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Pulmonary effects of remote ischemic preconditioning in a porcine model of ventilation-induced lung injury.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
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2018 (English)In: Respiratory Physiology & Neurobiology, ISSN 1569-9048, E-ISSN 1878-1519, Vol. 259, p. 111-118Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: One-lung ventilation (OLV) may result in lung injury due to increased mechanical stress and tidal recruitment. As a result, a pulmonary inflammatory response is induced. The present randomized, controlled, animal experiment was undertaken to assess the effects of remote ischemic preconditioning (RIP) on diffuse alveolar damage and immune response after OLV.

METHODS: Fourteen piglets (26 ± 2 kg) were randomized to control (n = 7) and RIP group (n = 7). For RIP, a blood pressure cuff at hind limb was inflated up to 200 mmHg for 5 min and deflated for another 5 min, this being done four times before OLV. Mechanical ventilation settings were constant throughout the experiment: VT = 10 ml/kg, FIO2 = 0.40, PEEP = 5cmH2O. OLV was performed by left-sided bronchial blockade. Number of cells was counted from BAL fluid; cytokines were assessed by immunoassays in lung tissue and serum samples. Lung tissue samples were obtained for histological analysis and assessment of diffuse alveolar damage (DAD) score.

RESULTS: Hemodynamic and respiratory data were similar in both groups. Likewise, no differences in pulmonary tissue TNF-α and protein content were found, but fewer leukocytes were counted in the ventilated lung after RIP. DAD scores were high without any differences between controls and RIP. On the other hand, alveolar edema and microhemorrhage were significantly increased after RIP.

CONCLUSIONS: OLV results in alveolar injury, possibly enhanced by RIP. On the other hand, RIP attenuates the immunological response and decreased alveolar leukocyte recruitment in a porcine model of OLV.

Place, publisher, year, edition, pages
2018. Vol. 259, p. 111-118
Keywords [en]
Alveolar immune response, Animal model, Broncho-alveolar lavage, One-lung ventilation, Remote ischemic preconditioning
National Category
Medical and Health Sciences
Research subject
Anaesthesiology and Intensive Care; Physiology
Identifiers
URN: urn:nbn:se:uu:diva-365777DOI: 10.1016/j.resp.2018.08.009ISI: 000453339400015PubMedID: 30176289OAI: oai:DiVA.org:uu-365777DiVA, id: diva2:1263202
Funder
Swedish Research Council, X2015-99x-22731-01-04Swedish Heart Lung FoundationAvailable from: 2018-11-14 Created: 2018-11-14 Last updated: 2019-01-15Bibliographically approved

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Hedenstierna, GöranAhlgren, Kerstin M.Larsson, AndersKretzschmar, Moritz

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