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Comparação entre posiçao prona e posiçao supina, associadas à ventilação oscilatória de alta frequência, em modelo experimental de lesão pulmonar agudaPires, Rafaelle Batistella [UNESP] 20 February 2013 (has links) (PDF)
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pires_rb_me_botfm.pdf: 268409 bytes, checksum: a7f99374144af3decea275454b7e5df4 (MD5) / A Síndrome do Desconforto Respiratório Agudo (SDRA) cursa com alta mortalidade apesar do melhor entendimento de sua fisiopatologia e avanços no tratamento. A Ventilação Oscilatória de Alta Frequência (VOAF) é método protetor por utilizar baixos volumes correntes (VC). Existem terapias adjuvantes à ventilação, dentre as quais se destaca a posição prona, que possibilita homogeneização da distribuição do VC e promove recrutamento alveolar. O objetivo foi investigar o efeito da posição prona associada à VOAF sobre a oxigenação, inflamação, histologia e dano oxidativo pulmonares, comparando-a com a posição supina neste mesmo modo ventilatório em modelo experimental de lesão pulmonar aguda (LPA) induzida em coelhos. Trinta coelhos foram instrumentados com traqueostomia e acessos vasculares e ventilados. A LPA foi induzida por infusão traqueal de salina aquecida (30mL/Kg, 38°C). Os coelhos foram submetidos à VOAF e divididos em dois grupos (n=15), um ventilado em posição supina (GS) e outro em posição prona (GP). VOAF foi iniciada com pressão aérea média de 16 cmH2O, que foi diminuída a cada 30 minutos até 10-11 cmH2O. Nos últimos 30 minutos os coelhos foram reposicionados em posição supina. Parâmetros ventilatórios e hemodinâmicos foram registrados a cada 30 minutos durante 150 minutos. Os desfechos foram: oxigenação, avaliada pela relação PaO2/FiO2 e índice de oxigenação (IO); inflamação pulmonar, avaliada pela porcentagem de polimorfonucleares (PMN) no lavado broncoalveolar (BAL) e pelo nível de TNF-alfa medido no BAL e no tecido pulmonar nas áreas ventral e dorsal; estresse oxidativo tecidual pulmonar, determinado pelo método de peroxidação lipídica (malondialdeído); e lesão tecidual pulmonar, determinada por escore histológico de lesão por área pulmonar. O nível de significância avaliado... / Acute respiratory distress syndrome (ARDS) has been associated to high mortality rate despite better understanding of its pathophysiology and advances in treatment. High-frequency oscillatory ventilation (HFOV) is a protective ventilatory method because of using low tidal volume (VT). There are also many adjunctive therapies, of which prone position is known to allow homogenization of VT distribution and to promote alveolar recruitment. The objective was to investigate the prone position and HFOV association effects on oxygenation, inflammation, oxidative damage and lung histology, comparing to the supine position in this same ventilation mode, in experimental acute lung injury (ALI) induced in rabbits. Thirty rabbits were instrumented with tracheotomy and vascular catheters and ventilated. ALI was induced by tracheal infusion of warm saline (30mL/Kg, 38°C). Rabbits were submitted to HFOV and divided in two groups (n=15), one ventilated in supine position (SG), and the other in prone position (PG). HFOV was initiated with mean airway pressure of 16 cmH2O, which was decreased each 30 minutes until 10-11 cmH2O. In the last 30 minutes, all rabbits were repositioned to supine position. Ventilatory and hemodynamic parameters were recorded every 30 minutes for 150 minutes. The outcomes were: oxygenation, measured by PaO2/FiO2 ratio and oxygenation index (OI); lung inflammation, assessed by the percentage of polymorphonuclear cells (PMN) in bronchoalveolar lavage fluid (BAL) and by the level of TNF- alpha measured in BAL and in lung tissue, in ventral and dorsal areas; lung tissue oxidative stress, determined by the method of lipid peroxidation (malondialdehyde); and lung tissue damage, as determined by a histological score of injury, in each lung area. A significance level of 5% was... (Complete abstract click electronic access below)
