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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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Histologic scores among the groups. Each values represent mean±SD. *p<0.05 versus prone; †p<0.05 versus supine or prone.
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Figure 6: Histologic scores among the groups. Each values represent mean±SD. *p<0.05 versus prone; †p<0.05 versus supine or prone.

Mentions: Gross postmortem inspection of the lungs in the supine group revealed edema and hemorrhage that were most prominent in the dependent regions. These changes appeared much less intense in the prone position. Histologic scores for dependent and nondependent were significantly higher in injurious ventilatory pattern (supine and prone) as compared with the control group (Fig. 6). In the dependent regions, mean histologic scores were significantly higher in the supine than the prone group (supine: 3.06±0.36; prone: 2.20±0.27; p=0.04). In the nondependent regions, however, mean histologic scores did not differ in both groups (supine: 2.31±0.12; prone: 2.01±0.46; p=0.52). Histologic scores were greater in dependent than in nondependent regions for animals ventilated in the supine group (p=0.02). In the prone group, however, no significant differences was found in histologic scores between dependent and nondependent regions (p=0.44).


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)

Histologic scores among the groups. Each values represent mean±SD. *p<0.05 versus prone; †p<0.05 versus supine or prone.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Histologic scores among the groups. Each values represent mean±SD. *p<0.05 versus prone; †p<0.05 versus supine or prone.
Mentions: Gross postmortem inspection of the lungs in the supine group revealed edema and hemorrhage that were most prominent in the dependent regions. These changes appeared much less intense in the prone position. Histologic scores for dependent and nondependent were significantly higher in injurious ventilatory pattern (supine and prone) as compared with the control group (Fig. 6). In the dependent regions, mean histologic scores were significantly higher in the supine than the prone group (supine: 3.06±0.36; prone: 2.20±0.27; p=0.04). In the nondependent regions, however, mean histologic scores did not differ in both groups (supine: 2.31±0.12; prone: 2.01±0.46; p=0.52). Histologic scores were greater in dependent than in nondependent regions for animals ventilated in the supine group (p=0.02). In the prone group, however, no significant differences was found in histologic scores between dependent and nondependent regions (p=0.44).

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