Desenvolvimento de lesão pulmonar aguda induzida por instilação intratraqueal de lipopolissacáride em um modelo animal de enfisema pulmonar por administração de elastase

Introduction: The response of lungs with emphysema to an acute lung injury (ALI) remains unclear. The aim of this study was to compare the severity of ALI in response to intratracheal instillation of lipopolysaccharide (LPS) in rats with and without emphysema. Methods: Twenty four adult male Wistar rats were randomized to four groups: control group (C-G), ALI group (ALI-G), emphysema group (E-G), emphysema and ALI group (E-ALI-G). The emphysema was induced by intratracheal instillation of elastase (12 UI). After three weeks, the animals of ALI groups received LPS intratracheally(2 mg/Kg). Euthanasia and the following analysis were performed 24 hours after ALI induction: blood gas measures, bronchoalveolar lavage (BAL), mRNA expression of inflammatory mediators and lung histology. Results: The animals of ALI-G (0.55 ± 0.15) and E-ALI-G (0.69 ± 0.08) showed a higher ALI score compared to C-G (0.12 ± 0.04) and E-G (0.16 ± 0.04) (p <0.05). Total cell count (E-G = 3.09 ± 0.83; ALI-G = 4.45 ± 1.90; E-ALI-G = 5.90 ± 2.10; C-G = 0.73 ± 0.37 x 105) and neutrophil count (E-G = 0.69 ± 0.35; ALI-G = 2.53 ± 1.09; E-ALI-G = 3.86 ± 1.40; C-G = 0.09 ± 0.07 x 105) in the BAL were higher in the groups E-G, ALI-G and E-ALI-G when compared to C-G (p <0.05). The IL-6, TNF-α, and CXCL2 mRNA expressions were higher in the animals that received LPS (ALI-G and E-ALI-G) compared to the C-G and E-G (p <0.05). Although there were no statistical differences between the animals with and without emphysema in response to LPS instillation, we observed a trend of higher ALI score and BAL cellularity in the E-ALI-G. The E-ALI-G also showed an increased BAL/serum albumin ratio. Conclusion: The presence of emphysema was associated with a trend of increase in the inflammatory pulmonary response to intratracheal LPS instillation.Introdução: A relação entre o enfisema e a lesão pulmonar aguda (LPA) ainda não está bem definida. O objetivo deste estudo foi comparar a gravidade da LPA em resposta à instilação intratraqueal de lipopolissacáride (LPS) em ratos com e sem enfisema. Métodos: Vinte e quatro ratos Wistar machos adultos foram randomizados para quatro grupos: grupo controle (G-C), grupo LPA (G-LPA), grupo enfisema (G-E) e grupo enfisema com LPA (G-E-LPA). O enfisema foi induzido por instilação intratraqueal de elastase (12 UI). Após três semanas, os animais dos grupos LPA receberam LPS intratraquealmente (2 mg/Kg). A eutanásia e as seguintes análises foram realizadas 24 horas após a indução de LPA: medidas dos gases sanguíneos, lavado broncoalveolar (LBA), expressão de RNAm de mediadores inflamatórios e histologia pulmonar. Resultados: Os animais dos grupos G-LPA (0,55 ± 0,15) e G-E-LPA (0,69 ± 0,08) apresentaram maior score de LPA em relação ao G-C (0,12 ± 0,04) e G-E (0,60 ± 0,04) (p <0,05). A contagem total de células (G-E = 3,09 ± 0,83; G-LPA = 4,45 ± 1,90; G-E-LPA = 5,90 ± 2,10; G-C = 0,73 ± 0,37 x 105) e de neutrófilos (G-E = 0,69 ± 0,35; G-LPA = 2,53 ± 1,09, G-E-LPA = 3,86 ± 1,40; G-C = 0,09 ± 0,07 x 105) no LBA foram maiores nos grupos G-E, G-LPA e G-E-LPA quando comparados ao G-C (p <0,05) . As expressões de RNAm de IL-6, TNF-α e CXCL2 foram maiores nos animais que receberam LPS (G-LPA e G-E-LPA) em comparação com G-C e G-E (p <0,05). Embora não haja diferenças estatísticas entre os animais com e sem enfisema em resposta à instilação de LPS, observou-se uma tendência de maior score de LPA e celularidade no LBA no G-E-LPA. O G-E-LPA também mostrou uma razão LBA/albumina sérica aumentada. Conclusão: A presença de enfisema foi associada a uma tendência de aumento da resposta inflamatória pulmonar secundária à instilação intratraqueal de LPS

Pre-treatment with dexamethasone attenuates experimental ventilator-induced lung injury

