The impact of intravenous fat emulsion administration in acute lung injury.
The aim of this study was to evaluate the effect of parenteral nutrition containing medium- and long-chain triglycerides on the function of the respiratory system and to investigate mechanisms involved in this process. We studied 13 patients with acute respiratory distress syndrome (ARDS), 8 receiving lipid and 5 placebo, and 6 without ARDS, receiving lipid. Bronchoalveolar lavage (BAL) was performed before and 1 hour after administration of lipid or placebo. In patients with ARDS, lipid administration resulted in deterioration of oxygenation (Pa(O(2))/FI(O(2)): from 129 +/- 37 to 95 +/- 42), compliance of respiratory system (from 39.2 +/- 12 to 33.1 +/- 9.2 ml/cm H(2)O), and pulmonary vascular resistance (from 258 +/- 47 to 321 +/- 58 dyne x s x cm(-5)). In the BAL fluid of the same group, an increase in total protein and phospholipid concentrations, phospholipase activities, platelet-activating factor and neutrophils, as well as alterations in BAL lipid profile were observed. No significant changes were observed in the control or in the ARDS-Placebo groups. In conclusion, this study indicates that administration of medium- and long-chain triglycerides in patients with ARDS causes alterations in lung function and hemodynamics. Inflammatory cells, possibly activated by lipids, release phospholipase A(2) and platelet-activating factor, enhancing edema formation, inflammation, and surfactant alterations.
Lekka
Marilena E
ME
Chemistry Department, Medical School, University of Ioannina, Greece.
Liokatis
Stamatis
S
Nathanail
Christos
C
Galani
Vasiliki
V
Nakos
George
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000166:cytology; D016022:Case-Control Studies; D016903:Drug Monitoring; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007249:Inflammation; D008170:Lung Compliance / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010743:Phospholipids / Q000032:analysis; D010972:Platelet Activating Factor / Q000032:analysis; D011506:Proteins / Q000032:analysis; D011652:Pulmonary Circulation / Q000187:drug effects; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000378:metabolism / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects
D005217:Fat Emulsions, Intravenous; D010743:Phospholipids; D010972:Platelet Activating Factor; D011506:Proteins