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Role of Fluid and Sodium Retention in Experimental Ventilator-Induced Lung Injury
Background: Ventilator-induced lung injury (VILI) via respiratory mechanics is deeply interwoven with hemodynamic, kidney and fluid/electrolyte changes. We aimed to assess the role of positive fluid balance in the framework of ventilation-induced lung injury. Methods:Post-hoc analysis of seventy-eig...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473803/ https://www.ncbi.nlm.nih.gov/pubmed/34588999 http://dx.doi.org/10.3389/fphys.2021.743153 |
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author | Gattarello, Simone Pasticci, Iacopo Busana, Mattia Lazzari, Stefano Palermo, Paola Palumbo, Maria Michela Romitti, Federica Steinberg, Irene Collino, Francesca Vassalli, Francesco Langer, Thomas Moerer, Onnen Saager, Leif Herrmann, Peter Cadringher, Paolo Meissner, Konrad Quintel, Michael Gattinoni, Luciano |
author_facet | Gattarello, Simone Pasticci, Iacopo Busana, Mattia Lazzari, Stefano Palermo, Paola Palumbo, Maria Michela Romitti, Federica Steinberg, Irene Collino, Francesca Vassalli, Francesco Langer, Thomas Moerer, Onnen Saager, Leif Herrmann, Peter Cadringher, Paolo Meissner, Konrad Quintel, Michael Gattinoni, Luciano |
author_sort | Gattarello, Simone |
collection | PubMed |
description | Background: Ventilator-induced lung injury (VILI) via respiratory mechanics is deeply interwoven with hemodynamic, kidney and fluid/electrolyte changes. We aimed to assess the role of positive fluid balance in the framework of ventilation-induced lung injury. Methods:Post-hoc analysis of seventy-eight pigs invasively ventilated for 48 h with mechanical power ranging from 18 to 137 J/min and divided into two groups: high vs. low pleural pressure (10.0 ± 2.8 vs. 4.4 ± 1.5 cmH(2)O; p < 0.01). Respiratory mechanics, hemodynamics, fluid, sodium and osmotic balances, were assessed at 0, 6, 12, 24, 48 h. Sodium distribution between intracellular, extracellular and non-osmotic sodium storage compartments was estimated assuming osmotic equilibrium. Lung weight, wet-to-dry ratios of lung, kidney, liver, bowel and muscle were measured at the end of the experiment. Results: High pleural pressure group had significant higher cardiac output (2.96 ± 0.92 vs. 3.41 ± 1.68 L/min; p < 0.01), use of norepinephrine/epinephrine (1.76 ± 3.31 vs. 5.79 ± 9.69 mcg/kg; p < 0.01) and total fluid infusions (3.06 ± 2.32 vs. 4.04 ± 3.04 L; p < 0.01). This hemodynamic status was associated with significantly increased sodium and fluid retention (at 48 h, respectively, 601.3 ± 334.7 vs. 1073.2 ± 525.9 mmol, p < 0.01; and 2.99 ± 2.54 vs. 6.66 ± 3.87 L, p < 0.01). Ten percent of the infused sodium was stored in an osmotically inactive compartment. Increasing fluid and sodium retention was positively associated with lung-weight (R(2) = 0.43, p < 0.01; R(2) = 0.48, p < 0.01) and with wet-to-dry ratio of the lungs (R(2) = 0.14, p < 0.01; R(2) = 0.18, p < 0.01) and kidneys (R(2) = 0.11, p = 0.02; R(2) = 0.12, p = 0.01). Conclusion: Increased mechanical power and pleural pressures dictated an increase in hemodynamic support resulting in proportionally increased sodium and fluid retention and pulmonary edema. |
format | Online Article Text |