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Comparação entre os efeitos da posição prona e do óxido nítrico inalatório sobre oxigenação, mecânica respiratória, lesão histopatológica e inflamação na lesão pulmonar aguda induzida experimentalmenteSatrapa, Débora Avellaneda Penatti [UNESP] 25 February 2014 (has links) (PDF)
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000771322.pdf: 795316 bytes, checksum: e03e738556583e78c68280d321cd6c8e (MD5) / Fundamentação/Objetivos: A Síndrome do Desconforto Respiratório Agudo (SDRA) cursa com altos índices de mortalidade apesar do melhor entendimento de sua fisiopatologia e avanços no tratamento. Existem várias terapias adjuvantes à ventilação mecânica (VM), dentre as quais se destaca a posição prona, que possibilita homogeneização da distribuição do volume corrente (VC) e promove recrutamento alveolar, e o óxido nítrico inalatório (NOi) que promove vasodilatação pulmonar seletiva direcionando o fluxo sanguíneo de áreas mal ventiladas para áreas bem ventiladas e com perfusão diminuída, otimizando a relação ventilação/perfusão e melhorando a oxigenação, com diminuição da resistência vascular pulmonar. Pela melhora da relação ventilação/perfusão, o gás pode permitir o emprego de VM menos agressiva, que, por sua vez, pode diminuir o risco de lesão pulmonar induzida pela VM e a morbidade. Objetivo: comparar os efeitos da posição prona com os do NOi sobre a oxigenação, mecânica respiratória, lesão histopatológica e inflamatória em modelo experimental de lesão pulmonar aguda (LPA). Métodos: Cinquenta coelhos foram instrumentados com traqueostomia e acessos vasculares e ventilados mecanicamente. A LPA foi induzida por infusão traqueal de salina aquecida (30mL/Kg, 38°C). Os coelhos foram submetidos à VMC protetora e distribuídos em quatro grupos: 1) animais com LPA em VMC protetora em posição supina (GVMS; n=15); 2) animais com LPA em VMC protetora + posição prona (GVMP; n=15); 3) animais com LPA em VMC protetora + NOi em posição supina (GVNO; n=15) e 4) animais sem lesão pulmonar submetidos à VMC protetora (sadio – GS; n=5). Os desfechos foram: oxigenação, avaliada pela relação PaO2/FiO2 e índice de oxigenação (IO); inflamação pulmonar, avaliada pela porcentagem de polimorfonucleares (PMN) no lavado broncoalveolar (BAL) e pelo nível de TNF-alfa medido no BAL e lesão ... / Background/Objectives: The Acute Respiratory Distress Syndrome (ARDS) is associated with high mortality rate despite better understanding of its pathophysiology and treatment advances. There are several adjuvant therapies that can be associated to mechanical ventilation (MV), among which stands out the prone position, which allows homogeneous tidal volume (VT) distribution and promotes alveolar recruitment; and inhaled nitric oxide (iNO) which promotes selective pulmonary vasodilation directing blood flow from areas poorly ventilated to well-ventilated areas and decreased perfusion, optimizing the ventilation/perfusion ratio and improving oxygenation with reduced pulmonary vascular resistance. Improved ventilation/perfusion ratio, allows the use of lesser aggressive mechanical ventilation (MV) treatment, which reduces the risk of lung injury induced by MV and morbidity. Objective: To compare the effects of prone position with iNO on oxygenation, respiratory mechanics, inflammatory and histological injury in an experimental model of acute lung injury (ALI). Methods: Fifty rabbits were instrumented with tracheotomy and vascular access and mechanically ventilated. ALI was induced by tracheal infusion of warm saline (30mL/kg, 38°C). Rabbits underwent protective conventional mechanical ventilation (CMV) were divided in four groups: 1) Animals with ALI in protective CMV + supine position (GVMS, n=15), 2) animals with ALI in protective CMV + prone position (GVMP, n=15) and 3) animals with ALI in protective CMV + iNO in supine position (GVNO, n=15). Additionally, there were five animals without lung injury submitted to protective CMV (Healthy group - GS, n=5). The outcomes were oxygenation, measured by PaO2/FiO2 ratio and oxygenation index (OI), lung inflammation assessed by the percentage of polymorphonuclear cells (PMN) in bronchoalveolar lavage (BAL) and TNF-alpha measured in BAL, and histological pulmonary injury determined by a injury ...
