Ventilator-induced lung injury

Mechanical ventilation has become essential for the support of critically ill patients; however, it can cause ventilator-induced lung injury (VILI) or aggravate ventilator-associated lung injury (VALI), contributing to the high mortality rates observed in acute respiratory distress syndrome. This chapter discusses the mechanisms leading to VILI/VALI, the diagnostic procedures of early detection and how to prevent it. The clinical relevance of low lung volume injury and the application of high positive end-expiratory pressure levels remain debatable. Furthermore, researchers were not successful in transferring the measurement of inflammatory mediators during VILI/VALI from bench to bedside. Therefore, the following issues still require elucidation: 1) the best ventilator strategy to be adopted; 2) which ventilator parameters should be managed; 3) how to monitor VILI/VALI (arterial blood gases, lung mechanics, proinflammatory mediators); 4) the role of imaging (computed tomography scan, lung ultrasound and positron emission tomography; and 5) how to prevent VILI/VALI (new ventilatory and pharmacological strategies)

Effects of different tidal volumes in pulmonary and extrapulmonary lung injury with or without intraabdominal hypertension

Abstract PURPOSE: We hypothesized that: (1) intraabdominal hypertension increases pulmonary inflammatory and fibrogenic responses in acute lung injury (ALI); (2) in the presence of intraabdominal hypertension, higher tidal volume reduces lung damage in extrapulmonary ALI, but not in pulmonary ALI. METHODS: Wistar rats were randomly allocated to receive Escherichia coli lipopolysaccharide intratracheally (pulmonary ALI) or intraperitoneally (extrapulmonary ALI). After 24 h, animals were randomized into subgroups without or with intraabdominal hypertension (15 mmHg) and ventilated with positive end expiratory pressure = 5 cmH(2)O and tidal volume of 6 or 10 ml/kg during 1 h. Lung and chest wall mechanics, arterial blood gases, lung and distal organ histology, and interleukin (IL)-1\u3b2, IL-6, caspase-3 and type III procollagen (PCIII) mRNA expressions in lung tissue were analyzed. RESULTS: With intraabdominal hypertension, (1) chest-wall static elastance increased, and PCIII, IL-1\u3b2, IL-6, and caspase-3 expressions were more pronounced than in animals with normal intraabdominal pressure in both ALI groups; (2) in extrapulmonary ALI, higher tidal volume was associated with decreased atelectasis, and lower IL-6 and caspase-3 expressions; (3) in pulmonary ALI, higher tidal volume led to higher IL-6 expression; and (4) in pulmonary ALI, liver, kidney, and villi cell apoptosis was increased, but not affected by tidal volume. CONCLUSIONS: Intraabdominal hypertension increased inflammation and fibrogenesis in the lung independent of ALI etiology. In extrapulmonary ALI associated with intraabdominal hypertension, higher tidal volume improved lung morphometry with lower inflammation in lung tissue. Conversely, in pulmonary ALI associated with intraabdominal hypertension, higher tidal volume increased IL-6 expression

Cama-de-frango em mono e policultivo de fáfia com cravo-de-defunto e manjericão Poultry manure in mono and intercrop of Brazilian ginseng with marigold and basil

O experimento foi conduzido em campo da Universidade Federal da Grande Dourados (UFGD), em Dourados-MS, de março de 2005 a setembro de 2006, em Latossolo Vermelho distroférrico. O objetivo foi avaliar a produção da Pfaffia glomerata (Spreng) Pedersen (fáfia) em monocultivo e os policultivos com Tagetes erecta L. (cravo-de-defunto) e Ocimum basilicum L. (manjericão), sem e com incorporação de cama-de-frango semidecomposta. Os fatores em estudo foram a fáfia (F), o cravo-de-defunto (C) e o manjericão (M) em monocultivos e os policultivos com duas fileiras de fáfia e três de cravo (F2C3) e duas fileiras de fáfia e três de manjericão (F2M3), todos sem e com incorporação ao solo de cama-de-frango de corte semidecomposta. Os dez tratamentos foram arranjados no delineamento blocos casualizados, com quatro repetições. A produção de massa fresca e seca da parte aérea da fáfia foi maior (13,22 t ha-1 e 4,39 t ha-1, respectivamente) em monocultivo, independente do uso da cama-de-frango. Por outro lado, nenhum dos tratamentos influenciou a massa fresca e seca e o número de raízes da fáfia, que foram, em média, de 10,02 e 2,07 t ha-1 e 417.916 raízes ha-1, respectivamente. O diâmetro das raízes foi maior (23,5 mm) no policultivo com o manjericão. As produções de massas frescas e secas dos capítulos florais do cravo-de-defunto foram maiores (14,28 t ha-1e 1,278 t ha-1, respectivamente) no policultivo com a fáfia, mas apenas a produção de massa fresca dos capítulos foi maior (14,17 t ha-1) com o uso da cama-de-frango. A produção de parte aérea do manjericão foram maiores (52,91 t ha-1) no policultivo, independente com qual espécie; porém, não foi influenciada pelo uso da cama-de-frango. A razão de área equivalente (RAE) para o policultivo da fáfia com o cravo-de-defunto foi de 2,15 com cama-de-frango e de 1,99 sem cama e com o manjericão, foi 2,44 com cama e de 3,08 sem cama. Como os valores foram maiores que 1,0, indicam que os policultivos foram efetivos.<br>This study was carried out in field of the Universidade Federal da Grande Dourados, in Dourados, Brazil, during the period from March 2005 to September 2006. The aim of the experiment was to evaluate Pfaffia glomerata (Spreng) Pedersen yield under monocropping system or intercropped with Tagetes erecta L. and Ocimum basilicum L, in a Distroferric Red Latosol (sand loam Rhodic Oxisol), using semi-decomposed poultry manure (PM). The study objects were Brazilian ginseng (BG), marigold (M) and basil (B) under monocropping and the intercropping of two Brazilian ginseng, three marigold (BG2M3) and three basil (BG2B3) lines, all of them with or without semi-decomposed poultry manure (PM) as fertilizer. Ten treatments were arranged in randomized blocks design, with four replications. Fresh and dry weight production from shoot of Brazilian ginseng were higher (13.22 t ha-1 and 4.39 t ha-1, respectively) under monocropping, independently of the use of poultry manure. Nevertheless, none of experimental designs influenced the dry and fresh weight production or root number of Brazilian ginseng which produced average values of 10.02 and 2.07 t ha-1 and 417,916 roots ha-1, respectively. Root diameter was higher (23.5 mm) under intercropping system with basil. Dry and fresh weight of marigold flowers were higher (14.28 t ha-1and 1.278 t ha-1, respectively) when intercropped with Brazilian ginseng, but only fresh weight of the flowers was increased (14.17 t ha-1) by poultry manure application. Basil shoot production was higher (52.91 t ha-1) when intercropped, independently of the used species; however, they were not influenced by the use of poultry manure. Land equivalent ration (LER) for the Brazilian ginseng intercropped with marigold was 2.15 under poultry manure application and 1.99 without it, and for the basil 2.44 under poultry manure application and 3.08 without it. Values higher than 1.0 indicate that the intercropping systems were effective