Aerosolized perfluorocarbon reduces adhesion molecule gene expression and neutrophil sequestration in acute respiratory distress

Ellen Schoof,Katharina Von Der Hardt,Michael A Kandler,Franziska Abendroth,Thomas Papadopoulos,Wolfgang Rascher,Jörg Dötsch

doi:10.1016/s0014-2999(02)02665-1

Abstract

In acute respiratory distress syndrome, neutrophil migration into the lung plays a key role in the development of lung injury. To study the effect of different modes of ventilation with perfluorocarbon (FC77®), intrapulmonary neutrophil accumulation and mRNA expression of E-selectin, P-selectin and intercellular adhesion molecule-1 (ICAM-1), mediating leukocyte sequestration, were measured in surfactant depleted piglets. After bronchoalveolar lavage, 20 animals either received aerosolized perfluorocarbon (Aerosol-PFC), partial liquid ventilation (PLV) with perfluorocarbon at functional residual capacity filling volume (FRC-PLV) or at low volume (LV-PLV) or intermittent mandatory ventilation (control). After 2 h of perfluorocarbon application, intermittent mandatory ventilation was continued for 6 h. In the Aerosol-PFC group, all measured adhesion molecules showed a significantly reduced gene expression compared to controls. FRC-PFC treatment was effective in significantly diminishing P-selectin and ICAM-1 mRNA expression. Relative lung tissue neutrophil counts were significantly reduced in the Aerosol-PFC and the FRC-PLV group. Treatment with aerosolized perfluorocarbon is at least as effective as partial liquid ventilation at FRC volume in reducing pulmonary adhesion molecule expression and neutrophil accumulation in acute respiratory distress syndrome.

Highlights

Критические состояния осложняются инфекция ми легких у 25—30% больных
The trachea was intubated with a 2.5 mm tube and mechanical ventilation (MV) started («TSE Animal Respirator Process Control O2 25», Technical Scientific Equipment, Germany)
Desquamated alveolar epithelium and macrophages were seen in some alveoli

Summary

Introduction

Критические состояния осложняются инфекция ми легких у 25—30% больных. Ассоциации грамотрица тельных микроорганизмов (Pseudomonas aeruginosa, Acinetobacter spp., Klebsiella pneumonia) являются веду щими при нозокомиальных инфекциях легких. По дан ным нашего исследования [1,2], у 70—80% больных в посевах бронхоальвеолярной лаважной жидкости выяв ляется Pseudomonas aeruginosa, у 70—90% — Acinetobacter baumanii/calcoaceticus, у 30—40% — Klebsilella pneumonia. Ведущее звено патогенеза грамотрицательных инфек ций — липополисахарид (ЛПС). Летальность при гра мотрицательных инфекциях легких достигает 70% [3]. Острый респираторный дистресс синдром осложняется нозокомиальной пневмонией у 34—60% больных, а тя желые нозокомиальные пневмонии в 12—33% — острым респираторным дистресс синдромом, что увеличивает летальность до 80% [4]

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