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Comparação entre os efeitos da posição prona e do óxido nítrico inalatório sobre oxigenação, mecânica respiratória, lesão histopatológica e inflamação na lesão pulmonar aguda induzida experimentalmente /Satrapa, Debora Avellaneda Penatti. January 2014 (has links)
Orientador: José Roberto Fioretto / Banca: Marcelo Barciela Brandão / Banca: Marcos Aurélio de Moraes / Resumo: Fundamentação/Objetivos: A Síndrome do Desconforto Respiratório Agudo (SDRA) cursa com altos índices de mortalidade apesar do melhor entendimento de sua fisiopatologia e avanços no tratamento. Existem várias terapias adjuvantes à ventilação mecânica (VM), dentre as quais se destaca a posição prona, que possibilita homogeneização da distribuição do volume corrente (VC) e promove recrutamento alveolar, e o óxido nítrico inalatório (NOi) que promove vasodilatação pulmonar seletiva direcionando o fluxo sanguíneo de áreas mal ventiladas para áreas bem ventiladas e com perfusão diminuída, otimizando a relação ventilação/perfusão e melhorando a oxigenação, com diminuição da resistência vascular pulmonar. Pela melhora da relação ventilação/perfusão, o gás pode permitir o emprego de VM menos agressiva, que, por sua vez, pode diminuir o risco de lesão pulmonar induzida pela VM e a morbidade. Objetivo: comparar os efeitos da posição prona com os do NOi sobre a oxigenação, mecânica respiratória, lesão histopatológica e inflamatória em modelo experimental de lesão pulmonar aguda (LPA). Métodos: Cinquenta coelhos foram instrumentados com traqueostomia e acessos vasculares e ventilados mecanicamente. A LPA foi induzida por infusão traqueal de salina aquecida (30mL/Kg, 38°C). Os coelhos foram submetidos à VMC protetora e distribuídos em quatro grupos: 1) animais com LPA em VMC protetora em posição supina (GVMS; n=15); 2) animais com LPA em VMC protetora + posição prona (GVMP; n=15); 3) animais com LPA em VMC protetora + NOi em posição supina (GVNO; n=15) e 4) animais sem lesão pulmonar submetidos à VMC protetora (sadio - GS; n=5). Os desfechos foram: oxigenação, avaliada pela relação PaO2/FiO2 e índice de oxigenação (IO); inflamação pulmonar, avaliada pela porcentagem de polimorfonucleares (PMN) no lavado broncoalveolar (BAL) e pelo nível de TNF-alfa medido no BAL e lesão... / Abstract: Background/Objectives: The Acute Respiratory Distress Syndrome (ARDS) is associated with high mortality rate despite better understanding of its pathophysiology and treatment advances. There are several adjuvant therapies that can be associated to mechanical ventilation (MV), among which stands out the prone position, which allows homogeneous tidal volume (VT) distribution and promotes alveolar recruitment; and inhaled nitric oxide (iNO) which promotes selective pulmonary vasodilation directing blood flow from areas poorly ventilated to well-ventilated areas and decreased perfusion, optimizing the ventilation/perfusion ratio and improving oxygenation with reduced pulmonary vascular resistance. Improved ventilation/perfusion ratio, allows the use of lesser aggressive mechanical ventilation (MV) treatment, which reduces the risk of lung injury induced by MV and morbidity. Objective: To compare the effects of prone position with iNO on oxygenation, respiratory mechanics, inflammatory and histological injury in an experimental model of acute lung injury (ALI). Methods: Fifty rabbits were instrumented with tracheotomy and vascular access and mechanically ventilated. ALI was induced by tracheal infusion of warm saline (30mL/kg, 38°C). Rabbits underwent protective conventional mechanical ventilation (CMV) were divided in four groups: 1) Animals with ALI in protective CMV + supine position (GVMS, n=15), 2) animals with ALI in protective CMV + prone position (GVMP, n=15) and 3) animals with ALI in protective CMV + iNO in supine position (GVNO, n=15). Additionally, there were five animals without lung injury submitted to protective CMV (Healthy group - GS, n=5). The outcomes were oxygenation, measured by PaO2/FiO2 ratio and oxygenation index (OI), lung inflammation assessed by the percentage of polymorphonuclear cells (PMN) in bronchoalveolar lavage (BAL) and TNF-alpha measured in BAL, and histological pulmonary injury determined by a injury ... / Mestre
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Efeitos do suporte ventilatorio com pressão controlada e volume controlado na função pulmonar dos pacientes submetidos a cirurgia cardiaca com circulação extra-corporea / Effects of pressure controlled ventilation and volume controlled ventilation on pulmonary function in cardiac surgery patients with cardiopulmonary bypassRodrigues, Cristiane Delgado Alves, 1978- 13 August 2018 (has links)
Orientador: Desanka Dragosavac / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-13T01:37:02Z (GMT). No. of bitstreams: 1
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Previous issue date: 2009 / Resumo: A insuficiência respiratória após a cirurgia cardíaca com utilização da circulação
