Ischemia and reperfusion increases susceptibility to ventilator-induced lung injury in rats.
OBJECTIVE
Hemorrhagic shock followed by resuscitation (HSR) commonly triggers an inflammatory response that leads to acute respiratory distress syndrome.


OBJECTIVE
HSR exacerbates mechanical stress-induced lung injury by rendering the lung more susceptible to ventilator-induced lung injury.


METHODS
Rats were subjected to HSR, and were randomized into an HSR + high tidal volume and zero positive end-expiratory pressure (PEEP) or a HSR + low tidal volume with 5 cm H(2)O PEEP. A sham-operated rat + high tidal volume and zero PEEP served as a control.


RESULTS
HSR increased susceptibility to ventilator-induced lung injury as evidenced by an increase in lung elastance and the wet/dry ratio and a reduction in Pa(O(2)) as compared with the other groups. The lung injury observed in the HSR + high tidal volume group was associated with a higher level of interleukin 6 in the lung and blood, increased epithelial cell apoptosis in the kidney and small intestine villi, and a tendency toward high levels of alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and creatinine in plasma.


CONCLUSIONS
HSR priming renders the lung and kidney more susceptible to mechanical ventilation-induced organ injury.
Crimi
Ettore
E
Division of Respiratory Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Zhang
Haibo
H
Han
Robin N N
RN
Del Sorbo
Lorenzo
L
Ranieri
V Marco
VM
Slutsky
Arthur S
AS
D000410:Alanine Transaminase / Q000097:blood; D000818:Animals; D017209:Apoptosis; D001219:Aspartate Aminotransferases / Q000097:blood; D054426:Chemokine CXCL2; D003404:Creatinine / Q000097:blood; D004847:Epithelial Cells / Q000473:pathology; D020287:In Situ Nick-End Labeling; D015850:Interleukin-6 / Q000032:analysis; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008168:Lung / Q000737:chemistry; D008297:Male; D015846:Monokines / Q000032:analysis; D009102:Multiple Organ Failure / Q000209:etiology; D051381:Rats; D017207:Rats, Sprague-Dawley; D015427:Reperfusion Injury / Q000150:complications*; D012128:Respiratory Distress Syndrome; D015656:Respiratory Mechanics; D012771:Shock, Hemorrhagic / Q000150:complications; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D012122:Ventilators, Mechanical / Q000009:adverse effects*
D054426:Chemokine CXCL2; D015850:Interleukin-6; D015846:Monokines; D014409:Tumor Necrosis Factor-alpha; D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase