Verapamil and flunarizine protect the isolated perfused rat liver against warm ischemia and reperfusion injury

Using the model of the isolated perfused rat liver, we investigated the influence of the two pharmacologically different calcium channel blockers, verapamil and flunarizine, on changes of ion homeostasis, liver weights, pH deviations and enzyme activities during warm ischemia (37°C) and reperfusion. The LDH and GLDH activities were determined and the calcium, potassium, and sodium concentrations were measured in the effluent. Warm ischemia (180 min) caused an increased enzyme release, a high influx of calcium and sodium into the liver and a massive potassium efflux current. Normoxic reperfusion led to a further increase in hepatic enzyme release and although the loss of potassium ceased, the calcium influx into the liver continued. By the end of reperfusion the liver weight had increased significantly (P<0.01) in the control group. The two calcium entry blockers were added to the perfusate in various concentrations. Both substances protected the liver against warm ischemia and normoxic reperfusion damage, but they did not inhibit calcium inflow. However, the potassium efflux was significantly reduced by all concentration tasted (P<0.001). After reperfusion the liver weights were significantly lower in the treated groups (P<0.001) than in control animals. Thus, the calcium entry blockers verapamil and flunarizine protect liver cells against damage caused by warm ischemia and reperfusion. Furthermore, they prevent the disruption of intracellular potassium homeostasis, which seems to be related to improved volume regulation of liver cells.     

Degradation of vasoactive intestinal peptide by isolated, ventilated, and perfused rat lungs

The degradation of vasoactive intestinal peptide (VIP) was studied using an isolated perfused rat lung model. 125iodine labelled VIP (125I-VIP) was used as a tracer. VIP was cleared from the perfusate by a single lung passage up to concentrations of 1 nmol l-1. The clearance rate was decreased at higher concentrations of VIP. VIP was taken up by the lung tissue and the cleavage products were re-extruded into the perfusate. The time delay of re-extrusion was increased at starting concentrations of VIP exceeding 1 nmol l-1 and in the presence of the lysosomal inhibitor chloroquine. After a bolus of 9 pmol or 40 nmol 125I-VIP into the pulmonary artery catheter 6.3 pmol or 2920 pmol, respectively, were bound by the lung. Most of the radioactive material was extruded within 25 min and consisted of low molecular weight 125I-labelled degradation products. We conclude that the receptors for VIP in the alveolar capillaries are of high affinity and capacity to extract VIP from the circulation and that lysosomes may be involved in the degradation. The degradation products are of low molecular weight.     

Effect of continuous hemofiltration on hemodynamics, lung inflammation and pulmonary edema in a canine model of acute lung injury

Objective This study examined whether continuous hemofiltration favorably affects cardiopulmonary variables, lung inflammation, and lung fluid balance in a canine model of oleic acid induced acute lung injury.Methods Eleven pentobarbital-anesthetized dogs were randomly divided into a control (mechanical ventilation, MV) group (n=6) and a MV plus hemofiltration (HF) group (n=5). All animals received an intravenous injection of oleic acid (0.09 ml/kg) to induce acute lung injury. Continuous arterial-venous hemofiltration (blood flow 100 ml/min, ultrafiltration rate at 50–65 ml kg^–1 h^–1) was started after establishment of oleic acid induced acute lung injury and continued for 4 h. Hemodynamics, lung mechanics, gas exchange, lung fluid balance, lung histology, and the level of plasma cytokines were assessed.Results After 240 min of HF treatment there was a significant increase in cardiac output, reduction in pulmonary arterial pressure, and improvement in both oxygenation and lung mechanics. Also, in the HF group the lung wet-to-dry weight ratio was significantly reduced. Histologically, HF reduced edema and inflammatory cell infiltration in the lung. There was also a significantly greater decrease in plasma IL-6 and IL-8 levels in the HF group than in group receiving MV alone.Conclusions In a canine model of acute lung injury continuous HF improved cardiopulmonary function, reduced pulmonary edema, decreased lung permeability and inflammation, and decreased the plasma concentration of proinflammatory cytokines.     

