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The role of the lactate dehydrogenase and the effect of prone position during ventilator-induced lung injury.

Lim SC, Kim YI - J. Korean Med. Sci. (2004)

Bottom Line: Serum levels of LDH progressively increased significantly during the VILI (supine and prone groups) as compared with controls.Wet weight/dry weight ratios (WW/DW) and histologic scores for dependent regions were significantly higher in the supine than the prone group.The prone position resulted in a less severe and more homogenous distribution of VILI.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea. lscmd@chonnam.ac.kr

ABSTRACT
To examine the impact of lactate dehydrogenase (LDH) as an early marker of ventilator-induced lung injury (VILI) and the effect of prone position during the VILI, we ventilated 28 normal white rabbits (10 supine, 10 prone, 8 controls) for 6 hr or until PaO2/FIO2 ratio was<200 mmHg. We applied an identical injurious ventilatory pattern (peak inspiratory pressure of 35 cmH2O with a PEEP of 3 cmH2O, I:E ratio of 1:2, and FIO2 of 0.40) in the supine and prone group. VILI was assessed by oxygenation, gravimetric analysis and histologic grading. Serum levels of LDH progressively increased significantly during the VILI (supine and prone groups) as compared with controls. There was a significant negative correlation between oxygenation and LDH levels (r=-0.619, p<0.001). Wet weight/dry weight ratios (WW/DW) and histologic scores for dependent regions were significantly higher in the supine than the prone group. There were no differences in WW/DW and histologic scores for nondependent regions between the supine and prone group. These findings suggest that serum LDH levels might be an early marker of severity of lung injury. The prone position resulted in a less severe and more homogenous distribution of VILI.

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Comparisons of oxygenation among the groups. PaO2 decreased significantly after 2 and 3 hr in the supine and prone groups as compared with baseline values, respectively. Data represent the mean±SD. *p<0.05 versus baseline values.
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Figure 2: Comparisons of oxygenation among the groups. PaO2 decreased significantly after 2 and 3 hr in the supine and prone groups as compared with baseline values, respectively. Data represent the mean±SD. *p<0.05 versus baseline values.

Mentions: There were no significant differences in oxygenation and systemic arterial pressure among the groups under baseline conditions. Systemic arterial pressure trended downward during the VILI in the prone as compared with supine group. However, there were no significant differences in systemic arterial pressure between supine and prone group. In the supine group, PaO2 decreased significantly after 2 hr as compared with baseline values (181.1±26.0 vs. 141.9±46.3 mm Hg; p<0.05). PaO2 decreased significantly after 3 hr as compared with baseline values in the prone group (182.0±19.2 vs. 137.1±47.2 mm Hg; p<0.05). Although PaO2 tended to be lower in the supine than prone group during the VILI, this change did not reach significance between two groups at end of experiment. PaO2 remained stable for 6 hr in the control group (Fig. 2).


The role of the lactate dehydrogenase and the effect of prone position during ventilator-induced lung injury.

Lim SC, Kim YI - J. Korean Med. Sci. (2004)

Comparisons of oxygenation among the groups. PaO2 decreased significantly after 2 and 3 hr in the supine and prone groups as compared with baseline values, respectively. Data represent the mean±SD. *p<0.05 versus baseline values.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2822303&req=5

Figure 2: Comparisons of oxygenation among the groups. PaO2 decreased significantly after 2 and 3 hr in the supine and prone groups as compared with baseline values, respectively. Data represent the mean±SD. *p<0.05 versus baseline values.
Mentions: There were no significant differences in oxygenation and systemic arterial pressure among the groups under baseline conditions. Systemic arterial pressure trended downward during the VILI in the prone as compared with supine group. However, there were no significant differences in systemic arterial pressure between supine and prone group. In the supine group, PaO2 decreased significantly after 2 hr as compared with baseline values (181.1±26.0 vs. 141.9±46.3 mm Hg; p<0.05). PaO2 decreased significantly after 3 hr as compared with baseline values in the prone group (182.0±19.2 vs. 137.1±47.2 mm Hg; p<0.05). Although PaO2 tended to be lower in the supine than prone group during the VILI, this change did not reach significance between two groups at end of experiment. PaO2 remained stable for 6 hr in the control group (Fig. 2).

Bottom Line: Serum levels of LDH progressively increased significantly during the VILI (supine and prone groups) as compared with controls.Wet weight/dry weight ratios (WW/DW) and histologic scores for dependent regions were significantly higher in the supine than the prone group.The prone position resulted in a less severe and more homogenous distribution of VILI.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea. lscmd@chonnam.ac.kr

ABSTRACT
To examine the impact of lactate dehydrogenase (LDH) as an early marker of ventilator-induced lung injury (VILI) and the effect of prone position during the VILI, we ventilated 28 normal white rabbits (10 supine, 10 prone, 8 controls) for 6 hr or until PaO2/FIO2 ratio was<200 mmHg. We applied an identical injurious ventilatory pattern (peak inspiratory pressure of 35 cmH2O with a PEEP of 3 cmH2O, I:E ratio of 1:2, and FIO2 of 0.40) in the supine and prone group. VILI was assessed by oxygenation, gravimetric analysis and histologic grading. Serum levels of LDH progressively increased significantly during the VILI (supine and prone groups) as compared with controls. There was a significant negative correlation between oxygenation and LDH levels (r=-0.619, p<0.001). Wet weight/dry weight ratios (WW/DW) and histologic scores for dependent regions were significantly higher in the supine than the prone group. There were no differences in WW/DW and histologic scores for nondependent regions between the supine and prone group. These findings suggest that serum LDH levels might be an early marker of severity of lung injury. The prone position resulted in a less severe and more homogenous distribution of VILI.

Show MeSH
Related in: MedlinePlus