmentation of hypoxic pulmonary vasoconstriction in the isolated perfused rat lung by in vitro antagonists of endothelium-dependent relaxation. J Clin Invest. 1988;82(5):1495–502.PubMedPubMedCentralCrossRef

29.

Kozian A, Schilling T, Freden F, Maripuu E, Rocken C, Strang C, et al. One-lung ventilation induces hyperperfusion and alveolar damage in the ventilated lung: an experimental study. Br J Anaesth. 2008;100(4):549–59.PubMedCrossRef

30.

McAuley DF, Frank JA, Fang XH, Matthay MA. Clinically relevant concentrations of beta(2)-adrenergic agonists stimulate maximal cyclic adenosine monophosphate-dependent airspace fluid clearance and decrease pulmonary edema in experimental acid-induced lung injury. Crit Care Med. 2004;32(7):1470–6.PubMedCrossRef

31.

Zarbock A, Allegretti M, Ley K. Therapeutic inhibition of CXCR2 by Reparixin attenuates acute lung injury in mice. Brit J Pharmacol. 2008;155(3):357–64.CrossRef

32.

Folkesson HG, Matthay MA, Hebert CA, Broaddus VC. Acid aspiration-induced lung injury in rabbits is mediated by interleukin-8-dependent mechanisms. J Clin Invest. 1995;96(1):107–16.PubMedPubMedCentralCrossRef

33.

Knight PR, Druskovich G, Tait A, Johnson K. The role of neutrophils, oxidants and proteases in pulmonary acid injury. Anesthesiology. 1992;77(4):772–8.PubMedCrossRef

34.

Wiener CM, Kirk W, Albert RK. Prone position reverses gravitational distribution of perfusion in dog lungs with oleic acid-induced injury. J Appl Physiol. 1990;68(4):1386–92.PubMed

35.

Lamm WJ, Graham MM, Albert RK. Mechanism by which the prone position improves oxygenation in acute lung injury. Am J Respir Crit Care Med. 1994;150(1):184–93.PubMedCrossRef

36.

Richter T, Bellani G, Scott Harris R, Vidal Melo MF, Winkler T, Venegas JG, et al. Effect of prone position on regional shunt, aeration, and perfusion in experimental acute lung injury. Am J Respir Crit Care Med. 2005;172(4):480–7.PubMedPubMedCentralCrossRef

37.

Richard JC, Bregeon F, Costes N, Bars DL, Tourvieille C, Lavenne F, et al. Effects of prone position and positive end-expiratory pressure on lung perfusion and ventilation. Crit Care Med. 2008;36(8):2373–80.PubMedCrossRef

38.

Musch G, Harris RS, Vidal Melo MF, O’Neill KR, Layfield JD, Winkler T, et al. Mechanism by which a sustained inflation can worsen oxygenation in acute lung injury. Anesthesiology. 2004;100(2):323–30.PubMedCrossRef

39.

Guldner A, Kiss T, Bluth T, Uhlig C, Braune A, Carvalho N, et al. Effects of Ultraprotective Ventilation, Extracorporeal Carbon Dioxide Removal, and Spontaneous Breathing on Lung Morphofunction and Inflammation in Experimental Severe Acute Respiratory Distress Syndrome. Anesthesiology. 2014. doi:10.1097/ALN.0000000000000504.

40.

Carvalho NC, Guldner A, Beda A, Rentzsch I, Uhlig C, Dittrich S, et al. Higher levels of spontaneous breathing reduce lung injury in experimental moderate acute respiratory distress syndrome. Crit Care Med. 2014;42(11):702–15.CrossRef

41.

Xia J, Zhang H, Sun B, Yang R, He H, Zhan Q. Spontaneous breathing with biphasic positive airway pressure attenuates lung injury in hydrochloric acid-induced acute respiratory distress syndrome. Anesthesiology. 2014;120(6):1441–9.PubMedCrossRef

Title: Reduced pulmonary blood flow in regions of injury 2 hours after acid aspiration in rats
Authors: Torsten Richter
Ralf Bergmann
Guido Musch
Jens Pietzsch
Thea Koch
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI: https://doi.org/10.1186/s12871-015-0013-0

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Reduced pulmonary blood flow in regions of injury 2 hours after acid aspiration in rats

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2015

Extracorporeal membrane oxygenation to support repeated whole-lung lavage in a patient with pulmonary alveolar proteinosis in life threatening dyspnoe – a case report

‘Sepsis-related anemia’ is absent at hospital presentation; a retrospective cohort analysis

Case report of Tako-Tsubo cardiomyopathy associated with repetitive anaesthesia in a female patient with Tako-Tsubo cardiomyopathy

Optimal pain management for radical prostatectomy surgery: what is the evidence?

Cardiac surgery in 260 octogenarians: a case series

Pilot study comparing simulation-based and didactic lecture-based critical care teaching for final-year medical students