Effects of platelet-activating factor on β- and H2-receptor-mediated increase of myocardial contractile force in isolated perfused guinea pig hearts

Platelet-activating factor (PAF) has been termed an important mediator of cardiovascular shock due to immunological reactions, including anaphylaxis and endotoxic reactions. Previous studies have shown that PAF is a potent cardiodepressive agent inducing a drastic coronary constriction and a sustained impairment of myocardial contractility. In this study, an attempt was made to further characterize the prolonged PAF effects on coronary circulation and myocardial contractile force in the isolated guinea pig heart perfused at constant pressure. An intracoronary PAF bolus (0.18 nmol, related to coronary flow rates of 1 ml/min) induced a precipitous decrease of coronary flow rates, left ventricular pressure, and left ventricular contraction (peak positive dP/dt), which was followed by a slow increase reaching new steady state after 15 min (-48%, -40%, -42% below baseline, respectively). If the specific PAF antagonist WEB 2086 (3.65 nmol/min, related to coronary flow rates of 1 ml/min) was infused 30 min after PAF administration, the prolonged PAF-mediated cardio-depressive effects were rapidly reversed. Several studies indicate that PAF induces a down regulation of beta-adrenoreceptors in different cell types, including human lung tissue. Therefore, a further objective of the study was to evaluate whether PAF selectively impairs the positive inotropic effects of beta-receptor agonists or also inhibits the contractile effects of inotropic drugs, which are known to enhance cardiac contractility independently of beta-receptors. In these experiments, the beta-agonist isoproterenol and the H2-agonist impromidine were administered as intracoronary boluses (0.35 nmol and 0.14 nmol, respectively, related to coronary flow rates of 1 ml/min) prior to PAF injection and 30 min after PAF.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of capsaicin on the endothelial permeability in isolated and perfused rabbit lungs

Summary— Changes in pulmonary endothelial permeability and in microvascular hemodynamics in response to capsaicin (10^?4M) were investigated in isolated, perfused rabbit lungs. Blood-free perfusate was recirculated through ventilated lungs in an isogravimetric state, under zone III conditions with a constant flow. Using the occlusions method, the total pressure gradient between the arterial and the venous levels (δPt) was partitioned into four components: arterial (δPa), pre- (δPa') and post-(δPv') capillary, and venous (δPv). The capillary filtration coefficient (Kf,c) was evaluated by measuring the amount of fluid filtering through the endothelium when arterial and venous pressures were suddenly increased. Capsaicin caused no changes in the vascular pressures at any level of the pulmonary circulation but induced a significant 3-fold increase in the Kf,c (P < 0.05). This reaction was accompanied by pulmonary oedema. The mechanisms involved in the permeability changes were investigated by testing the capacity of different drugs to block the response to capsaicin. Clonidine (10^?7M to 10^?5M), morphine (10^?6M), aspirin (10^?3M), ketanserin (10^?8M) and (±) CP 96,345 (10^?6M), an antagonist of neurokinin NK₁ receptor, completely prevented the effects of capsaicin on the Kf,c. In contrast, terfenadine (10^?7) together with cimetidine (10^?5M) had no protective effect against capsaicin. It was concluded that capsaicin-induced pulmonary oedema was due to an increase in the capillary filtration coefficient and not to hemodynamic changes. This alteration in the endothelium permeability is mediated by the release of endogenous peptides from C-fibers upon the action of capsaicin and subsequent activation of NK₁ receptors, probably by substance P. Moreover, 5-hydroxytryptamine receptors and arachidonic acid derivates are also involved in this reaction.     

