Abstract
Background The energy delivered by a ventilator to the respiratory system in one minute is defined as mechanical power (MP). However, the effect of ventilator-induced lung injury (VILI) in patients suffering from acute respiratory distress syndrome (ARDS) is still unknown. Our previous studies revealed that CXCL10 may be a potential biomarker of lung injury in ARDS. Therefore, the aim of this study was to compare the lung injury of rats and patients under different MP conditions to explore the involvement of CXCL10 and its receptor CXCR3 in VILI. Methods Patients were divided into the high mechanical power group (HMPp group) and low mechanical power group (LMPp group), while rats were assigned to the high mechanical power group (HMPr group), medium mechanical power group (MMPr group), and low mechanical power group (LMPr group). CXCL10 and CXCR3 plasma content in ARDS patients and rats under ventilation at different MP was measured, as well as their protein and mRNA expression in rat lungs. Results CXCL10 and CXCR3 content in the plasma of ARDS patients in the HMPp was significantly higher than that in the LMPp. The increase of MP during mechanical ventilation in the rats gradually increased lung damage, and CXCL10 and CXCR3 levels in rat plasma gradually increased with the increase of MP. CXCL10 and CXCR3 protein and mRNA expression in the HMPr group and MMPr group was significantly higher than that in the LMPr group (P < 0.05). More mast cells were present in the trachea, bronchus, blood vessels, and lymphatic system in the rat lungs of the HMPr group, and the number of mast cells in the HMPr group (13.32 ± 3.27) was significantly higher than that in the LMPr group (3.25 ± 0.29) (P < 0.05). Conclusion The higher the MP, the more severe the lung injury, and the higher the CXCL10/CXCR3 expression. Therefore, CXCL10/CXCR3 might participate in VILI by mediating mast cell chemotaxis.
Highlights
Acute respiratory distress syndrome (ARDS) is one of the most common critical illnesses in intensive care medicine
Mechanical ventilation is required in the treatment of acute respiratory distress syndrome (ARDS), but improper use can cause or aggravate lung injury, leading to pulmonary fibrosis and ventilatorinduced lung injury (VILI), which is highly affecting the prognosis of critically ill patients [2]
It was designed according to the simplified equation proposed by Gattinoni et al [18], under the premise that the tidal volume, positive end-expiratory pressure, inspiratory flow, and other parameters are constant by changing the breathing frequency of the mechanical ventilation, in order to achieve the purpose of changing the size of mechanical power (MP)
Summary
Acute respiratory distress syndrome (ARDS) is one of the most common critical illnesses in intensive care medicine. The concept of mechanical power (MP) combines the comprehensive effects of the above respiratory mechanical parameters; it can allow a better evaluation and prevention of VILI during mechanical ventilation in patients with ARDS. It may become a new standard for guiding safe lung ventilation in ARDS patients. The effect of ventilator-induced lung injury (VILI) in patients suffering from acute respiratory distress syndrome (ARDS) is still unknown. CXCL10 and CXCR3 plasma content in ARDS patients and rats under ventilation at different MP was measured, as well as their protein and mRNA expression in rat lungs. CXCL10/CXCR3 might participate in VILI by mediating mast cell chemotaxis
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