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Query: UMLS:C0432222 (SEM)
 47,337 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The respiratory burst of neutrophils generates oxygen radicals that can result in lipid peroxidation and may contribute to acute lung injury in the adult respiratory distress syndrome (ARDS). Because ceruloplasmin and transferrin are inhibitors of lipid peroxidation and may play a role in regulating tissue injury, antigen levels of ceruloplasmin and transferrin and ceruloplasmin oxidase levels were measured in the serum and bronchoalveolar lavage fluid (BALF) of ARDS patients (n = 28), patients at risk for ARDS (n = 22), and normal control subjects (n = 45). Serum ceruloplasmin levels were similar in ARDS (mean +/- SEM) (3.8 +/- 0.3 microM) and at-risk (3.3 +/- 0.4 microM) patients compared with control subjects (3.2 +/- 0.2 microM). Serum transferrin levels were decreased in ARDS (14.9 +/- 1.7 microM) and at-risk (20.4 +/- 1.7 microM) patients compared with normal control subjects (32.9 +/- 1.2 microM), and serum transferrin levels correlated with serum unsaturated iron binding capacity (UIBC). Ceruloplasmin was detected in only one of 38 normal BALF samples (0.002 +/- 0.002 microM) and two of 13 at-risk BALF samples (0.15 +/- 0.1 microM), yet it was present in 17 of 23 ARDS BALF samples (0.9 +/- 0.2 microM). Transferrin was also increased in ARDS BALF (5.4 +/- 1.1 microM) compared with at-risk (0.7 +/- 0.5 microM) and normal (0.4 +/- 0.1 microM) samples. Ceruloplasmin that was present in the BALF and serum samples had functional oxidase activity, and purified human ceruloplasmin inhibited hydroxyl radical formation by phorbol myristate acetate (PMA)-stimulated neutrophils.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Ceruloplasmin and transferrin levels are altered in serum and bronchoalveolar lavage fluid of patients with the adult respiratory distress syndrome. 131 27

The change in venous blood density in an in vitro rabbit lung preparation was measured after the osmolarity of the blood was elevated 17 to 50 mosmol/liter by a constant arterial infusion of hypertonic saline. We observed a transient density decrease of the blood flowing from the lung and then a return to the preinfusion density within 10 sec, an indication of the rapid completion of fluid extraction from the interstitia by the elevation in osmotic pressure. By fitting the time course of the density change with the prediction of an extraction model, we obtained the osmotic conductance sigma K (the product of the reflection and filtration coefficient) of the lung due to the increase in NaCl osmotic pressure as 1.33 +/- 0.18 ml/[hr.(mosmol/liter).g wet lung tissue] (mean +/- SEM), the interstitial volume participating in the extraction process as 0.27 +/- 0.04 ml/g of lung tissue, and the volume of fluid extracted as 1.12 +/- 0.16 microliter/g tissue for every mosmol/liter elevation. Since we also found no significant difference between the osmotic extraction parameters determined in blood-perfused lungs and those determined in plasma-perfused lungs, we concluded that the rapid density change is the result of the fluid extraction and not the flow impediment of red blood cells caused by the increase in osmolarity.
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PMID:Determination of fluid extraction and osmotic conductance sigma K in the lung with hypertonic NaCl infusion. II. Experiments. 147 32

Tissue hypoxia is thought to be pivotal to the development of multiple organ failure, but cannot be measured directly in clinical practice. We assessed the relationship between initial arterial blood lactate concentrations and the presence of the phenomenon of delivery-dependent oxygen consumption, both of which may indicate tissue hypoxia. Twenty-three critically ill patients with septic shock and adult respiratory distress syndrome were studied prospectively and allocated to one of two groups according to blood lactate concentrations. In group 1, blood lactate concentration was less than the level widely accepted as significant (2 mmol.l-1); in group 2, the concentration exceeded 2 mmol.l-1. In both groups, resuscitation with colloid, blood and vasoactive drugs resulted in significant increases in oxygen delivery; in group 1 (n = 13), mean (SEM) oxygen delivery increased from 484 (36) to 730 (44) ml.min-1.m-2 (p < 0.005) and in group 2 (n = 10) from 550 (54) to 780 (54) ml.min-1.m-2 (p < 0.05). In neither group was there a significant change in oxygen consumption. However, there were individuals in both groups who exhibited pathological delivery dependence. This suggests that the absence of hyperlactataemia does not preclude delivery dependence of oxygen consumption with the attendant potential for tissue hypoxia.
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PMID:The relationship of blood lactate concentrations, oxygen delivery and oxygen consumption in septic shock and the adult respiratory distress syndrome. 821 72