The open lung concept: pressure controlled ventilation is as effective as high frequency oscillatory ventilation in improving gas exchange and lung mechanics in surfactant-deficient animals

Objective: To demonstrate in experimental animals with respiratory insufficiency that under well-defined conditions, commercially available ventilators allow settings which are as effective as high frequency oscillatory ventilators (HFOV), with respect to the levels of gas exchange, protein infiltration, and lung stability. Design: Prospective, randomized, animal study. Setting: Experimental laboratory of a university. Subjects: 18 adult male Sprague-Dawley rats. Interventions: Lung injury was induced by repeated whole-lung lavage. Thereafter, the animals were assigned to pressure-controlled ventilation (PCV) plus The Open Lung Concept (OLC) or HFOV plus OLC (HFO_OLC). In both groups, an opening maneuver was performed by increasing airway pressures to improve the arterial oxygen tension/fractional inspired oxygen (PaO₂/FIO₂) ratio to L 500 mm Hg; thereafter, airway pressures were reduced to minimal values, which kept PaO₂/FIO₂ L 500 mm Hg. Pressure amplitude was adjusted to keep CO₂ as close as possible in the normal range. Measurements and results: Airway pressure, blood gas tension, and arterial blood pressure were recorded every 30 min. At the end of the 3-h study period, a pressure-volume curve was recorded and bronchoalveolar lavage was performed to determine protein content. After the recruitment maneuver, the resulting mean airway pressure to keep a PaO₂/FIO₂ L 500 mm Hg was 25 ± 1.3 cm H₂O during PCV_OLC and 25 ± 0.5 cm H₂O during HFOV_OLC. Arterial oxygenation in both groups was above L 500 mm Hg and arterial carbon dioxide tension was kept close to the normal range. No differences in mean arterial pressure, lung mechanics and protein influx were found between the two groups. Conclusions: This study shows that in surfactant-deficient animals, PCV, in combination with a recruitment maneuver, opens atelectatic lung areas and keeps them open as effectively as HFOV. Received: 14 October 1998 Final revision received: 11 April 1999 Accepted: 25 June 1999     

肺表面活性物质和吸入一氧化氮治疗感染性急性肺损伤

目的　研究肺表面活性物质 (Surf)和吸入一氧化氮 (iNO)治疗幼猪感染性腹膜炎诱发急性肺损伤 (ALI)的作用及疗效。方法　健康雄性幼猪 (7 5± 0 5 )kg 30只 ,随机分为 5组 ,每组 6只 :正常组 (N组 ) ,对照组 (C组 ) ,吸入一氧化氮组 (NO组 ) ,肺表面活性物质组 (Surf组 ) ,联合应用Surf和吸入NO组 (SNO组 )。正常组腹腔注射无菌生理盐水后 ,单纯机械通气 ;其余动物腹腔注射标准大肠杆菌菌株诱发ALI后再随机分为四组进行治疗。监测血气 ,呼吸力学 ,支气管肺泡灌洗液 (BALF)成分分析和肺病理改变。结果　腹腔注射大肠杆菌后 4～ 6h动物出现ALI,C组动脉血氧合 (PaO2 /FiO2 )和呼吸系统动态顺应性 (Cdyn)显著性下降 ,治疗后SNO组有较高的PaO2 /FiO2 和Cdyn (与C组比较P <0 0 1) ,肺组织病理损害较轻 ;与SNO组相比 ,单独应用Surf效果稍差 ;NO组对Cdyn肺组织病理损害改善不明显。结论　联合应用Surf和吸入NO能明显改善氧合、肺功能 ,减轻肺病理损害 ,延缓肺损伤的进展     

β-adrenergic priming of rats in vivo modulates the effect of β-agonist in vitro on surfactant phospholipid metabolism of isolated lungs

