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Intensive Care Medicine

Erschienen in:

01.05.2005 | Experimental

Alveolar fibrinolytic capacity suppressed by injurious mechanical ventilation

verfasst von: Peter Dahlem, Albert P. Bos, Jack J. Haitsma, Marcus J. Schultz, Joost C. M. Meijers, Burkhard Lachmann

Erschienen in: Intensive Care Medicine | Ausgabe 5/2005

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Abstract

Objective

To investigate the effect of mechanical ventilation on alveolar fibrinolytic capacity.

Design and setting

Randomized controlled animal study in 66 Sprague-Dawley rats.

Subjects and interventions

Test animals received intratracheal fibrinogen and thrombin instillations; six were killed immediately (fibrin controls), and the others were allocated to three ventilation groups (ventilation period: 225 min) differing in positive inspiratory pressure and positive end-expiratory pressure, respectively: group 1, 16 cmH₂O and 5 cmH₂O (n=17); group 2, 26 cmH₂O and 5 cmH₂O (n=16); group 3, 35 cmH₂O and of 5 cmH₂O (n=17). Ten animals that had not been ventilated served as healthy controls.

Measurements and results

After animals were killed, we measured D-dimers, plasminogen activator inhibitor (PAI) 1, and tumor necrosis factor α in the bronchoalveolar lavage fluid and calculated lung weight and pressure/volume (P/V) plots. The median D-dimer concentration (mg/l) decreased with increasing pressure amplitude (192 in group 1, IQR 119; 66 in group 2, IQR 107; 29 in group 3, IQR 30) while median PAI-1 (U/ml) increased (undetectable in group 1; 0.55 in group 2, IQR 4.55; 3.05 in group 3, IQR 4.85). PAI-1 level was correlated with increased lung weight per bodyweight (Spearman’s rank correlation 0.708). Tumor necrosis factor α concentration was not correlated with PAI-1 level.

Conclusions

Alveolar fibrinolytic capacity is suppressed during mechanical ventilation with high pressure amplitudes due to local production of PAI-1.

Liebermann J, Ambrus CM (1963) Fibrinolysin, fibrin and hyaline membranes. Pediatrics 32:940–942

Bachofen M, Weibel ER (1982) Structural alterations of lung parenchyma in the adult respiratory distress syndrome. Clin Chest Med 3:35–56

Idell S (2003) Coagulation, fibrinolysis, and fibrin deposition in acute lung injury. Crit Care Med 31:S213–S220CrossRefPubMed

Levi M, Schultz MJ, Rijneveld AW, Van der Poll T (2003) Bronchoalveolar coagulation and fibrinolysis in endotoxemia and pneumonia. Crit Care Med 31:S238–S242

Bertozzi P, Astedt B, Zenzius L, Lynch K, LeMaire F, Zapol W, Chapman HA Jr (1990) Depressed bronchoalveolar urokinase activity in patients with adult respiratory distress syndrome. N Engl J Med 322:890–897PubMed

Idell S (1994) Extravascular coagulation and fibrin deposition in acute lung injury. New Horiz 2:566–574

Barazzone C, Belin D, Piguet PF, Vassalli JD, Sappino AP (1996) Plasminogen activator inhibitor-1 in acute hyperoxic mouse lung injury. J Clin Invest 98:2666–2673

Van der Poll T, de Jonge E, Levi M (2001) Regulatory role of cytokines in disseminated intravascular coagulation. Semin Thromb Hemost 27:639–651

Seeger W, Stohr G, Wolf HR, Neuhof H (1985) Alteration of surfactant function due to protein leakage: special interaction with fibrin monomer. J Appl Physiol 58:326–338

10.

Fukuda Y, Ishizaki M, Masuda Y, Kimura G, Kawanami O, Masugi Y (1987) The role of intraalveolar fibrosis in the process of pulmonary structural remodeling in patients with diffuse alveolar damage. Am J Pathol 126:171–182

11.

Chung SI, Lee SY, Uchino R, Carmassi F (1996) Factors that control extravascular fibrinolysis. Semin Thromb Hemost 22:479–488

12.

Gunther A, Kalinowski M, Elssner A, Seeger W (1994) Clot-embedded natural surfactant: kinetics of fibrinolysis and surface activity. Am J Physiol 267:L618–L624PubMed

13.

Fan J, Kapus A, Li YH, Rizoli S, Marshall JC, Rotstein OD (2000) Priming for enhanced alveolar fibrin deposition after hemorrhagic shock: role of tumor necrosis factor. Am J Respir Cell Mol Biol 22:412–421

14.

Tremblay L, Valenza F, Ribeiro SP, Li J, Slutsky AS (1997) Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model. J Clin Invest 99:944–952PubMed

15.

Dreyfuss D, Saumon G (1998) Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med 157:294–323PubMed

16.

Ranieri VM, Suter PM, Tortorella C, De Tullio R, Dayer JM, Brienza A, Bruno F, Slutsky AS (1999) Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA 282:54–61CrossRefPubMed

17.

Slutsky AS, Tremblay LN (1998) Multiple system organ failure. Is mechanical ventilation a contributing factor? Am J Respir Crit Care Med 157:1721–1725PubMed

18.

Slutsky AS (1999) Lung injury caused by mechanical ventilation. Chest 116:9S-15SCrossRef

19.

Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308CrossRefPubMed

20.

Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, Takagaki TY, Carvalho CR (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338:347–354CrossRefPubMed

21.

Brochard L, Roudot-Thoraval F, Roupie E, Delclaux C, Chastre J, Fernandez-Mondejar E, Clementi E, Mancebo J, Factor P, Matamis D, Ranieri M, Blanch L, Rodi G, Mentec H, Dreyfuss D, Ferrer M, Brun-Buisson C, Tobin M, LeMaire F (1998) Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trail Group on Tidal Volume reduction in ARDS. Am J Respir Crit Care Med 158:1831–1838

22.

