Abstract
BackgroundSaline fluid nebulization is highly recommend to combat the complications following tracheostomy, yet the understandings on the role of osmolality in saline solution for nebulization remain unclear.ObjectivesTo investigate the biological changes in the early stage after tracheostomy, to verify the efficacy of saline fluid nebulization and explore the potential role of osmolality of saline nebulization after tracheostomy.MethodsSprague-Dawley rats undergone tracheostomy were taken for study model, the sputum viscosity was detected by rotational viscometer, the expressions of TNF-α, AQP4 in bronchoalveolar lavage fluid were assessed by western blot analysis, and the histological changes in endothelium were evaluated by HE staining and scanning electron microscopy (SEM).ResultsStudy results revealed that tracheostomy gave rise to the increase of sputum viscosity, TNF-α and AQP4 expression, mucosa and cilia damage, yet the saline fluid nebulization could significantly decrease the changes of those indicators, besides, the hypertonic, isotonic and hypertonic saline nebulization produced different efficacy.ConclusionsOsmolality plays an important role in the saline fluid nebulization after tracheostomy, and 3% saline fluid nebulization seems to be more beneficial, further studies on the role of osmolality in saline fluid nebulization are warranted.
Highlights
Saline fluid nebulization is highly recommend to combat the complications following tracheostomy, yet the understandings on the role of osmolality in saline solution for nebulization remain unclear
As a rather simple yet serious surgery, tracheostomy are widely conducted in intensive care units (ICUs) and emergency department, it is well documented that tracheostomy may shorten the duration of ventilation, reduce pulmonary morbidity, save critical care resource utilization and decrease the hospital length of stay [1,2,3], the trachea opening and tube insertion render the trachea directly exposing to the external environment, making the airway in dry condition and hard to clear the sputum, and result in ventilator-associated pneumonia [4,5,6]
The bronchoalveolar lavage fluid (BALF) are widely used for detecting biological molecules change in clinic and laboratory [16], and it have been reported that TNFα and AQP4 in BALF are closely associated with the airway function, the elevated TNF-α expression in BALF may be related to inflammatory mechanism and causes ventilator-induced lung injury even high mortality [17], besides, increased inflammatory cytokines and AQP4 in BALF have been observed in the condition of hypobaric hypoxia [18], it’s noteworthy that even though TNF-α and AQP4 may related to the change of airway function, the role of TNF-α and AQP4 in the conditions of tracheostomy remain unclear, further studies on this issue are warranted
Summary
Saline fluid nebulization is highly recommend to combat the complications following tracheostomy, yet the understandings on the role of osmolality in saline solution for nebulization remain unclear. Given the insufficiency of evidence on the role of osmolality in saline nebulization, and the optimal osmolality in saline nebulization to patients’ outcome is highly relevant, we performed this experimental study with the following objectives: (1) to discuss the biological changes in the early stage after tracheostomy; (2) to compare the efficacy of hypotonic, isotonic and hypertonic saline solutions nebulization on the airway after tracheostomy; and (3) to analyze the role of saline osmolality on the sputum viscosity, histological changes, expression of TNF-α and AQP4 in BALF The bronchoalveolar lavage fluid (BALF) are widely used for detecting biological molecules change in clinic and laboratory [16], and it have been reported that TNFα and AQP4 in BALF are closely associated with the airway function, the elevated TNF-α expression in BALF may be related to inflammatory mechanism and causes ventilator-induced lung injury even high mortality [17], besides, increased inflammatory cytokines and AQP4 in BALF have been observed in the condition of hypobaric hypoxia [18], it’s noteworthy that even though TNF-α and AQP4 may related to the change of airway function, the role of TNF-α and AQP4 in the conditions of tracheostomy remain unclear, further studies on this issue are warranted.
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