ABSTRACT Objective: To evaluate the effects that administering dexamethasone before the induction of ventilator-induced lung injury (VILI) has on the temporal evolution of that injury. Methods: Wistar rats were allocated to one of three groups: pre-VILI administration of dexamethasone (dexamethasone group); pre-VILI administration of saline (control group); or ventilation only (sham group). The VILI was induced by ventilation at a high tidal volume. Animals in the dexamethasone and control groups were euthanized at 0, 4, 24, and 168 h after VILI induction. We analyzed arterial blood gases, lung edema, cell counts (total and differential) in the BAL fluid, and lung histology. Results: At 0, 4, and 24 h after VILI induction, acute lung injury (ALI) scores were higher in the control group than in the sham group (p < 0.05). Administration of dexamethasone prior to VILI induction decreased the severity of the lung injury. At 4 h and 24 h after induction, the ALI score in the dexamethasone group was not significantly different from that observed for the sham group and was lower than that observed for the control group (p < 0.05). Neutrophil counts in BAL fluid were increased in the control and dexamethasone groups, peaking at 4 h after VILI induction (p < 0.05). However, the neutrophil counts were lower in the dexamethasone group than in the control group at 4 h and 24 h after induction (p < 0.05). Pre-treatment with dexamethasone also prevented the post-induction oxygenation impairment seen in the control group. Conclusions: Administration of dexamethasone prior to VILI induction attenuates the effects of the injury in Wistar rats. The molecular mechanisms of such injury and the possible clinical role of corticosteroids in VILI have yet to be elucidated

The effects of prone position ventilation on experimental mild acute lung injury induced by intraperitoneal lipopolysaccharide injection in rats

The benefits of prone position ventilation are well demonstrated in the severe forms of acute respiratory distress syndrome, but not in the milder forms. We investigated the effects of prone position on arterial blood gases, lung inflammation, and histology in an experimental mild acute lung injury (ALI) model. ALI was induced in Wistar rats by intraperitoneal Escherichia coli lipopolysaccharide (LPS, 5 mg/kg). After 24 h, the animals with PaO2/FIO2 between 200 and 300 mmHg were randomized into 2 groups: prone position (n = 6) and supine position (n = 6). Both groups were compared with a control group (n = 5) that was ventilated in the supine position. All of the groups were ventilated for 1 h with volume-controlled ventilation mode (tidal volume = 6 ml/kg, respiratory rate = 80 breaths/min, positive end-expiratory pressure = 5 cmH2O, inspired oxygen fraction = 1). Significantly higher lung injury scores were observed in the LPS-supine group compared to the LPS-prone and control groups (0.32 ± 0.03; 0.17 ± 0.03 and 0.13 ± 0.04, respectively) (p < 0.001), mainly due to a higher neutrophil infiltration level in the interstitial space and more proteinaceous debris that filled the airspaces. Similar differences were observed when the gravity-dependent lung regions and non-dependent lung regions were analyzed separately (p < 0.05). The BAL neutrophil content was also higher in the LPS-supine group compared to the LPS-prone and control groups (p < 0.05). There were no significant differences in the wet/dry ratio and gas exchange levels. In this experimental extrapulmonary mild ALI model, prone position ventilation for 1 h, when compared with supine position ventilation, was associated with lower lung inflammation and injury.Rede Mineira TOXIFARFundação de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG)Center of Reproductive BiologyPrograma de Apoio ao Recém-Doutor/Propesq/UFJF (2013/2014)1.915 JCR (2016) Q3, 41/59 Respiratory SystemUE

Laços familiares e aspectos materiais da dinâmica mercantil na cidade de São Paulo (séculos XVIII e XIX)

Based on the family ties established within the active merchant community of the city of São Paulo through the 18th and 19th centuries, the author sets out to tell the life story of nine merchants involved in matrimonial alliances, with a focus on the transactions carried out, their sociopolitical engagement and the fortunes of their descendants. Having done that, she seeks out connections between the urban development of the city center and the activities of these businessmen by means of analyses centered on the material aspects of their lives, particularly those related to their homes and home furniture

Effect of lung recruitment and titrated Positive End-Expiratory Pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome - A randomized clinical trial

IMPORTANCE: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS: An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501; experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stay; ventilator-free days through day 28; pneumothorax requiring drainage within 7 days; barotrauma within 7 days; and ICU, in-hospital, and 6-month mortality. RESULTS: A total of 1010 patients (37.5% female; mean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.20; 95% CI, 1.01 to 1.42; P = .041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%; HR, 1.18; 95% CI, 1.01 to 1.38; P = .04), decreased the number of mean ventilator-free days (5.3 vs 6.4; difference, −1.1; 95% CI, −2.1 to −0.1; P = .03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%; difference, 2.0%; 95% CI, 0.0% to 4.0%; P = .03), and the risk of barotrauma (5.6% vs 1.6%; difference, 4.0%; 95% CI, 1.5% to 6.5%; P = .001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. CONCLUSIONS AND RELEVANCE: In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01374022