Tidal volume in animal models of hemorrhagic and endotoxic shock

Liu,Fei; Ma,Tao; Liu,Zhi

doi:10.3892/etm.2013.969

Tidal volume in animal models of hemorrhagic and endotoxic shock

Authors:
- Fei Liu
- Tao Ma
- Zhi Liu
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Affiliations: Department of Emergency, The First Affiliated Hospital of China Medical University, Shenyang 110001, P.R. China
Published online on: February 20, 2013 https://doi.org/10.3892/etm.2013.969
Pages: 1067-1072

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Abstract

The aim of this study was to examine the characteristics of lung, kidney and small intestine injury caused by early resuscitation from hemorrhagic shock (HS) and endotoxic shock (ES) when ventilating with different tidal volumes (Vts). The study also considered the determination of the appropriate Vt for use in mechanical ventilation (MV) during treatment for shock. Resuscitated rabbits were ventilated with varying Vts for 120 min following 60 min of HS or ES. The histopathology, ultrastructure and apoptotic index (AI) of the lung, kidney and small intestine were then measured. Organs from the high-Vt groups (VT=12-15 ml/kg) showed the highest pathological scores (PSs; P<0.05). For HS, the renal PS and AI of the HS-M group (Vt=8-10 ml/kg)were lower than those of the HS-L group (Vt=4-6 ml/kg) and the lung PS and AI of the HS-C (control) group were lower compared with those of the HS-M group. For ES, the lung PS of the ES-L group was lower compared with that of the ES-M group (Vt=8-10 ml/kg) and the lung AI of the ES-C (control) group was lower compared with that of the ES-L group (Vt=4-6 ml/kg). When ventilated with the same Vt, ES resulted in higher PSs in the lung and intestine and a lower renal PS (P<0.05) than HS. MV was not recommended for either shock type. When it was necessary for MV to be applied, low Vt (4‑6 ml/kg) protected the lung in ES. Moderate Vt (8‑10 ml/kg) may be relatively safe to use for HS.

