#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Comparison of two experimental ARDS models in pigs using electrical impedance tomography


Autoři: Nadine Hochhausen aff001;  Jakob Orschulik aff002;  Andreas Follmann aff001;  Susana Aguiar Santos aff002;  Henriette Dohmeier aff001;  Steffen Leonhardt aff002;  Rolf Rossaint aff001;  Michael Czaplik aff001
Působiště autorů: Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany aff001;  Philips Chair for Medical Information Technology, RWTH Aachen University, Aachen, Germany aff002
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0225218

Souhrn

Background

Animal trials contribute to major achievements in medical science. The so-called lavage model is frequently used to evaluate ventilation strategies in acute respiratory distress syndrome (ARDS) using electrical impedance tomography (EIT). But, the lavage model itself might have systematic impacts on EIT parameters. Therefore, we established an additional experimental model, in which ARDS is caused by intravenously administered lipopolysaccharide (LPS). In this study, we want to examine if EIT measurements provide consistent results in both experimental models or whether the pathophysiology of the model influences the findings. Overall, we want to compare both experimental models regarding clinical parameters and EIT-derived indices, namely the global inhomogeneity (GI) index and the regional ventilation delay (RVD) index.

Methods

Nineteen pigs were included in this study, allocated to the control group (CO; n = 5), lavage group (LAV; n = 7) and LPS group (LPS; n = 7). After baseline measurements and the establishment of ARDS, assessment of respiratory mechanics, hemodynamics, gas exchange and EIT recordings were performed hourly over eight hours.

Results

In both experimental ARDS models, EIT measurements provided reliable results. But, the GI and the RVD index did not show consistent results as compared to the CO group. Initially, GI and RVD index were higher in the LAV group but not in the LPS group as compared to the CO group. This effect disappeared during the study. Furthermore, the GI index and the RVD index were higher in the LAV group compared to the LPS group in the beginning as well. This, once again, disappeared. Clinical lung injury parameters remained more stable when using LPS.

Conclusion

The two models showed quite different influences on the GI and RVD index. This implies, that the underlying pathophysiology affects EIT parameters and thus the findings. Hence, translation to EIT-guided clinical therapy in humans suffering from ARDS might be limited.

Klíčová slova:

Acute respiratory distress syndrome – Blood pressure – Endotoxins – Heart rate – Hemodynamics – Respiration – Electrical impedance tomography – Systolic pressure


Zdroje

1. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet Lond Engl. 1967 Aug 12;2(7511):319–23.

2. Nanchal RS, Truwit JD. Recent advances in understanding and treating acute respiratory distress syndrome. F1000Research. 2018;7.

3. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):818–24. doi: 10.1164/ajrccm.149.3.7509706 7509706

4. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med. 2000 May 4;342(18):1334–49. doi: 10.1056/NEJM200005043421806 10793167

5. Ballard-Croft C, Wang D, Sumpter LR, Zhou X, Zwischenberger JB. Large-animal models of acute respiratory distress syndrome. Ann Thorac Surg. 2012 Apr;93(4):1331–9. doi: 10.1016/j.athoracsur.2011.06.107 22244649

6. Aguiar Santos S, Czaplik M, Orschulik J, Hochhausen N, Leonhardt S. Lung pathologies analyzed with multi-frequency electrical impedance tomography: Pilot animal study. Respir Physiol Neurobiol. 2018;254:1–9. doi: 10.1016/j.resp.2018.03.016 29614341

7. Rocco PRM, Nieman GF. ARDS: what experimental models have taught us. Intensive Care Med. 2016 May;42(5):806–10. doi: 10.1007/s00134-016-4268-9 26928038

8. van Genderingen HR, van Vught AJ, Jansen JRC. Estimation of regional lung volume changes by electrical impedance pressures tomography during a pressure-volume maneuver. Intensive Care Med. 2003 Feb;29(2):233–40. doi: 10.1007/s00134-002-1586-x 12594585

9. Gómez-Laberge C, Rettig JS, Smallwood CD, Boyd TK, Arnold JH, Wolf GK. Interaction of dependent and non-dependent regions of the acutely injured lung during a stepwise recruitment manoeuvre. Physiol Meas. 2013 Feb;34(2):163–77. doi: 10.1088/0967-3334/34/2/163 23348518

10. Frerichs I, Amato MBP, van Kaam AH, Tingay DG, Zhao Z, Grychtol B, et al. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group. Thorax. 2017 Jan;72(1):83–93. doi: 10.1136/thoraxjnl-2016-208357 27596161

11. Lobo B, Hermosa C, Abella A, Gordo F. Electrical impedance tomography. Ann Transl Med. 2018 Jan;6(2):26. doi: 10.21037/atm.2017.12.06 29430443

12. Zhao Z, Pulletz S, Frerichs I, Müller-Lisse U, Möller K. The EIT-based global inhomogeneity index is highly correlated with regional lung opening in patients with acute respiratory distress syndrome. BMC Res Notes. 2014;7:82. doi: 10.1186/1756-0500-7-82 24502320