Abstract. To evaluate the effects of multiple β -adrenergic stimulations on pulmonary surfactant phospholipids, perfused lungs from β -adrenergic primed and non-primed rats were challenged with the β -agonist terbutaline in vitro . Cell-free lung lavage, lavagable alveolar cells and lung tissue were analysed for phospholipid content and incorporation of precursors. In lung lavage, terbutaline in vitro doubled the incorporation of ¹⁴C-choline and ³H-palmitate into total phosphatidylcholine (PC) and of ³H-palmitate into phosphatidylglycerol (PG). β -adrenergic priming in vivo prior to terbutaline in vitro lowered the increase of precursor incorporation. For lavagable cells, terbutaline in vitro increased the incorporation of ³H-palmitate into PC. Priming in vivo reduced this effect and diminished the specific ³H-choline incorporation into lavagable cell PC below control level. For lung tissue, priming increased the amounts of PC and disaturated PC (DSPC) whereas terbutaline in vitro decreased DSPC in both primed and non-primed lungs. Terbutaline in vitro slightly increased the incorporation of ¹⁴C-choline and ³H-palmitate into PC and DSPC in non-primed but not in primed lungs. β -adrenergic blockade by ICI 118.551 prevented all effects but generally increased ³H-palmitate incorporation into the phospholipids and, in lavagable cells, the amount of PC. We conclude that long-term β -adrenergic treatment may alter the metabolism of pulmonary surfactant phospholipids by increasing tissue PC and DSPC and by decreasing the secretion of newly-synthesized PC.     

治疗性高碳酸血症对急性肺损伤动物病理生理指标的影响

目的 通过观察治疗性高碳酸血症对急性肺损伤(ALI)兔模型病理生理指标的影响,研究其是否对ALI具有保护作用.方法 18只新西兰兔随机分成正常对照组(Ⅰ组)、ALI模型组(Ⅱ组)、治疗性高碳酸血症组(Ⅲ组),Ⅱ、Ⅲ组兔油酸复制ALI模型,Ⅲ组在ALI后吸入8%CO2形成治疗性高碳酸血症,动态观察4h各组动物的病理生理指标变化.结果 Ⅱ、Ⅲ组均达到ALI标准(氧合数＜300 mmHg).Ⅲ组的动脉血二氧化碳分压达(89.30±8.32)mmHg,与Ⅱ组比较,其气道峰压、气道平台压显著降低(t分别=2.99、4.72,P均＜0.05),动态、静态胸肺顺应性增加(t分别=-3.26、-4.55,P均＜0.05),动脉血氧分压和氧合指数升高(t分别=-4.95、-4.95,P均＜0.05),支气管肺泡灌洗液总蛋白含量及肺含水量显著减少(t分别=3.56、4.82,P均＜0.05).肺组织病理显示Ⅲ组的肺脏充血水肿、红细胞炎性细胞渗出较Ⅱ组不明显.结论 治疗性高碳酸血症对油酸引起的兔ALI具有保护作用.     

Metabolism and cytotoxicity of naphthalene oxide in the isolated perfused mouse lung

Naphthalene produces selective injury to Clara cells in the mouse in vivo and in the isolated perfused lung. To investigate the role of circulating reactive metabolites in lung injury, the stability, metabolism and cytotoxicity of naphthalene oxide, a reactive intermediate, were examined in the perfused mouse lung. The T1/2 of naphthalene oxide is 4 min in Waymouth's medium. Addition of 5% bovine serum albumin to the medium increased the half-life of the epoxide to 11 min. Perfusion of the lung with 0.2 or 2 mumol of naphthalene oxide decreased pulmonary reduced glutathione levels to 62 and 42% of control, respectively. 1,4-Naphthoquinone and naphthol-glucuronide represented 36 and 25% of the total polar metabolites isolated after infusion of naphthalene oxide, whereas dihydrodiol and thioether conjugates were minor metabolites. In comparison, thioethers and dihydrodiol were the primary metabolites isolated from lungs perfused with [14C]naphthalene. Histologic examination of the lungs fixed 4 hr after infusion of naphthalene oxide (0.25-1.0 mumol/60 min) revealed selective vacuolation and necrosis of Clara cells, significant decreases in the mass of bronchiolar Clara cells and increases in the mass of vacuolated cells. Injury to lungs perfused with naphthalene or secondary metabolites such as naphthoquinones, 1-naphthol and 1,2-dihydro-1,2-dihydroxynaphthalene was less dramatic. In contrast to other studies implicating quinones as mediators of aromatic hydrocarbon toxicity, the current work suggests that epoxides play a significant role in naphthalene-induced lung injury. This investigation also demonstrates that circulating epoxides are capable of eliciting selective Clara cell injury.     

