Lung and 'end organ' injury due to mechanical ventilation in animals: comparison between the prone and supine positions
Loading...
Date
Authors
Nakos, G.
Batistatou, A.
Galiatsou, E.
Konstanti, E.
Koulouras, V.
Kanavaros, P.
Doulis, A.
Kitsakos, A.
Karachaliou, A.
Lekka, M. E.
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Type
Type of the conference item
Journal type
peer reviewed
Educational material type
Conference Name
Journal name
Critical Care
Book name
Book series
Book edition
Alternative title / Subtitle
Description
Introduction Use of the prone position in patients with acute lung injury improves their oxygenation. Most of these patients die from multisystem organ failure and not from hypoxia, however. Moreover, there is some evidence that the organ failure is caused by increased cell apoptosis. In the present study we therefore examined whether the position of the patients affects histological changes and apoptosis in the lung and 'end organs', including the brain, heart, diaphragm, liver, kidneys and small intestine. Methods Ten mechanically ventilated sheep with a tidal volume of 15 ml/kg body weight were studied for 90 minutes. Five sheep were placed in the supine position and five sheep were placed in the prone position during the experiment. Lung changes were analyzed histologically using a semiquantitative scoring system and the extent of apoptosis was investigated with the TUNEL method. Results In the supine position intra-alaveolar hemorrhage appeared predominantly in the dorsal areas, while the other histopathologic lesions were homogeneously distributed throughout the lungs. In the prone position, all histological changes were homogeneously distributed. A significantly higher score of lung injury was found in the supine position than in the prone position (4.63 +/- 0.58 and 2.17 +/- 0.19, respectively) ( P < 0.0001). The histopathologic changes were accompanied by increased apoptosis ( TUNEL method). In the supine position, the apoptotic index in the lung and in most of the 'end organs' was significantly higher compared with the prone position ( all P < 0.005). Interestingly, the apoptotic index was higher in dorsal areas compared with ventral areas in both the prone and supine positions ( P < 0.003 and P < 0.02, respectively). Conclusion Our results suggest that the prone position appears to reduce the severity and the extent of lung injury, and is associated with decreased apoptosis in the lung and 'end organs'.
Description
Keywords
respiratory-distress-syndrome, in-vivo, apoptosis, failure, pathophysiology, oxygenation, barotrauma, pressures, perfusion, posture
Subject classification
Citation
Link
<Go to ISI>://000240382800038
http://ccforum.com/content/pdf/cc4840.pdf
http://ccforum.com/content/pdf/cc4840.pdf
Language
en
Publishing department/division
Advisor name
Examining committee
General Description / Additional Comments
Institution and School/Department of submitter
Πανεπιστήμιο Ιωαννίνων. Σχολή Θετικών Επιστημών. Τμήμα Χημείας