extracorpórea (CEC) é resultante de inúmeros fatores relacionados à Síndrome de Resposta Inflamatória Sistêmica (SIRS). Grande número desses pacientes desenvolve Lesão Pulmonar Aguda (LPA) e alguns até Síndrome da Angústia Respiratória no Adulto (SARA). Há inúmeros fatores que podem influenciar direta e/ou indiretamente a lesão pulmonar observada no pós-operatório de pacientes submetidos à cirurgia cardíaca com CEC. A própria ventilação mecânica (VM) pode causar lesão pulmonar induzida pela ventilação (LPIV). Discutem-se técnicas e métodos ventilatórios que visam prevenir e corrigir a hipoxemia freqüentemente observada nessa condição. No entanto, ainda não há na literatura consenso sobre qual a melhor modalidade ventilatória a ser empregada. As propostas gerais de suporte ventilatório com baixos volumes, pressão limitada, fluxo decrescente e PEEP (pressão positiva no final de expiração), além de evitar a transfusão desnecessária, devem ser usadas para minimizar a lesão pulmonar em cirurgia cardíaca. O objetivo principal deste trabalho foi comparar o efeito das modalidades ventilatórias pressão controlada e volume controlado na função respiratória e
reações inflamatórias de pacientes submetidos à cirurgia cardíaca eletiva com circulação extracorpórea. Participaram deste estudo 22 pacientes submetidos à cirurgia cardíaca com circulação extracorpórea. Onze foram submetidos à ventilação com pressão controlada, fluxo decrescente e PEEP de 5 cmH2O (Ventilador Esprit - PCV/E), 5 pacientes à ventilação com volume controlado, fluxo decrescente e PEEP de 5 cmH2O (Ventilador Esprit - VCV/E) e 6 pacientes à ventilação com volume controlado, fluxo quadrado, sem PEEP (Ventilador Takaoka - VCV/T), usado de rotina no Centro Cirúrgico.Na UTI os pacientes foram ventilados com ventilador Espirit na modalidade de SIMV (pressão ou volume controlado), associado ao suporte pressórico, que foi usado também para desmame nos três grupos. A monitorização respiratória foi feita com aparelho NICO2/Dixtal. As reações inflamatórias foram mensuradas através do lactato e leucócitos. Os parâmetros ventilatórios monitorizados foram: PaO2/FiO2, PaCO2, volume expirado, pressão de pico inspiratória, complacência dinâmica, resistência das vias aéreas, ventilação alveolar, espaço morto e tempo de ventilação mecânica. Todos os pacientes apresentaram lesão pulmonar e o grupo VCV/T apresentou SARA no final da cirurgia. O índice de oxigenação apresentou queda no decorrer do tempo nos três grupos (p=0.002), com pior resultado na admissão do paciente na UTI. A pressão parcial de gás carbônico (PaCO2) não apresentou alterações estatisticamente significantes. O volume corrente expirado (VT EXP) apresentou aumento apenas no grupo PCV/E antes e após a CEC (p=0.0081). A pressão inspiratória das vias aéreas (PIT) aumentou no decorrer do tempo nos três grupos (p=0.0411), sem diferença entre os grupos. A complacência dinâmica (C DIN) apresentou queda no decorrer do tempo nos três grupos (p=0.0063), sem diferença entre os grupos. A resistência de vias aéreas (R VAs) aumentou no decorrer do tempo nos três grupos, apresentando diferença estatisticamente significante apenas no grupo VCV/T (p=0.0012), comparado com demais grupos. O espaço morto fisiológico (VD/VT) e a ventilação alveolar (V ALV) não apresentaram alterações nem entre grupos nem no decorrer do tempo. O lactado aumentou no decorrer do tempo após a CEC nos três grupos (p<0.0001), diminuiu após 48 horas de UTI, mas não retornou aos valores iniciais. Os leucócitos apresentaram aumento dos valores no decorrer do tempo nos três grupos (p<0.0001). Não houve diferença de lactato e leucócitos entre os grupos. Concluise que todos pacientes apresentaram lesão pulmonar aguda e que não houve diferença significante nos parâmetros estudados ente os grupos, exceto piora de resistência e maior lesão pulmonar no final da cirurgia no grupo VCV/T. Os dois marcadores inflamatórios, lactato e leucócitos, aumentaram devido à resposta inflamatória, sem diferença entre os grupos estudados. / Abstract: Postoperative lung injury after cardiac surgery with cardiopulmonary bypass (CPB) is usually related to the systemic inflammatory response syndrome (SIRS). Many patients undergoing this procedure develop acute lung injury (ALI), and some of them acute respiratory distress syndrome (ARDS). Many factors can be directly or indirectly related to the postoperative lung dysfunction frequently seen after cardiac surgery with CPB, including ventilator-associated lung injury (VALI). Thus, many different approaches to mechanical ventilation (MV) have been investigated with the aim of prevent and/or treat postoperative lung injury. Low-tidal-volume mechanical ventilation, plateau pressure limitation, decelerating inspiratory flow, positive end-expiratory pressure (PEEP) and a restrictive red blood cell transfusion strategy are recommended to reduce the incidence and the severity of ALI in patients undergoing cardiac surgery with CPB. The main objective of the present study was to compare the effects of pressure controlled ventilation (PCV) versus volume controlled ventilation (VCV) on postoperative pulmonary function and in the incidence of SIRS in patients undergoing scheduled cardiac surgery with CPB. The study population was composed by 22 adult patients undergoing cardiac surgery with CPB that was mechanically ventilated as following: pressure-controlled ventilation with decelerating inspiratory flow and 5 cmH2O PEEP (Ventilator Esprit - PCV/E; n = 11); volume-controlled ventilation with decelerating inspiratory flow and 5 cmH2O (Ventilator Esprit - VCV/E; n = 5) and volume-controlled ventilation with