title: Hypervolemia induces and potentiates lung damage after recruitment maneuver in a model of sepsis-induced acute lung injury.
abstract: BACKGROUND
  Recruitment maneuvers (RMs) seem to be more effective in extrapulmonary acute lung injury (ALI), caused mainly by sepsis, than in pulmonary ALI. Nevertheless, the maintenance of adequate volemic status is particularly challenging in sepsis. Since the interaction between volemic status and RMs is not well established, we investigated the effects of RMs on lung and distal organs in the presence of hypovolemia, normovolemia, and hypervolemia in a model of extrapulmonary lung injury induced by sepsis.
  
  
  METHODS
  ALI was induced by cecal ligation and puncture surgery in 66 Wistar rats. After 48 h, animals were anesthetized, mechanically ventilated and randomly assigned to 3 volemic status (n = 22/group): 1) hypovolemia induced by blood drainage at mean arterial pressure (MAP) approximately 70 mmHg; 2) normovolemia (MAP approximately 100 mmHg), and 3) hypervolemia with colloid administration to achieve a MAP approximately 130 mmHg. In each group, animals were further randomized to be recruited (CPAP = 40 cm H2O for 40 s) or not (NR) (n = 11/group), followed by 1 h of protective mechanical ventilation. Echocardiography, arterial blood gases, static lung elastance (Est,L), histology (light and electron microscopy), lung wet-to-dry (W/D) ratio, interleukin (IL)-6, IL-1beta, caspase-3, type III procollagen (PCIII), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) mRNA expressions in lung tissue, as well as lung and distal organ epithelial cell apoptosis were analyzed.
  
  
  RESULTS
  We observed that: 1) hypervolemia increased lung W/D ratio with impairment of oxygenation and Est,L, and was associated with alveolar and endothelial cell damage and increased IL-6, VCAM-1, and ICAM-1 mRNA expressions; and 2) RM reduced alveolar collapse independent of volemic status. In hypervolemic animals, RM improved oxygenation above the levels observed with the use of positive-end expiratory pressure (PEEP), but increased lung injury and led to higher inflammatory and fibrogenetic responses.
  
  
  CONCLUSIONS
  Volemic status should be taken into account during RMs, since in this sepsis-induced ALI model hypervolemia promoted and potentiated lung injury compared to hypo- and normovolemia.
authors.affiliation: Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Av Carlos Chagas Filho, Rio de Janeiro 21949-902, Brazil. pedro.leme@gmail.com
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Silva
authors.forename: Fernanda F
authors.initials: FF
authors.lastname: Cruz
authors.forename: Livia C
authors.initials: LC
authors.lastname: Fujisaki
authors.forename: Gisele P
authors.initials: GP
authors.lastname: Oliveira
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Samary
authors.forename: Debora S
authors.initials: DS
authors.lastname: Ornellas
authors.forename: Tatiana
authors.initials: T
authors.lastname: Maron-Gutierrez
authors.forename: Nazareth N
authors.initials: NN
authors.lastname: Rocha
authors.forename: Regina
authors.initials: R
authors.lastname: Goldenberg
authors.forename: Cristiane S N B
authors.initials: CS
authors.lastname: Garcia
authors.forename: Marcelo M
authors.initials: MM
authors.lastname: Morales
authors.forename: Vera L
authors.initials: VL
authors.lastname: Capelozzi
authors.forename: Marcelo
authors.initials: M
authors.lastname: Gama de Abreu
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.forename: Patricia R M
authors.initials: PR
authors.lastname: Rocco
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D000818:Animals; D017209:Apoptosis / Q000502:physiology; D001810:Blood Volume; D001938:Brazil; D008854:Microscopy, Electron; D023421:Models, Animal; D011175:Positive-Pressure Respiration; D011650:Pulmonary Alveoli / Q000503:physiopathology; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D012121:Respiration, Artificial; D018805:Sepsis / Q000150:complications* / Q000503:physiopathology; D016896:Treatment Outcome