亚低温对急性肺损伤大鼠肺泡表面活性蛋白A含量的影响

目的 探讨亚低温对内毒素脂多糖(LPS)诱导急性肺损伤(ALI)大鼠肺泡表面活性蛋白A(SP-A)含量的影响.方法 按随机数字表法将40只雄性Wistar大鼠分组.采用气管内滴入LPS制备ALI动物模型;对照组气管内只滴人生理盐水.模型组和对照组分别于术后1 h和8 h处死8只大鼠;亚低温组于滴入LPS 1 h后将体温降低并维持在32.5～33.0℃,8 h后处死8只大鼠.各组分别于术前及术后1 h、8 h测定动脉血气,并计算氧合指数(PaO2/FiO2);采用酶联免疫吸附法检测支气管肺泡灌洗液(BALF)中SP-A含量;光镜下观察肺组织形态结构的变化.结果 气管内滴入LPS 1 h后,大鼠PaO2/FiO2均达到ALI的诊断标准.与对照1 h组比较,模型1 h组BALF中SP-A含量(μg/L)明显降低(53.27±1.95比74.81±6.55,P＜0.01);模型8 h组和亚低温8 h组SP-A含量(4.35±2.76和51.36±2.33)均较对照8 h组(70.81±5.01)明显降低,但亚低温8 h组SP-A含量较模型8 h组明显增高(均P＜0.01).光镜下观察,对照1 h和8 h组肺泡结构基本正常;模型8 h组肺组织炎症反应最重;模型1 h组和亚低温8 h组肺组织炎症反应较模型8 h组有所减轻.结论 亚低温能延缓内毒素诱导的ALI大鼠早期肺泡内SP-A含量下降的程度,在一定程度上可减轻肺损伤.

Abstract：

Objective To investigate the effect of hypothermia (HT) on the concentration of surfactant protein A (SP-A) during lipopolysaccharide (LPS) induced acute lung injury (ALI) in rats.Methods Forty male Wistar rats were randomly divided into three groups. The ALI model was reproduced by LPS intratracheal instillation; only saline was instilled intratracheally for control group. Rats in both model group and control group were sacrificed respectively at 1 hour and 8 hours (each n= 8). In HT group the body temperature was lowered to 32. 5 - 33.0 ℃ 1 hour after LPS instillation, and 8 rats were sacrificed st 8 hours. The arterial blood gas was determined in all the groups before and 1 hour and 8 hours after instillation of saline or LPS, and the oxygenation index (PaO2/FiO2) was calculated. The concentration of SP-A in bronchoalveolar lavage fluid (BALF) was determined by enzyme linked immunosorbent assay. The morphological changes in lung tissue of rats were observed under light microscope. Results At 1 hour after intratracheal instillation of LPS, the PaO2/FiO2 of each group reached the diagnostic criterion of ALI.Compared with control 1-hour group, the SP-A (μg/L) in BALF of model 1-hour group was decreased (53. 27±1.95 vs. 74. 81±6. 55, P＜0. 01); the SP-A in model 8-hour group and HT 8-hour group (4.35±2. 76 and 51.36±2. 33) was both obviously decreased compared with control 8-hour group (70. 81±-5. 01,both P＜0. 01). Compared with model 8-hour group, the SP-A of HT 8-hour group was obviously increased (P＜0. 01). Results of light microscopic examination, it was revealed that the alveolar structure of control 1-hour group and control 8-hour group was almost normal. Inflammatory response in lung tissues in model 8-hour group was found to be most serious; compared with model 8-hour group, inflammatory response in lung tissues in model 1-hour group and HT 8-hour group was reduced in certain degree. Conclusion A certain extent of HT may reduce lung injury of early endotoxin-induced ALI rats by delaying lowering of alveolar SP-A levels.     

