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Early Identification of Acute Lung Injury in a Porcine Model of Hemorrhagic Shock.

Publication ,  Journal Article
Morris, MC; Kim, Y; Blakeman, TC; Stevens-Topie, S; Jung, AD; Cox, DB; Robinson, BBR; Pritts, TA; Makley, AT; Goodman, MD
Published in: J Surg Res
March 2020

BACKGROUND: Acute lung injury (ALI) is a frequent complication after severe trauma. Lung-protective ventilation strategies and damage control resuscitation have been proposed for the prevention of ALI; however, there are no clinical or laboratory parameters to predict who is at risk of developing ALI after trauma. In the present study, we explored pulmonary inflammatory markers as a potential predictor of ALI using a porcine model of hemorrhagic shock. MATERIALS AND METHODS: Female swine were randomized to mechanical ventilation with low tidal volume (VT) (6 mL/kg) or high VT (12 mL/kg). After equilibration, animals underwent pressure-controlled hemorrhage (mean arterial pressure [MAP] 35 ± 5 mmHg) for 1 h, followed by resuscitation with fresh whole blood or Hextend. They were maintained at MAP of 50 ± 5 mmHg for 3 h in the postresuscitation phase. Bronchoalveolar lavage fluids were collected hourly and analyzed for inflammatory markers. Lung samples were taken, and porcine neutrophil antibody staining was used to evaluate the presence of neutrophils. ELISA evaluated serum porcine surfactant protein D levels. Sham animals were used as negative controls. RESULTS: Pigs that underwent hemorrhagic shock had higher heart rates, lower cardiac output, lower MAPs, and worse acidosis compared with sham at the early time points (P < 0.05 each). There were no significant differences in central venous pressure or pulmonary capillary wedge pressure between groups. Pulmonary neutrophil infiltration, as defined by neutrophil antibody staining on lung samples, was greater in the shock groups regardless of resuscitation fluid (P < 0.05 each). Bronchoalveolar lavage fluid neutrophil levels were not different between groups. There were no differences in levels of porcine surfactant protein D between groups at any time points, and the levels did not change over time in each respective group. CONCLUSIONS: Our study demonstrates the reproducibility of a porcine model of hemorrhagic shock that is consistent with physiologic changes in humans in hemorrhagic shock. Pulmonary neutrophil infiltration may serve as an early marker for ALI; however, the practicality of this finding has yet to be determined.

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Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

March 2020

Volume

247

Start / End Page

453 / 460

Location

United States

Related Subject Headings

  • Time Factors
  • Sus scrofa
  • Surgery
  • Shock, Hemorrhagic
  • Resuscitation
  • Respiration, Artificial
  • Reproducibility of Results
  • Pulmonary Surfactant-Associated Protein D
  • Prognosis
  • Predictive Value of Tests
 

Citation

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Morris, M. C., Kim, Y., Blakeman, T. C., Stevens-Topie, S., Jung, A. D., Cox, D. B., … Goodman, M. D. (2020). Early Identification of Acute Lung Injury in a Porcine Model of Hemorrhagic Shock. J Surg Res, 247, 453–460. https://doi.org/10.1016/j.jss.2019.09.060
Morris, Mackenzie C., Young Kim, Thomas C. Blakeman, Sabre Stevens-Topie, Andrew D. Jung, Daniel B. Cox, Bryce B. R. Robinson, Timothy A. Pritts, Amy T. Makley, and Michael D. Goodman. “Early Identification of Acute Lung Injury in a Porcine Model of Hemorrhagic Shock.J Surg Res 247 (March 2020): 453–60. https://doi.org/10.1016/j.jss.2019.09.060.
Morris MC, Kim Y, Blakeman TC, Stevens-Topie S, Jung AD, Cox DB, et al. Early Identification of Acute Lung Injury in a Porcine Model of Hemorrhagic Shock. J Surg Res. 2020 Mar;247:453–60.
Morris, Mackenzie C., et al. “Early Identification of Acute Lung Injury in a Porcine Model of Hemorrhagic Shock.J Surg Res, vol. 247, Mar. 2020, pp. 453–60. Pubmed, doi:10.1016/j.jss.2019.09.060.
Morris MC, Kim Y, Blakeman TC, Stevens-Topie S, Jung AD, Cox DB, Robinson BBR, Pritts TA, Makley AT, Goodman MD. Early Identification of Acute Lung Injury in a Porcine Model of Hemorrhagic Shock. J Surg Res. 2020 Mar;247:453–460.
Journal cover image

Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

March 2020

Volume

247

Start / End Page

453 / 460

Location

United States

Related Subject Headings

  • Time Factors
  • Sus scrofa
  • Surgery
  • Shock, Hemorrhagic
  • Resuscitation
  • Respiration, Artificial
  • Reproducibility of Results
  • Pulmonary Surfactant-Associated Protein D
  • Prognosis
  • Predictive Value of Tests