square-wave inspiratory flow and without PEEP (Ventilator Takaoka - VCV/T; n = 6). This last ventilator is routinely used only in the operating theater. In the intensive care unit (ICU) the patients were ventilated with the ventilator Espirit, by applying SIMV (pressure or volume-controlled) and pressure support ventilation (PSV), that was also used during weaning in all groups. Respiratory monitoring was done with a NICO2 apparatus (Dixtal). Systemic inflammatory response was evaluated by means of serially white blood cells (WBC) counts and serum lactate levels. The following respiratory function variables were serially measured: PaO2/FiO2, PaCO2, expired volume, peak inspiratory pressure, dynamic compliance, airway flow resistance, alveolar ventilation, physiologic dead space ventilation and time on mechanical ventilation. All patients have shown postoperative pulmonary dysfunction and in the group VCV/T a degree of lung injury compatible with ARDS definition was recorded at the end of surgical procedure. PaO2/FiO2 has shown a significant decrease during time course in all three groups (p=0.002), with a nadir at ICU admission. PaCO2 didn't show significant alterations. Expired volume has shown increase only in PCV/E group, by comparing pre- and post-CPB moments (p=0.0081). Peak airway inspiratory pressure has increased during time course in all three groups (p=0.0411), without significant differences between them. Dynamic compliance (C DIN) has shown a decrease during time course in all three groups (p=0.0063), without significant differences between them. Airway flow resistance has increased during time course in all three groups, with statistically significant difference by comparing VCV/T group with the other two (p=0.0012). Physiologic dead space ventilation (VD/VT) and alveolar ventilation (V ALV) have not shown significant alterations during time course or between groups. Serum lactate levels have increased during time course just after CPB in all three groups (p<0.0001), decreasing 48 hours after the surgical procedure, but not returning to preoperative levels. WBC counts have shown a significant time course increase in all three groups (p<0.0001). However, no significant differences in serum lactate levels serum and WBC counts were seen between groups. It was concluded that all patients undergoing cardiac surgery with CPB have shown some degree of acute pulmonary dysfunction and this complication was not apparently directly related to the mechanical ventilation modality, except by an increase in airway flow resistance and a slight high degree of acute lung injury in the VCV/T group at the end of surgical procedure. Additionally, both systemic inflammatory markers, serum lactate levels and white blood cells counts, have increased during time course in all groups, without significant differences between them. / Mestrado / Pesquisa Experimental / Mestre em Cirurgia
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O papel da heme oxigenase 1 na síndrome do desconforto respiratório agudo associada à malária. / The role of heme oxygenase 1 in malaria-associated acute respiratory distress syndrome.Marcelo Luís Monteiro Pereira 25 August 2016 (has links)
A malária é uma doença causada pelo parasita do gênero Plasmodium e que foi responsável por cerca de 440.000 mortes em 2015. A síndrome do desconforto respiratório agudo (SDRA) é uma das principais complicações clínicas da malária. O modelo murino DBA/2 reproduz os sinais clínicos da SDRA observados em humanos, quando infectado com o Plasmodium berghei ANKA. Além disso, altos níveis da enzima heme oxigenase 1 (HO-1) foram observados em casos de malária cerebral e em SDRA em humanos. Os nossos dados indicam que os níveis da HO-1 estão aumentados em camundongos que desenvolvem SDRA associada à malária (SDRA-AM). Adicionalmente, a droga indutora de HO-1 (hemina) aumentou a sobrevivência e preveniu a SDRA-AM. Verificou-se também uma redução na permeabilidade pulmonar e nos níveis de VEGF, além de uma melhoria nos parâmetros respiratórios em animais tratados com hemina. Assim sendo, a indução da HO-1 antes do desenvolvimento da SDRA-AM é protetora e assim, a HO-1 pode ser um alvo de novos fármacos, como forma de prevenir o desenvolvimento da SDRA-AM em humanos. / Malaria is a serious disease, caused by the parasite of the genus Plasmodium, which was responsible to 440,000 deaths in 2015. Acute lung injury/ acute respiratory distress syndrome (ALI/ARDS) is one of the main clinical complications in severe malaria. The murine model DBA/2 reproduces the clinical signs of ALI/ARDS observed in humans, when infected with Plasmodium berghei ANKA. Additionally, high levels heme oxygenase 1 (HO-1) were reported in cases of cerebral malaria and in ALI/ARDS in humans. Our data have indicated that the HO-1 levels are increased in mice that develop malaria associated ALI/ARDS (MA-ALI/ARDS). Additionally, a HO-1 inducing drug (hemin) increased the survival rate and prevented mice from developing MA-ALI/ARDS in treated mice. Also, there was a decrease in the lung permeability and in lung VEGF levels, and an amelioration of respiratory parameters. Therefore, the induction of HO-1 before the development of MA-ALI/ARDS is protective, making this enzyme a possible target of new drugs to prevent the development of MA-ALI/ARDS in humans.
