A long-lasting porcine model of ARDS caused by pneumonia and ventilator-induced lung injury
Barbeta, Enric (Hospital Clínic i Provincial de Barcelona)
Arrieta, Marta (Universitat de Barcelona)
Motos, Ana (Universitat de Barcelona)
Bobi, Joaquim (Hospital Clínic i Provincial de Barcelona)
Yang, Hua (Beijing Chao-Yang Hospital)
Yang, Minlan (Beijing Chao-Yang Hospital)
Tanzella, Giacomo (San Martino Policlinico Hospital)
Di Ginnatale, Pierluigi (SS. Annunziata Hospital)
Nogas, Stefano (San Martino Policlinico Hospital)
Vargas, Carmen Rosa (Universitat de Barcelona)
Cabrera, Roberto (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Battaglini, Denise (San Martino Policlinico Hospital)
Meli, Andrea (Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico)
Kiarostami, Kasra (Universitat de Barcelona)
Vázquez, Nil (Universitat de Barcelona)
Fernández-Barat, Laia (Universitat de Barcelona)
Rigol, Montserrat (Hospital Clínic i Provincial de Barcelona)
Mellado-Artigas, Ricard (Hospital Clínic i Provincial de Barcelona)
Frigola, Gerard (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Camprubí-Rimblas, Marta (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Ferrer, Pau (Universitat Pompeu Fabra)
Martinez, Daniel (Hospital Clínic i Provincial de Barcelona)
Artigas Raventós, Antoni (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Ferrando, Carlos (Hospital Clínic i Provincial de Barcelona)
Ferrer, Miquel (Hospital Clínic i Provincial de Barcelona)
Torres, Antoni (Hospital Clínic i Provincial de Barcelona)
Universitat Autònoma de Barcelona

Data:	2023
Resum:	Animal models of acute respiratory distress syndrome (ARDS) do not completely resemble human ARDS, struggling translational research. We aimed to characterize a porcine model of ARDS induced by pneumonia-the most common risk factor in humans-and analyze the additional effect of ventilator-induced lung injury (VILI). Bronchoscopy-guided instillation of a multidrug-resistant Pseudomonas aeruginosa strain was performed in ten healthy pigs. In six animals (pneumonia-with-VILI group), pulmonary damage was further increased by VILI applied 3 h before instillation and until ARDS was diagnosed by PaO/FiO < 150 mmHg. Four animals (pneumonia-without-VILI group) were protectively ventilated 3 h before inoculum and thereafter. Gas exchange, respiratory mechanics, hemodynamics, microbiological studies and inflammatory markers were analyzed during the 96-h experiment. During necropsy, lobar samples were also analyzed. All animals from pneumonia-with-VILI group reached Berlin criteria for ARDS diagnosis until the end of experiment. The mean duration under ARDS diagnosis was 46. 8 ± 7. 7 h; the lowest PaO/FiO was 83 ± 5. 45 mmHg. The group of pigs that were not subjected to VILI did not meet ARDS criteria, even when presenting with bilateral pneumonia. Animals developing ARDS presented hemodynamic instability as well as severe hypercapnia despite high-minute ventilation. Unlike the pneumonia-without-VILI group, the ARDS animals presented lower static compliance (p = 0. 011) and increased pulmonary permeability (p = 0. 013). The highest burden of P. aeruginosa was found at pneumonia diagnosis in all animals, as well as a high inflammatory response shown by a release of interleukin (IL)-6 and IL-8. At histological examination, only animals comprising the pneumonia-with-VILI group presented signs consistent with diffuse alveolar damage. In conclusion, we established an accurate pulmonary sepsis-induced ARDS model. The online version contains supplementary material available at 10. 1186/s13054-023-04512-8.
Ajuts:	Instituto de Salud Carlos III PI18/00974
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	ARDS ; Double hit ; Injurious mechanical ventilation ; Pneumonia ; Porcine model ; Ventilator-induced lung injury
Publicat a:	Critical Care, Vol. 27 (june 2023) , ISSN 1466-609X

DOI: 10.1186/s13054-023-04512-8
PMID: 37328874

14 p, 7.1 MB

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