Frank JA, Matthay MA (2003) Science review: mechanisms of ventilator-induced injury. Crit Care 7:233–241

23.

Dreyfuss D, Saumon G (1993) Role of tidal volume, FRC, and end-inspiratory volume in the development of pulmonary edema following mechanical ventilation. Am Rev Respir Dis 148:1194–1203PubMed

24.

Parker JC, Hernandez LA, Longenecker GL, Peevy K, Johnson W (1990) Lung edema caused by high peak inspiratory pressures in dogs. Role of increased microvascular filtration pressure and permeability. Am Rev Respir Dis 142:321–328

25.

Schermuly RT, Gunther A, Ermert M, Ermert L, Ghofrani HA, Weissmann N, Grimminger F, Seeger W, Walmrath D (2001) Conebulization of surfactant and urokinase restores gas exchange in perfused lungs with alveolar fibrin formation. Am J Physiol Lung Cell Mol Physiol 280:L792–L800

26.

Lachmann B, Robertson B, Vogel J (1980) In vivo lung lavage as an experimental model of the respiratory distress syndrome. Acta Anaesthesiol Scand 24:231–236PubMed

27.

Sato N, Takahashi H, Shibata A (1995) Fibrinogen/fibrin degradation products and D-dimer in clinical practice: interpretation of discrepant results. Am J Hematol 48:168–174

28.

Coughlin SR (2000) Thrombin signalling and protease-activated receptors. Nature 407:258–264CrossRefPubMed

29.

Haitsma JJ, Uhlig S, Goggel R, Verbrugge SJ, Lachmann U, Lachmann B (2000) Ventilator-induced lung injury leads to loss of alveolar and systemic compartmentalization of tumor necrosis factor-alpha. Intensive Care Med 26:1515–1522CrossRefPubMed

30.

Verbrugge SJ, Uhlig S, Neggers SJ, Martin C, Held HD, Haitsma JJ, Lachmann B (1999) Different ventilation strategies affect lung function but do not increase tumor necrosis factor-alpha and prostacyclin production in lavaged rat lungs in vivo. Anesthesiology 91:1834–1843CrossRefPubMed

31.

Gunther A, Mosavi P, Heinemann S, Ruppert C, Muth H, Markart P, Grimminger F, Walmrath D, Temmesfeld-Wollbruck B, Seeger W (2000) Alveolar fibrin formation caused by enhanced procoagulant and depressed fibrinolytic capacities in severe pneumonia. Comparison with the acute respiratory distress syndrome. Am J Respir Crit Care Med 161:454–462PubMed

32.

Schultz MJ, Millo J, Levi M, Hack CE, Weverling GJ, Garrard CS, Van der Poll T (2004) Local activation of coagulation and inhibition of fibrinolysis in the lung during ventilator associated pneumonia. Thorax 59:130–135CrossRefPubMed

33.

Idell S (1995) Coagulation, fibrinolysis and fibrin deposition in lung injury and repair.743–776

34.

Ricard JD, Dreyfuss D, Saumon G (2001) Production of inflammatory cytokines in ventilator-induced lung injury: a reappraisal. Am J Respir Crit Care Med 163:1176–1180PubMed

35.

Ricard JD, Dreyfuss D, Saumon G (2002) Ventilator-induced lung injury. Curr Opin Crit Care 8:12–20

36.

Uhlig U, Haitsma JJ, Goldmann T, Poelma DL, Lachmann B, Uhlig S (2002) Ventilation-induced activation of the mitogen-activated protein kinase pathway. Eur Respir J 20:946–956

37.

Vlahakis NE, Hubmayr RD (2003) Response of alveolar cells to mechanical stress. Curr Opin Crit Care 9:2–8

38.

Geiser T (2003) Idiopathic pulmonary fibrosis-a disorder of alveolar wound repair? Swiss Med Wkly 133:405–411

39.

Vassalli JD, Sappino AP, Belin D (1991) The plasminogen activator/plasmin system. J Clin Invest 88:1067–1072

40.

Idell S, Zwieb C, Boggaram J, Holiday D, Johnson AR, Raghu G (1992) Mechanisms of fibrin formation and lysis by human lung fibroblasts: influence of TGF-beta and TNF-alpha. Am J Physiol 263:L487–L494

41.

Yamamoto H, Teramoto H, Uetani K, Igawa K, Shimizu E (2002) Cyclic stretch upregulates interleukin-8 and transforming growth factor-beta1 production through a protein kinase C-dependent pathway in alveolar epithelial cells. Respirology 7:103–109

42.

Cheng JJ, Chao YJ, Wung BS, Wang DL (1996) Cyclic strain-induced plasminogen activator inhibitor-1 (PAI-1) release from endothelial cells involves reactive oxygen species. Biochem Biophys Res Commun 225:100–105

43.

Prabhakaran P, Ware LB, White KE, Cross MT, Matthay MA, Olman MA (2003) Elevated levels of plasminogen activator inhibitor-1 in pulmonary edema fluid are associated with mortality in acute lung injury. Am J Physiol Lung Cell Mol Physiol 285:L20–L28

Titel: Alveolar fibrinolytic capacity suppressed by injurious mechanical ventilation
verfasst von: Peter Dahlem
Albert P. Bos
Jack J. Haitsma
Marcus J. Schultz
Joost C. M. Meijers
Burkhard Lachmann
Publikationsdatum: 01.05.2005
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 5/2005
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-005-2588-2

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Alveolar fibrinolytic capacity suppressed by injurious mechanical ventilation