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Proinflammatory cytokines modify the expression of surfactant proteins:study in perinatal rabbit lungVäyrynen, O. (Outi) 18 June 2003 (has links)
Abstract
Deficiency of pulmonary surfactant is the main cause of respiratory distress syndrome (RDS) in premature newborn infants, which is often complicated by chronic lung disease (CLD). Preterm birth is often associated with intra-amniotic infection (IUI), which is characterized by increased proinflammatory cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α), in the amniotic fluid. In very preterm birth due to IUI, the incidence of RDS is decreased, while the incidence of CLD is increased. Maternal glucocorticoids are used in imminent preterm birth to prevent RDS. This study was designed to clarify the contrasting association of these perinatal pulmonary diseases with IUI and the pathogenesis of these lung diseases using an in vitro rabbit model.
IL-1 increased the expression of surfactant protein (SP)-A and SP-B in very immature lung. Contrariwise, in transitional and mature fetal lung as well as in newborn lung, IL-1 additively with TNF-α decreased the expression of SP-B and SP-C. Bacterial lipopolysaccharide (LPS) decreased SP-A, -B and -C mRNAs in mature fetal and newborn lung, but had no effect on SP expression in immature lung. Interferon-γ (IFN-γ) had no effect on SP expression at any gestational age, but it modified the effects of the other cytokines. Dexamethasone (Dx) and IL-1 in combination additively increased SP-A and SP-B mRNAs in immature lung. Dx abolished the inhibitory effect of IL-1 on SP-B and SP-C in mature lung. Dx and IL-1 together tended to stabilize SP mRNAs. The present findings provide additional evidence of the role of the transcription factors nuclear factor-κB (NF-κB) and C/CAAT enhancer-binding protein δ (C/EBPδ) in the upregulation of SP-A by IL-1 in immature lung.
Proinflammatory cytokines profoundly influence the expression of surfactant proteins in a manner that is strictly dependent on the length of gestation. The present findings help to explain the differences in the incidence of RDS and CLD in preterm births caused by IUI, and they may clarify further the role of surfactant in the pathogenesesis of lung diseases in neonatal infants. / Tiivistelmä
Keuhkosurfaktantin puute aiheuttaa ennenaikaisesti syntyville keskosille vastasyntyneen hengitysvaikeusoireyhtymää eli RDS-tautia (Respiratory Distress Syndrome). Toinen keskosilla esiintyvä keuhkosairaus on krooninen keuhkosairaus eli CLD (Chronic Lung Disease). Glukokortikoideja käytetään hoitona ennenaikaisen synnytyksen uhatessa, koska niiden tiedetään vähentävän RDS-taudin riskiä. Kohdunsisäinen infektio on huomattava ennenaikaisen synnytyksen aiheuttaja. Infektiossa tulehduksen välittäjäaineet, kuten sytokiinit interleukiini-1 (IL-1) ja tuumorinekroositekijä alfa (TNF-α) lisääntyvät lapsivedessä. Infektiosta aiheutunut ennenaikainen synnytys vähentää RDS-taudin ilmaantumista pienille keskosille ja toisaalta lisää kroonisen keuhkosairauden riskiä. Tutkimuksen oli tavoitteena selvittää, miksi RDS ja CLD ilmaantuvat eriävästi infektion vuoksi ennenaikaisesti syntyneille vauvoille.
Viljelemällä eri-ikäisten kanin sikiöiden sekä vastasyntyneiden kanin poikasten keuhkon kappaleita tutkittiin tulehduksen välittäjäaineiden sekä anti-inflammatorisen glukokortikoidin (deksametasonin) vaikutusta surfaktantin toiminnalle tarpeellisten surfaktanttiproteiinien (SP) ilmentymiseen. IL-1 lisäsi SP-A:n ja SP-B:n ilmentymistä erittäin epäkypsässä kanin sikiön keuhkossa. Toisaalta IL-1 ja TNF-α vähensivät SP-B:n ja SP-C:n ilmentymistä kypsemmässä sikiön sekä vastasyntyneen kanin keuhkossa. Interferoni-gamma (IFN-γ) ei vaikuttanut surfaktanttiproteiinien ilmentymiseen missään gestaatioiässä, mutta se muunsi muiden sytokiinien surfaktanttivaikutusta. Gram-negatiivisten bakteerien soluseinän tuote, lipopolysakkaridi (LPS) vähensi SP-A:n, SP-B:n ja SP-C:n ilmentymistä kypsässä kanin sikiön ja vastasyntyneen kanin keuhkossa. IL-1:llä ja deksametasonilla oli positiivinen yhteisvaikutus surfaktanttiproteiinien ilmentymiseen. Tämän surfaktanttiproteiineja lisäävän vaikutuksen mekanismiksi havaittiin pääasiallisesti lisääntynyt mRNA:n stabiliteetti. Lisäksi tutkimus antaa lisätietoa kahden transkriptiofaktorin, NF-κB:n (nuclear factor kappa B) ja C/EBPγ:n (C/CAAT enhancer binding protein delta), osuudesta IL-1:n aiheuttamassa SP-A:n ilmentymisen lisääntymisessä.