Interactions between acetylcholine and substance P effects on lung mechanics in the rabbit

Summary— The pharmacological mechanisms involved in the acetylcholine (ACh)- and substance P (SP)-induced changes in pulmonary mechanics were studied in isolated perfused rabbit lungs. Tracheal pressure (Ptr) and airflow were measured by a Fleisch pneumotachograph and pressure transducers. Air volume, lung resistance (R_L) and dynamic compliance (Cdyn) were calculated. ACh induced a dose-dependent increase in Ptr and R_L, and a decrease in Cdyn. These effects were strongly prevented by atropine, and partly by SR140333, a neurokinin NK₁ receptor antagonist; SR48968, a neurokinin NK₂ receptor antagonist; indomethacin and antihistaminics. Ketanserin had no significant protective effect against ACh. SP also induced concentration-dependent increases in R_L and decreases in Cdyn. SR140333 and atropine strongly inhibited the effects of SP, while ketanserin, SR48968, antihistaminics and indomethacin did not protect the lungs against this drug. 5-hydroxytryptamine induced no significant change in lung mechanic parameters. Cumulative concentrations of histamine increased R_L and decreased Cdyn. We conclude that ACh-induced changes in lung resistance and compliance are in part mediated by a direct effect on airway smooth muscle and in part by the stimulation of C fibers, by the release of histamine from mast cells and by the synthesis of arachidonic acid metabolites. In turn, the effects of SP on lung mechanics are partly due to cholinergic activation.     

Pulmonary hypertension and edema induced by platelet-activating factor in isolated, perfused rat lungs are blocked by BN52021

The experimental intravenous administration of platelet activating factor (PAF) induces pulmonary hypertension and directly or indirectly increases capillary permeability. Selective PAF antagonists BN52021 and L652-731 have been shown to inhibit the action of PAF in vitro and in vivo. Using a unique isolated perfused rat lung model, we measured the effect of these PAF antagonists on PAF-induced pulmonary hypertension and edema. Isolated rat lungs were perfused with Krebs-Henseleit solution. The right and left pulmonary arteries were dissected so that they could be perfused selectively, permitting the use of one lung as an internal control for a specific pharmacologic challenge. Exposure of one lung to PAF induced an increase of perfusion pressure and wet/dry lung weight ratio in a dose-dependent manner compared with the control lung. The PAF antagonists attenuated the increase in perfusion pressure and wet/dry lung weight caused by PAF (0.75 micrograms) in a dose-dependent manner. In addition, prostaglandin F2 alpha induced an equivalent increase in pulmonary pressure without causing a similar increase in lung edema. PAF-induced pulmonary hypertension and the increase in wet/dry lung weight ratio appear to be PAF receptor-mediated processes, and the use of specific antagonists and this technique may be useful probes to determine the role of PAF in pathophysiologic states.     

Metabolic activation and bronchiolar Clara cell necrosis from naphthalene in the isolated perfused mouse lung

A method for isolation and maintenance of the mouse lung ex vivo suitable for the study of the relationship between metabolism and toxicity is described. Physical, biochemical and morphological evaluations revealed that the lung is viable for up to 5 hr. No significant alterations in the architecture of the bronchiolar epithelium were observed by light or electron microscopy, despite evidence of interstitial and peribronchial edema. Although increases in pulmonary arterial pressure were noted at 5 hr, lung wet/dry weight was elevated only minimally (11%). Glutathione levels remained stable for the first 3 hr but fell to 57 +/- 14% of control at 5 hr. Naphthalene monooxygenase activity was not altered significantly during 5 hr of perfusion. Perfusion of the lung with naphthalene resulted in swelling and vacuolation of Clara cells followed by concentration-dependent losses of this cell type from the bronchiolar epithelium. Clara cells comprised 63% of the epithelial cells in terminal airways of control mice; 10 mumol of naphthalene decreased this number to 30%. Perfusion with naphthalene resulted in concentration-dependent decreases in pulmonary glutathione. Reactive metabolites were bound covalently to protein in the lung and in the perfusate. This study is the first to provide unambiguous evidence that naphthalene-induced Clara cell necrosis can be mediated entirely by processes resident in the lung. In addition, this work validates the use of the isolated perfused mouse lung for studying the role of reactive metabolites produced in situ vs. those entering the lung via the circulation.     

