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      Effects of Direct Hemoperfusion Using a Cytokine-Adsorbing Column on Endotoxin-Induced Experimental Acute Lung Injury in Rats

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          Abstract

          Background: Effects of direct hemoperfusion with a cytokine-adsorbing column, CTR, on endotoxin-induced experimental acute lung injury in rats were evaluated. Methods: 36 Sprague-Dawley rats were ventilated mechanically and allocated to one of the following three groups (n = 12 per group): saline control, saline instilled into trachea; endotoxin control, endotoxin (40 mg/kg) instilled into trachea, and treatment group, CTR treated for 90 min after endotoxin (40 mg/kg) instillation. Blood gases, cytokine concentrations and lung histopathology were evaluated. Results: The decreased Pa O<sub>2</sub> in the treatment group had recovered at 120 min after instillation and was significantly higher than that in the endotoxin control. The increased Pa CO<sub>2</sub> in the endotoxin control was significantly higher than that in the treatment group. The elevated cytokine concentrations and the neutrophil infiltration into the lungs were less in the treatment group than in the endotoxin control. Conclusion: The present study showed that CTR treatment inhibited hypoxia, hypercapnia, and inflammatory responses in an acute lung injury model.

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          Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: a prospective study.

          To evaluate the outcome in patients with severe adult respiratory distress syndrome (ARDS) managed with limitation of peak inspiratory pressure to 30 to 40 cm H2O, low tidal volumes (4 to 7 mL/kg), spontaneous breathing using synchronized intermittent mandatory ventilation from the start of ventilation, and permissive hypercapnia without the use of bicarbonate to buffer acidosis. Also, to compare hospital mortality rate with that predicted by the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system and the "ventilator score." A ten-bed general intensive care unit in a university hospital. Prospective, descriptive study. Fifty-three patients with severe ARDS having a lung injury score of > or = 2.5. Data recording. The hospital mortality rate was significantly lower than that predicted by the APACHE II scores (26.4% vs. 53.3%, p = .004), even after correcting the latter for the effect of hypercapnic acidosis (26.4% vs. 51.1%, p = .008). The mortality rate increased with increasing number of organ failures, but was only 43% in patients with > or = 4 organ failures, 20.5% with < or = 3 organ failures, and 6.6% with only respiratory failure. The mean maximum PaCO2 was 66.5 torr (range 38 to 158 torr [8.87 kPa, range 5.07 to 21.07]), and the mean arterial pH at the same time was 7.23 (range 6.79 to 7.45). There was no correlation between the maximum PaCO2 or the corresponding pH and the total respiratory rate at the same time. No pneumothoraces developed during mechanical ventilation. These results lend further support to the hypothesis that limitation of peak inspiratory pressure and reduction of regional lung overdistention by the use of low tidal volumes with permissive hypercapnia may reduce ventilator-induced lung injury and improve outcome in severe ARDS. This hypothesis is supported by a large body of experimental evidence, which also suggests that ventilator-induced lung injury may result in the release of inflammatory mediators, and thus may have the potential to augment the development of multiple organ dysfunction. However, the hypothesis requires testing in a randomized trial as acute hypercapnia could potentially have some adverse as well as beneficial effects.
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            Pulmonary endothelium in acute lung injury: from basic science to the critically ill.

            Pulmonary endothelium is an active organ possessing numerous physiological, immunological, and metabolic functions. These functions may be altered early in acute lung injury (ALI) and further contribute to the development of acute respiratory distress syndrome (ARDS). Pulmonary endothelium is strategically located to filter the entire blood before it enters the systemic circulation; consequently its integrity is essential for the maintenance of adequate homeostasis in both the pulmonary and systemic circulations. Noxious agents that affect pulmonary endothelium induce alterations in hemodynamics and hemofluidity, promote interactions with circulating blood cells, and lead to increased vascular permeability and pulmonary edema formation. We highlight pathogenic mechanisms of pulmonary endothelial injury and their clinical implications in ALI/ARDS patients.
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              Direct hemoperfusion using a polymyxin B immobilized column improves acute respiratory distress syndrome.

              Acute respiratory distress syndrome (ARDS) is characterized by a high mortality rate. We have studied whether direct hemoperfusion using a polymyxin B immobilized fiber column (PMX-DHP) is effective for acute lung injury (ALI) and ARDS. Two ALI and eighteen ARDS patients were evaluated, four congestive heart failure (CHF) patients were evaluated as cardiogenic pulmonary edema, and we retrospectively compared the outcome with ten patients with ARDS who had been hospitalized between 1990 and 1998 as the untreated group. PMX-DHP was carried out twice at a rate of 80-100 ml/minute for 2 hours, with a time interval of approximately 24 hours. We monitored systolic blood pressure (BP), diastolic BP, and the PaO(2)/FIO(2) (PF) ratio before and after PMX-DHP treatment. The mortality was classified if patients were alive at day 30 after initiating PMX-DHP. The mortality of ARDS patients was approximately 20%. Systolic BP increased significantly from 106 +/- 20 to 135 +/- 21 and to 125 +/- 20 mmHg on the following day. Diastolic BP increased from 61 +/- 16 to 78 +/- 15, and to 72 +/- 12 mmHg. The PF ratio increased significantly from 125 +/- 54 to 153 +/- 73, and 163 +/- 78 Torr. CHF patients did not reveal improvement of systolic, diastolic BP, and PF ratio after PMX-DHP. Eight of ten patients in the untreated group died through exacerbated ARDS. In ARDS patients, PMX-DHP improved circulatory disturbance and oxygenation despite the underlying diseases. The mortality improved compared with that before induction of PMX-DHP. Copyright 2002 Wiley-Liss, Inc.
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                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                0253-5068
                1421-9735
                2010
                July 2010
                25 June 2010
                : 30
                : 1
                : 44-49
                Affiliations
                aIntensive Care Unit, Kanazawa University Hospital, and bDepartment of Anesthesiology and Intensive Care Medicine, Kanazawa University, Kanazawa, Japan
                Article
                317118 Blood Purif 2010;30:44–49
                10.1159/000317118
                20616543
                f5c8b611-6514-4673-91a5-a66371995bae
                © 2010 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 17 December 2009
                : 19 April 2010
                Page count
                Figures: 8, Tables: 1, References: 16, Pages: 6
                Categories
                Original Paper

                Cardiovascular Medicine,Nephrology
                Cytokine-adsorbing column,Cytokine adsorption,Acute respiratory failure,Acute lung injury,Endotoxin

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