Sytokiinien vaikutukset surfaktanttiproteiinien ilmentymiseen ovat riippuvaisia gestaatioiästä. Tutkimuksen löydökset auttavat ymmärtämään RDS:n ja CLD:n vastakohtaista esiintymismäärää keskosilla, joiden ennenaikainen synnytys on aiheutunut kohdunsisäisestä tulehduksesta. Edelleen tutkimus selittää glukokortikoidien positiivista vaikutusta hengitysvajaukseen johtavassa keuhkotulehduksessa.
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Evaluation des Lungenultraschalls bei der Diagnostik des Atemnotsyndroms von Neu- und Frühgeborenen zur Reduktion von RöntgenstrahlungTaubert, Nicole 15 June 2016 (has links)
Das Atemnotsyndrom (ANS) ist eine der häufigsten Atemwegserkrankungen von Frühgeborenen. Es ist bei Kindern, die nach der Geburt auf neonatologischen Intensivstationen betreut werden, häufig
behandlungsbedürftig. Daher gibt es für das ANS einen etablierten und gut untersuchten Diagnostik- und Behandlungsalgorithmus. Zur Diagnostik dienen insbesondere eine klinische Untersuchung und eine Röntgenaufnahme des Thorax. Diese Röntgenuntersuchung ist allerdings mit verschiedenen Belastungen für Patienten und Personal verbunden, wobei vorrangig die ionisierende Strahlung zu nennen ist.
Um diese Strahlenexposition bei den Kindern zu verringern, sollte in dieser Arbeit untersucht werden, wie exakt die Diagnosestellung des ANS mittels Lungenultraschall möglich ist. Zusätzlich sollte analysiert werden, ob die Ergebnisgenauigkeit des Lungenultraschalls beim ANS von bestimmten Faktoren abhängig ist und wie stark die klinische Symptomatik der Kinder mit dem bildmorphologischen Schweregrad des ANS übereinstimmt.
In dieser Promotionsarbeit wurden 65 Neu- und Frühgeborene der neonatologischen Intensivstation der Universitätsklinik Leipzig retrospektiv untersucht. Dabei konnten wir zeigen, dass die bildmorphologischen Ergebnisse der Neonatologen und Radiologen häufig miteinander übereinstimmten. Die Ergebnisgenauigkeit war besonders hoch, wenn die Kinder ein geringes Gestationsalter aufwiesen, mit einer Atemhilfe versorgt waren oder zusätzlich Sauerstoff mit einer FiO2>0,25 erhielten. Der Lungenultraschall war nur in geringem Ausmaß vom jeweiligen Untersucher abhängig. Die Höhe der FiO2 war am besten geeignet, um den klinischen Schweregrad des ANS abschätzen zu können.
Aufgrund der guten Studienlage und unserer exzellenten Ergebnisse empfehlen wir die Verwendung des Lungenultraschalls als zusätzliche Untersuchungstechnik bei der ANS-Diagnostik. Als alleinige Diagnostik ist die Lungensonographie besonders bei der Verlaufs- und Therapiekontrolle des ANS geeignet.:1 Bibliographische Beschreibung
2 Abkürzungsverzeichnis
3 Einleitung
3.1 Entstehung des Atemnotsyndroms
3.2 Diagnose des Atemnotsyndroms
3.3 Symptome des Atemnotsyndroms
3.4 Therapie des Atemnotsyndroms
3.5 Vor- und Nachteile der Diagnostik
3.6 Ziele der Arbeit
4 Methoden
4.1 Patienteneinschluss
4.2 Ablauf
4.3 Auswertung der Röntgenbilder und Technik der sonographischen Untersuchung
4.4 Erhebung der klinischen Daten
4.5 Grundlagen der sonographischen Untersuchung
4.6 Statistische Auswertung
5 Ergebnisse
5.1 Basis- und Geburtsdaten
5.2 Untersuchungsdaten
5.2.1 Klinische Daten
5.2.2 Röntgen- und Sonographiebefunde
5.2.2.1 Befunde des Radiologen
5.2.2.2 Befunde des Neonatologen
5.2.2.3 Vergleich der Befunde des Radiologen und Neonatologen
5.2.2.4 Korrelation zwischen Röntgen- und Sonographiebefunden
5.2.2.5 Korrelation zwischen klinischem Index und Röntgen- sowie Sonographiebefunden
5.2.2.6 Vergleich der Röntgen- und Ultraschallbefunde in Abhängigkeit von verschiedenen Basisdaten der Neugeborenen
5.3 Qualität der Befunde
5.3.1 Vergleich der Ergebnisse der drei Neonatologen mit dem Radiologen
5.3.2 Vergleich der Ergebnisse der drei Neonatologen untereinander
6 Diskussion
7 Zusammenfassung
8 Literaturverzeichnis
9 Anhang
9.1 Tabelle mit klinischen Daten der Neugeborenen
9.2 Selbständigkeitserklärung
9.3 Lebenslauf
9.4 Danksagung
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A Bioengineered Neonate Lung Model to Study Exogenous Pulmonary Surfactant Delivery in AirwaysCombs, Hannah 25 October 2022 (has links)
No description available.