13. Lowhagen K, Lundin S, Stenqvist O. Regional intratidal gas distribution in acute lung injury and acute respiratory distress syndrome assessed by electric impedance tomography. Minerva Anestesiol. 2010;76(12):1024–35. 21178912

14. Costa ELV, Borges JB, Melo A, Suarez-Sipmann F, Toufen C, Bohm SH, et al. Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography. Intensive Care Med. 2009 Jun;35(6):1132–7. doi: 10.1007/s00134-009-1447-y 19255741

15. Wrigge H, Zinserling J, Muders T, Varelmann D, Günther U, von der Groeben C, et al. Electrical impedance tomography compared with thoracic computed tomography during a slow inflation maneuver in experimental models of lung injury. Crit Care Med. 2008 Mar;36(3):903–9. doi: 10.1097/CCM.0B013E3181652EDD 18431279

16. Hudson LD, Milberg JA, Anardi D, Maunder RJ. Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med. 1995 Feb;151(2 Pt 1):293–301. doi: 10.1164/ajrccm.151.2.7842182 7842182

17. National Research Council (US) Committee for the Update of the Guide for the Care and Use of Laboratory Animals. Guide for the Care and Use of Laboratory Animals [Internet]. 8th ed. Washington (DC): National Academies Press (US); 2011. (The National Academies Collection: Reports funded by National Institutes of Health). http://www.ncbi.nlm.nih.gov/books/NBK54050/

18. Zhao Z, Möller K, Steinmann D, Guttmann J. Global and local inhomogeneity indices of lung ventilation based on electrical impedance tomography. In: Vander Sloten J, Verdonck P, Nyssen M, Haueisen J, editors. 4th European Conference of the International Federation for Medical and Biological Engineering. Springer Berlin Heidelberg; 2009. p. 256–9. (IFMBE Proceedings).

19. Zhao Z, Möller K, Steinmann D, Frerichs I, Guttmann J. Evaluation of an electrical impedance tomography-based Global Inhomogeneity Index for pulmonary ventilation distribution. Intensive Care Med. 2009 Nov;35(11):1900–6. doi: 10.1007/s00134-009-1589-y 19652949

20. Umbrello M, Formenti P, Bolgiaghi L, Chiumello D. Current Concepts of ARDS: A Narrative Review. Int J Mol Sci. 2016 Dec 29;18(1).

21. Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, et al. Incidence and outcomes of acute lung injury. N Engl J Med. 2005 Oct 20;353(16):1685–93. doi: 10.1056/NEJMoa050333 16236739

22. Bannerman DD, Goldblum SE. Mechanisms of bacterial lipopolysaccharide-induced endothelial apoptosis. Am J Physiol Lung Cell Mol Physiol. 2003 Jun;284(6):L899–914. doi: 10.1152/ajplung.00338.2002 12736186

23. Wang HM, Bodenstein M, Markstaller K. Overview of the pathology of three widely used animal models of acute lung injury. Eur Surg Res Eur Chir Forsch Rech Chir Eur. 2008;40(4):305–16.

24. Russ M, Kronfeldt S, Boemke W, Busch T, Francis RCE, Pickerodt PA. Lavage-induced Surfactant Depletion in Pigs As a Model of the Acute Respiratory Distress Syndrome (ARDS). J Vis Exp JoVE. 2016 07;(115).

25. Zhao Z, Steinmann D, Frerichs I, Guttmann J, Möller K. PEEP titration guided by ventilation homogeneity: a feasibility study using electrical impedance tomography. Crit Care Lond Engl. 2010;14(1):R8.

26. Hochhausen N, Biener I, Rossaint R, Follmann A, Bleilevens C, Braunschweig T, et al. Optimizing PEEP by Electrical Impedance Tomography in a Porcine Animal Model of ARDS. Respir Care. 2017 Mar;62(3):340–9. doi: 10.4187/respcare.05060 27999152

27. Blankman P, Hasan D, Groot Jebbink E, Gommers D. Detection of “best” positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial. Crit Care Lond Engl. 2014 May 10;18(3):R95.

28. Becher T, Rostalski P, Kott M, Adler A, Schadler D, Weiler N, et al. Global and regional assessment of sustained inflation pressure-volume curves in patients with acute respiratory distress syndrome. Physiol Meas. 2017 Mar 24;

29. Reifferscheid F, Elke G, Pulletz S, Gawelczyk B, Lautenschläger I, Steinfath M, et al. Regional ventilation distribution determined by electrical impedance tomography: reproducibility and effects of posture and chest plane. Respirol Carlton Vic. 2011 Apr;16(3):523–31.


Článek vyšel v časopise

PLOS One


2019 Číslo 11
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

KOST
Koncepce osteologické péče pro gynekology a praktické lékaře
nový kurz
Autoři: MUDr. František Šenk

Sekvenční léčba schizofrenie
Autoři: MUDr. Jana Hořínková

Hypertenze a hypercholesterolémie – synergický efekt léčby
Autoři: prof. MUDr. Hana Rosolová, DrSc.

Svět praktické medicíny 5/2023 (znalostní test z časopisu)

Imunopatologie? … a co my s tím???
Autoři: doc. MUDr. Helena Lahoda Brodská, Ph.D.

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#