Bench-to-bedside review: The role of the alveolar epithelium in the resolution of pulmonary edema in acute lung injury

Clearance of pulmonary edema fluid is accomplished by active ion transport, predominantly by the alveolar epithelium. Various ion pumps and channels on the surface of the alveolar epithelial cell generate an osmotic gradient across the epithelium, which in turn drives the movement of water out of the airspaces. Here, the mechanisms of alveolar ion and fluid clearance are reviewed. In addition, many factors that regulate the rate of edema clearance, such as catecholamines, steroids, cytokines, and growth factors, are discussed. Finally, we address the changes to the alveolar epithelium and its transport processes during acute lung injury (ALI). Since relevant clinical outcomes correlate with rates of edema clearance in ALI, therapies based on our understanding of the mechanisms and regulation of fluid transport may be developed.     

Effects of L-NAME and inhaled nitric oxide on ventilator-induced lung injury in isolated, perfused rabbit lungs

OBJECTIVE: To determine whether nitric oxide (NO) might modulate ventilator-induced lung injury. DESIGN: Randomized prospective animal study. SETTING: Animal research laboratory in a university hospital. SUBJECTS: Isolated, perfused rabbit heart-lung preparation. INTERVENTIONS: Thirty-six isolated, perfused rabbit lungs were randomized into six groups (n = 6) and ventilated using pressure-controlled ventilation for two consecutive periods (T1 and T2). Peak alveolar pressure during pressure-controlled ventilation was 20 cm H2O at T1 and was subsequently (T2) either reduced to 15 cm H2O in the three low-pressure control groups (Cx) or increased to 25 cm H2O in the three high-pressure groups (Px). In the control and high-pressure groups, NO concentration was increased to approximately equal to 20 ppm (inhaled NO groups: CNO, PNO), reduced by NO synthase inhibition (L-NAME groups: CL-Name, PL-Name), or not manipulated (groups CE, PE). MEASUREMENTS AND MAIN RESULTS: Changes in ultrafiltration coefficients (deltaKf [vascular permeability index: g.min(-1).cm H2O(-1).100 g(-1)]), bronchoalveolar lavage fluid 8-isoprostane, and NOx (nitrate + nitrite) concentrations were the measures examined. Neither L-NAME nor inhaled NO altered lung permeability in the setting of low peak alveolar pressure (control groups). In contrast, L-NAME virtually abolished the change in permeability (deltaKf: PL-Name (0.10 +/- 0.03) vs. PNO [1.75 +/- 1.10] and PE [0.37 +/- 0.11; p <.05]) and the increase in bronchoalveolar lavage 8-isoprostane concentration induced by high-pressure ventilation. Although inhaled NO was associated with the largest change in permeability, no significant difference between the PE and PL-NAME groups was observed. The change in permeability (deltaKf) correlated with bronchoalveolar lavage NOx (r2 =.6; p <.001). CONCLUSIONS: L-NAME may attenuate ventilator-induced microvascular leak and lipid peroxidation and NO may contribute to the development of ventilator-induced lung injury. Measurement of NO metabolites in the bronchoalveolar lavage may afford a means to monitor lung injury induced by mechanical stress.     