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Prone Positioning in Acute Respiratory Distress Syndrome PatientsThornton, Sarah Rose H 01 January 2018 (has links)
Introduction: Acute respiratory distress syndrome (ARDS), seen in critically ill patients, is a disease process that affects the lungs and directly impacts a patient’s oxygenation. Despite treatment, patients often die of ARDS secondary to systemic complications. Prone positioning has been introduced as a treatment to improve the outcomes of ARDS patients. This thesis summarized and critiqued recent literature on the outcomes of prone positioning in ARDS patients.
Methodology: An initial literature search was conducted using CINAHL Plus with Text, Medline, Cochrane Database of Systematic Reviews, and US National Library of Medicine National Institutes of Health. Multiple search terms were used. Inclusion criteria consisted of peer reviewed research articles, academic journal articles, and evidence-based research or practices published within the last ten years. All studies included adult subjects and were published in the English language. Studies that did not address patient outcomes such as mortality, length of stay, or hemodynamic oxygenation were excluded from the review.
Results: The review of literature contains one meta-analysis and two studies. Data indicated that prone positioning was statistically significant in reducing mortality when performed in sessions of 12 hours or longer (p=0.05). Hemodynamic oxygenation improved significantly after at least 48 hours of implementing prone positioning. There was no trend in the length of stay or duration in mechanical ventilation whether supine or prone positioning was used. Complications such as endotracheal tube dislodgement, incidence of ventilator-associated pneumonia, and pressure ulcers were reported in both supine and prone position with an increased risk of pressure ulcers and endotracheal tube obstruction in the prone position groups.
Conclusions: Findings support a benefit in patient outcomes in patients placed in prone position with ARDS. Mortality was reduced when prone sessions lasted longer than 12 hours possibly due to the improvement in patient oxygenation 48 hours after initiation of prone positioning intervention. Further research is needed to solidify these findings and establish guidelines and optimal procedural methods to maximize patient outcomes and lower the incidence of patient complications.
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Geschlechtsspezifische Unterschiede im fetalen alveolaren NatriumtransportKaltofen, Till 08 February 2017 (has links) (PDF)
Die Inzidenz des Atemnotsyndroms ist bei männlichen Neugeborenen etwa 1,7-mal so hoch wie bei weiblichen. Zur Erforschung der Ursachen dieser Tatsache wurden in der vorliegenden Arbeit geschlechtsabhängige Unterschiede im transepithelialen Natriumtransport an fetalen distalen Lungenepithelzellen von Ratten untersucht. Die zugrunde liegende Versuchsanordnung stellt ein Modell der Typ II Pneumozyten des späten Frühgeborenen dar. In Ussing Kammer Messungen wurde ein höherer Natriumtransport in weiblichen Zellen im Vergleich zu männlichen Zellen nachgewiesen. Des Weiteren zeigten Genexpressionsanalysen eine höhere Expression der am Natriumtransport beteiligten Kanäle und Transporter in weiblichen Zellen. Um mögliche Ursachen der festgestellten Geschlechtsunterschiede zu eruieren, wurde die Genexpression von Hormonrezeptoren untersucht. Die Ergebnisse lassen vermuten, dass die Rezeptoren weiblicher Geschlechtshormone dabei eine wichtige Rolle spielen. Abschließend betrachtet diese Arbeit die absolute Zahl fetaler distaler Lungenepithelzellen in Rattenfeten beider Geschlechter. Hierbei fanden sich ebenfalls Geschlechtsdifferenzen.
Zusammenfassend kann die vorliegende Arbeit zu einem besseren Verständnis der Pathogenese und der Inzidenz des Atemnotsyndroms des Frühgeborenen beitragen.
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