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1	Giuliani D, Mioni C, Bazzani C, et al: Selective melanocortin MC4 receptor agonists reverse haemorrhagic shock and prevent multiple organ damage. Br J Pharmacol. 150:595–603. 2007. View Article : Google Scholar : PubMed/NCBI
2	Madách K, Aladzsity I, Szilágyi A, et al: 4G/5G polymorphism of PAI-1 gene is associated with multiple organ dysfunction and septic shock in pneumonia induced severe sepsis: prospective, observational, genetic study. Crit Care. 14:R792010.PubMed/NCBI
3	Dellinger RP, Levy MM, Carlet JM, et al: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 34:17–60. 2008. View Article : Google Scholar
4	Wheeler AP: Recent developments in the diagnosis and management of severe sepsis. Chest. 132:1967–1976. 2007. View Article : Google Scholar
5	No authors listed. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 342:1301–1308. 2000.
6	Parsons PE, Eisner MD, Thompson BT, et al: Lower tidal volume ventilation and plasma cytokine markers of inflammation in patients with acute lung injury. Crit Care Med. 33:1–6. 2005.
7	Ragaller M and Richter T: Acute lung injury and acute respiratory distress syndrome. J Emerg Trauma Shock. 3:43–51. 2010. View Article : Google Scholar : PubMed/NCBI
8	Imai Y, Parodo J, Kajikawa O, et al: Injurious mechanical ventilation and end-organ epithelial cell apoptosis and organ dysfunction in an experimental model of acute respiratory distress syndrome. JAMA. 289:2104–2112. 2003. View Article : Google Scholar : PubMed/NCBI
9	Dhanireddy S, Altemeier WA, Matute-Bello G, et al: Mechanical ventilation induces inflammation, lung injury, and extra-pulmonary organ dysfunction in experimental pneumonia. Lab Invest. 86:790–799. 2006. View Article : Google Scholar : PubMed/NCBI
10	O’Mahony DS, Liles WC, Altemeier WA, et al: Mechanical ventilation interacts with endotoxemia to induce extrapulmonary organ dysfunction. Crit Care. 10:R1362006.PubMed/NCBI
11	Wolthuis EK, Vlaar AP, Choi G, Roelofs JJ, Juffermans NP and Schultz MJ: Mechanical ventilation using non-injurious ventilation settings causes lung injury in the absence of pre-existing lung injury in healthy mice. Crit Care. 13:R12009. View Article : Google Scholar : PubMed/NCBI
12	Douzinas EE, Andrianakis I, Livaditi O, et al: The level of hypotension during hemorrhagic shock is a major determinant of the post-resuscitation systemic inflammatory response: an experimental study. BMC Physiol. 8:152008. View Article : Google Scholar : PubMed/NCBI
13	Brégeon F, Delpierre S, Chetaille B, et al: Mechanical ventilation affects lung function and cytokine production in an experimental model of endotoxemia. Anesthesiology. 102:331–339. 2005.PubMed/NCBI
14	Paller MS, Hoidal JR and Ferris TF: Oxygen free radicals in ischemic acute renal failure in the rat. J Clin Invest. 74:1156–1164. 1984. View Article : Google Scholar : PubMed/NCBI
15	Chiu CJ, McArdle AH, Brown R, Scott HJ and Gurd FN: Intestinal mucosal lesions in low flow states. A morphological, hemodynamic, and metabolic reappraisal. Arch Surg. 101:478–483. 1970. View Article : Google Scholar : PubMed/NCBI
16	Liu F, Zhang HY and Liu Z: Effects of mechanical ventilation with different tidal volumes on small intestine injury of early resuscitated hemorrhagic and endotoxic shock rabbits. World Chinese Journal of Digestology. 16:833–838. 2008.(In Chinese).
17	Ng CS, Wan S, Ho AM and Underwood MJ: Gene expression changes with a ‘non-injurious’ ventilation strategy. Crit Care. 13:4032009.
18	Krismer AC, Wenzel V, Lindner KH, et al: Influence of positive end-expiratory pressure ventilation on survival during severe hemorrhagic shock. Ann Emerg Med. 46:337–342. 2005. View Article : Google Scholar : PubMed/NCBI
19	Krismer AC, Wenzel V, Lindner KH, et al: Influence of negative expiratory pressure ventilation on hemodynamic variables during severe hemorrhagic shock. Crit Care Med. 34:2175–2181. 2006. View Article : Google Scholar
20	Herff H, Paal P, von Goedecke A, Lindner KH, Severing AC and Wenzel V: Influence of ventilation strategies on survival in severe controlled hemorrhagic shock. Crit Care Med. 36:2613–2620. 2008. View Article : Google Scholar : PubMed/NCBI
21	Carcoana OV, Mathew JP, Davis E, et al: Mannitol and dopamine in patients undergoing cardiopulmonary bypass: a randomized clinical trial. Anesth Analg. 97:1222–1229. 2003. View Article : Google Scholar : PubMed/NCBI
22	Legrand M, Mik EG, Johannes T, Payen D and Ince C: Renal hypoxia and dysoxia after reperfusion of the ischemic kidney. Mol Med. 14:502–516. 2008. View Article : Google Scholar : PubMed/NCBI
23	Han X, Fink MP, Uchiyama T, Yang R and Delude RL: Increased iNOS activity is essential for pulmonary epithelial tight junction dysfunction in endotoxemic mice. Am J Physiol Lung Cell Mol Physiol. 286:L259–L267. 2004. View Article : Google Scholar : PubMed/NCBI
24	Moriez R, Salvador-Cartier C, Theodorou V, Fioramonti J, Eutamene H and Bueno L: Myosin light chain kinase is involved in lipopolysaccharide-induced disruption of colonic epithelial barrier and bacterial translocation in rats. Am J Pathol. 167:1071–1079. 2005. View Article : Google Scholar : PubMed/NCBI
25	Han X, Fink MP, Yang R and Delude RL: Increased iNOS activity is essential for intestinal epithelial tight junction dysfunction in endotoxemic mice. Shock. 21:261–270. 2004. View Article : Google Scholar : PubMed/NCBI
26	Schreiber T, Hueter L, Schwarzkopf K, Hohlstein S, Schmidt B and Karzai W: Increased susceptibility to ventilator-associated lung injury persists after clinical recovery from experimental endotoxemia. Anesthesiology. 104:133–141. 2006. View Article : Google Scholar
27	Saldias FJ, Comellas AP, Pesce L, Lecuona E and Sznajder JI: Dopamine increases lung liquid clearance during mechanical ventilation. Am J Physiol Lung Cell Mol Physiol. 283:L136–L143. 2002. View Article : Google Scholar : PubMed/NCBI
28	Chamorro-Marín V, García-Delgado M, Touma-Fernández A, Aguilar-Alonso E and Fernández-Mondejar E: Intratracheal dopamine attenuates pulmonary edema and improves survival after ventilator-induced lung injury in rats. Crit Care. 12:R392008.PubMed/NCBI
29	Birnbaum J, Klotz E, Spies CD, et al: Effects of dopamine on the intestinal microvascular blood flow and leukocyte activation in a sepsis model in rats. Crit Care. 10:R1172006. View Article : Google Scholar : PubMed/NCBI
30	Abdelsalam M: Permissive hypoxemia: is it time to change our approach? Chest. 129:210–211. 2006. View Article : Google Scholar : PubMed/NCBI