Vasodilatory property of N-alpha benzoyl-L-arginine ethyl ester in the rat isolated pulmonary artery and perfused lung

L-arginine has been proposed to be the precursor of the endothelium-derived relaxing factor. In this study, we evaluated the pulmonary vascular effects of L-arginine-HCl and its benzoyl derivative N-alpha-benzoyl-L-arginine ethyl ester (BAEE) in the rat, in comparison with other vasodilators such as acetylcholine and sodium nitroprusside. In isolated pulmonary artery rings incubated with indomethacin (10 microM) and precontracted with phenylephrine (2 microM), BAEE (10(-6)-10(-5) M) significantly (P less than .05) relaxed the rings more than L-arginine. This effect was potentiated by the endothelium (P less than .05). The relaxing effect of BAEE (ED50 = 2.1 X 10(-6) M) and acetylcholine (ED50 = 2.4 X 10(-7) M) was significantly less potent than that of sodium nitroprusside (ED50 = 1.1 X 10(-8) M). Moreover, pretreatment with the soluble guanylate cyclase inhibitors methylene blue (10(-5) M) and hemoglobin (10(-5) M) antagonized BAEE-induced relaxation in intact pulmonary rings but had no effect on the relaxation elicited with atrial natriuretic peptide. In the isolated lung preparations perfused with the endoperoxide analog U46619 (5-10 nmol/min), sodium nitroprusside (10(-10)-10(-8) M) elicited potent vasodilation (ED50 = 2.8 X 10(-9) mol) whereas no vasodilation was observed with acetylcholine (10(-8)-10(-5) mol). BAEE (10(-6)-10(-5) M) decreased in a dose-dependent manner pulmonary perfusion pressure, and similar doses of L-arginine showed only a mild vasodilating effect.(ABSTRACT TRUNCATED AT 250 WORDS)     

Relationship between pulmonary oxygen consumption,lung inflammation,and calculated venous admixture in patients with acute lung injury

Objective To determine in patients with acute lung injury whether increased pulmonary oxygen consumption (VO_2pulm), computed as the difference between oxygen consumption measured by indirect calorimetry (VO_2meas) and calculated by the reverse Fick method (VO_2Fick), would: (1) correlate with the degree of lung inflammation assessed by bronchoalveolar lavage (BAL); (2) lead to an overestimation of calculated venous admixture (Q_va/Q_t).Design Prospective study.Setting University hospital, medical intensive care unit.Intervention None.Measurements and results In nine mechanically ventilated patients with acute lung injury (Apache II 12±5, lung injury score 2±0.6, mean±SD), whole-body VO₂ (VO_2wb) was determined simultaneously by indirect calorimetry and the reverse Fick technique, after which BAL was immediately performed. VO_2meas was significantly higher than VO_2Fick (128±24 and 102±18 ml/min per m², respectively,p<0.001). Median VO_2pulm was 25.3 ml/min per m² (range 1.98–51.5), thus representing 19±11% of VO_2wb. Total BAL cellularity was increased in all patients (median 47, range 24–200×10⁴/ml), as was the total polymorphonuclear (PMN) count (median 78 range 5–93×10⁴/ml). Macrophage counts were in the normal range. There were raised BAL levels of interleukin-6 (IL-6) (median 945, range 23–1800 ng/ml) and elastase (median 391, range 5–949 ng/ml). Median protein levels were 270 g/ml (range 50–505). There was no correlation between VO_2pulm and BAL cellularity, PMNs, elastase, IL-6, or protein. Q_va/Q_t was 31.7±8%. Q_va/Q_t, corrected for the presence of VO_2pulm, (Q_va/Q_tcorr), was 30.3±8% (p<0.01 vs Q_va/Q_t), a 4.2% overestimation due to VO_2pulm. There was no correlation between Q_va/Q_t or Q_va/Q_tcorr and VO_2pulm.Conclusions In mechanically ventilated patients with acute lung injury, VO_2pulm was increased and led to a 19% underestimation of VO_2wb determined by the reverse Fick method, as well as to a 4.2% overestimation of calculated Q_va/Q_t. Lung inflammatory activity was increased, as assessed by BAL cellularity, IL-6 and elastase levels. However, there was no correlation between VO_2pulm and the intensity of pulmonary inflammation.