ABSTRACT
Objective To investigate the effect of high-frequency oscillatory ventilation (HFOV) on inflammatory responses in lung tissues of dogs with severe acute respiratory distress syndrome (ARDS).Methods Healthy mongrel dogs of both sexes,weighing 13.7-16.2 kg,in which severe ARDS was induced by intravenous infusion of the mixture of oleic acid 0.2 ml/kg and autologous blood (equal to the volume of oleic acid).Twenty-four dogs with severe ARDS were randomly divided into 4 groups (n=6 each) using a random number table:conventional mechanical ventilation with low tidal volume group (group CMV),HFOV-9 Hz group,HFOV-12 Hz group and HFOV-15 Hz group.In HFOV-9 Hz,HFOV-12 Hz and HFOV-15 Hz groups,the frequency was 9,12,and 15 Hz,respectively,mean airway pressure 20 cmH2O,oscillation pressure 70 cmH2O,and inspired oxygen fraction ratio 1.0.In group CMV,the animals were mechanically ventilated in volume-controlled mode,with positive end-expiratory pressure 5 cmH2O,tidal volume 6 ml/kg,respiratory rate 30 breaths/min,inspiratory/expiratory ratio 1:2,and inspired oxygen fraction ratio 1.0.At 4 h of ventilation,the animals were sacrificed,and lungs were removed for determination of wet/dry weight (W/D) ratio,contents of tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6) and IL-10 (by enzyme-linked immunosorbent assay),and expression of vascular endothelial (VE)-Cadherin (by Western blot) and for microscopic examination.Lung injury scores were assessed.Results Compared with group CMV,the lung injury scores,W/D ratio,and contents of TNF-α and IL-6 were significantly decreased,the content of IL-10 was significantly increased,and the expression of VE-Cadherin was significantly up-regulated in the other three groups (P＜0.05).Compared with group HFOV-9Hz,the lung injury scores,W/D ratio and contents of TNF-α and IL-6 were significantly decreased,the content of IL-10 was significantly increased,and the expression of VE-Cadherin was significantly up-regulated in group HFOV-15 Hz,and the content of IL-6 was significantly decreased in group HFOV-12 Hz (P＜0.05).Conclusion HFOV can significantly inhibit inflammatory responses in lung tissues of dogs with severe ARDS as compared with mechanical ventilation with low tidal volume,which may be involved in the mechanism of lung-protective ventilation effect.
ABSTRACT
Objective To approach the effect of Shenfu injection (SFI) and conventional early goal-directed therapy (EGDT) on organ functions and outcomes of septic shock patients. Methods Eighty-four cases conformed to the criteria for the diagnosis of septic shock admitted to Department of Critical Care Medicine of Xuzhou Central Hospital were randomly divided into conventional treatment group (42 cases), and SFI treatment group (42 cases). Conventional treatment was given in the two groups;in SFI treatment group, SFI 100 mL was additionally given by trace continuous intravenous pump 20 mL/h, twice daily for 7 days. Before and after treatment for 1, 6, 12, 24, 48, 72 hours, the levels of hemodynamic status, lactic acid and dosage of vasoactive drugs used, organ function, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, the time of weaning from ventilator, the length of stay in intensive care unit (ICU), time without organ failure and 28-day mortality rate were observed. Results Compared with those before treatment, after treatment in the two groups, the mean arterial pressure (MAP), cardiac index (CI) and systemic vascular resistance index (SVRI) were increased, while the levels of heart rate (HR) and lactate were decreased (all P0.05). Compared with that before treatment, in the conventional treatment group after treatment for 1 and 3 days, gamma glutamyl transpeptidase (GGT) was increased, on the 5th day it began to decrease, reaching its minimum on the 7th day (U/L:26.75±16.74 vs. 46.96±25.85);while in SFI treatment group, GGT was increased after treatment for 1 day, on 3rd day it began to decrease, reaching its lowest level on the 7th day (U/L:22.41±17.87 vs. 51.23±27.74);aspartate aminotransferase (AST), total bilirubin (TBil), oxygenation index (PaO2/FiO2) were increased after the treatment for 1, 3, 5, 7 days, and blood urea nitrogen (BUN), creatinine (Cr) were decreased at different time points after treatment. In the conventional treatment group, the precursor protein (PA) was decreased after treatment for 1, 3, 5 days, on the 7th day it was increased (mg/L:134.20±63.44 vs. 115.70±45.96);while in SFI treatment group, after the treatment for 1 days and 3 days, it was decreased, on the 5th day it was increased, reaching its highest level on the 7th day (mg/L:145.40±59.75 vs. 108.20±54.34). Compared with those before treatment, after treatment for 1, 3, 5, 7 days, APACHEⅡscore and SOFA score were decreased in the two groups, but there was no statistically significant difference in APACHEⅡscore between the two groups, in SFI treatment group after treatment for 3 days, SOFA score was significantly lower than that of the conventional treatment group (6.31±3.86 vs. 7.14±4.03, P0.05). Conclusion The combined use of SFI and EGDT can improve hemodynamics, reduce damage to vital organs, and shorten the times for ventilation and stay in ICU in septic shock patients.