id | pubmed-8473803 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-84738032021-09-28 Role of Fluid and Sodium Retention in Experimental Ventilator-Induced Lung Injury Gattarello, Simone Pasticci, Iacopo Busana, Mattia Lazzari, Stefano Palermo, Paola Palumbo, Maria Michela Romitti, Federica Steinberg, Irene Collino, Francesca Vassalli, Francesco Langer, Thomas Moerer, Onnen Saager, Leif Herrmann, Peter Cadringher, Paolo Meissner, Konrad Quintel, Michael Gattinoni, Luciano Front Physiol Physiology Background: Ventilator-induced lung injury (VILI) via respiratory mechanics is deeply interwoven with hemodynamic, kidney and fluid/electrolyte changes. We aimed to assess the role of positive fluid balance in the framework of ventilation-induced lung injury. Methods:Post-hoc analysis of seventy-eight pigs invasively ventilated for 48 h with mechanical power ranging from 18 to 137 J/min and divided into two groups: high vs. low pleural pressure (10.0 ± 2.8 vs. 4.4 ± 1.5 cmH(2)O; p < 0.01). Respiratory mechanics, hemodynamics, fluid, sodium and osmotic balances, were assessed at 0, 6, 12, 24, 48 h. Sodium distribution between intracellular, extracellular and non-osmotic sodium storage compartments was estimated assuming osmotic equilibrium. Lung weight, wet-to-dry ratios of lung, kidney, liver, bowel and muscle were measured at the end of the experiment. Results: High pleural pressure group had significant higher cardiac output (2.96 ± 0.92 vs. 3.41 ± 1.68 L/min; p < 0.01), use of norepinephrine/epinephrine (1.76 ± 3.31 vs. 5.79 ± 9.69 mcg/kg; p < 0.01) and total fluid infusions (3.06 ± 2.32 vs. 4.04 ± 3.04 L; p < 0.01). This hemodynamic status was associated with significantly increased sodium and fluid retention (at 48 h, respectively, 601.3 ± 334.7 vs. 1073.2 ± 525.9 mmol, p < 0.01; and 2.99 ± 2.54 vs. 6.66 ± 3.87 L, p < 0.01). Ten percent of the infused sodium was stored in an osmotically inactive compartment. Increasing fluid and sodium retention was positively associated with lung-weight (R(2) = 0.43, p < 0.01; R(2) = 0.48, p < 0.01) and with wet-to-dry ratio of the lungs (R(2) = 0.14, p < 0.01; R(2) = 0.18, p < 0.01) and kidneys (R(2) = 0.11, p = 0.02; R(2) = 0.12, p = 0.01). Conclusion: Increased mechanical power and pleural pressures dictated an increase in hemodynamic support resulting in proportionally increased sodium and fluid retention and pulmonary edema. Frontiers Media S.A. 2021-09-13 /pmc/articles/PMC8473803/ /pubmed/34588999 http://dx.doi.org/10.3389/fphys.2021.743153 Text en Copyright © 2021 Gattarello, Pasticci, Busana, Lazzari, Palermo, Palumbo, Romitti, Steinberg, Collino, Vassalli, Langer, Moerer, Saager, Herrmann, Cadringher, Meissner, Quintel and Gattinoni. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Physiology Gattarello, Simone Pasticci, Iacopo Busana, Mattia Lazzari, Stefano Palermo, Paola Palumbo, Maria Michela Romitti, Federica Steinberg, Irene Collino, Francesca Vassalli, Francesco Langer, Thomas Moerer, Onnen Saager, Leif Herrmann, Peter Cadringher, Paolo Meissner, Konrad Quintel, Michael Gattinoni, Luciano Role of Fluid and Sodium Retention in Experimental Ventilator-Induced Lung Injury |
title | Role of Fluid and Sodium Retention in Experimental Ventilator-Induced Lung Injury |
title_full | Role of Fluid and Sodium Retention in Experimental Ventilator-Induced Lung Injury |
title_fullStr | Role of Fluid and Sodium Retention in Experimental Ventilator-Induced Lung Injury |
title_full_unstemmed | Role of Fluid and Sodium Retention in Experimental Ventilator-Induced Lung Injury |
title_short | Role of Fluid and Sodium Retention in Experimental Ventilator-Induced Lung Injury |
title_sort | role of fluid and sodium retention in experimental ventilator-induced lung injury |
topic | Physiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473803/ https://www.ncbi.nlm.nih.gov/pubmed/34588999 http://dx.doi.org/10.3389/fphys.2021.743153 |
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