Oxygenation improves in patients with adult respiratory distress syndrome and in animals with oleic acid-induced lung injury when they are turned from the supine to the prone position. Dependent and nondependent pleural pressures (Ppl) were measured in six pigs ventilated in the supine and prone positions before and after volume infusion (VI). Before VI the mean +/- SEM AaPO2 difference was 26 +/- 8 mm Hg when the animals were supine and 10 +/- 2 mm Hg when they were prone (p > 0.05). After VI the AaPO2 was 64 +/- 6 mm Hg when the animals were supine (p < 0.05) and 43 +/- 7 mm Hg when they were prone (p < 0.05). VI increased the Ppl gradient from 0.53 +/- 0.1 to 0.71 +/- 0.1 cm H2O/cm when the animals were supine (p < 0.05) and from 0.17 +/- 0.1 to 0.27 +/- 0.1 cm H2O/cm when they were prone (p < 0.05). Dependent Ppl at FRC was much less positive when the animals were prone versus supine (0.9 +/- 0.3 versus 3.0 +/- 0.5 cm H2O, p < 0.05), suggesting that the airways in these dependent regions would narrow and/or close and that ventilation to these regions would diminish as a result of VI.
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PMID:Prone position alters the effect of volume overload on regional pleural pressures and improves hypoxemia in pigs in vivo. 148 16

Intrapulmonary activation of leukocytes and release of cellular mediators and enzymes are involved in the pathophysiology of the adult respiratory distress syndrome (ARDS). To investigate a possible role of local cytokines, we measured bronchoalveolar fluid (BALF) and plasma levels of tumor necrosis factor alpha (TNF-alpha) and its soluble inhibitors (sTNF-RI + RII), interleukin-1 beta (IL-1 beta), interferon-alpha (IFN-alpha), and granulocyte elastase in 14 patients at risk for ARDS and in 35 patients developing ARDS after trauma, sepsis, or shock. During clinical development of severe ARDS, BALF cytokines increased markedly: TNF-alpha from 116 +/- 36 to 10,731 +/- 5,048 pg/ml (mean +/- SEM), p = 0.001; sTNF-RI + RII from 3.7 +/- 1.4 to 24.6 +/- 2.6 ng/ml, p less than 0.05; and IL-1 beta from 7,746 +/- 5,551 to 42,255 +/- 19,176 pg/ml, p = 0.01. Plasma cytokines were not increased in most patients, nor were they correlated with the development or severity of ARDS. BALF elastase was higher in patients developing ARDS than in those at risk but not going into pulmonary failure (0.97 +/- 0.26 versus 0.28 +/- 0.13 U/ml, p = 0.026), and the highest values were observed in the early stages of severe ARDS (1.85 +/- 0.39 U/ml). BALF elastase levels correlated with IFN-alpha (r = 0.72, p less than 0.001). In conclusion, local release of TNF-alpha and IL-1 beta, possibly by pulmonary macrophages or other cells, and/or accumulation in the lung is associated with the development of ARDS.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:High bronchoalveolar levels of tumor necrosis factor and its inhibitors, interleukin-1, interferon, and elastase, in patients with adult respiratory distress syndrome after trauma, shock, or sepsis. 158 41

1. The aim of the present study was to evaluate the systemic synthesis of cysteinyl leukotrienes in patients with multiple trauma. In order to do this, the urinary excretion of leukotriene E4 was assessed in the first 10 days after trauma. 2. Leukotriene E4 was unequivocally identified by g.c.-m.s. in the urine of healthy subjects and patients with multiple trauma after its conversion to 5-hydroxyeicosanoic acid. Leukotriene E4 was routinely isolated from 24 h urine samples by solid-phase extraction followed by reverse-phase h.p.l.c. and was subsequently quantified by r.i.a. 3. Healthy subjects excreted daily 10 +/- 3 nmol of leukotriene E4/mol of creatinine (mean +/- SEM, n = 16) into urine. 4. Patients with multiple trauma who did not develop adult respiratory distress syndrome (n = 7) excreted 76.8 +/- 6.7 nmol of leukotriene E4/mol of creatinine (mean +/- SEM) daily during the first 10 days after trauma, which was significantly (P less than 0.01) more than did healthy subjects. 5. Excretion of leukotriene E4 was even more enhanced in three patients with multiple trauma who developed adult respiratory distress syndrome. Maximal amounts of 593 +/- 185 nmol of leukotriene E4/mol of creatinine (mean +/- SEM) were excreted on day 9 after trauma by these three patients, which corresponds to a 7.7- and a 59-fold increase in excretion of leukotriene E4 compared with patients with multiple trauma who did not develop adult respiratory distress syndrome and healthy subjects, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Enhanced urinary excretion of leukotriene E4 by patients with multiple trauma with or without adult respiratory distress syndrome. 185 91

The effect of lanthanum on lung phospholipid secretion stimulated by lung distension was examined in 29.5-d gestation newborn rabbits. Lung lavage with saline alone produced 608 +/- 109 micrograms phospholipid/lung (mean +/- SEM), whereas lavage with 10(-3) M lanthanum produced only 153 +/- 40 micrograms phospholipid/lung (p less than 0.05), the difference in yield being attributed to inhibited lavage-induced secretion with lanthanum. If this interpretation is correct, then an increased residual tissue surfactant should be found in lanthanum-lavaged lungs. Postlavaged lung was separated into IA, IB, and IC fractions by homogenization and then centrifugation with 0.25 and 0.65 M sucrose. The surfactant IB fraction was 763 +/- 65 micrograms phospholipid/g wet lung for saline-lavaged lungs, but 1002 +/- 90 micrograms phospholipid/g wet lung for lanthanum-lavaged lungs (p less than 0.002). This confirms that decreased secretion with lanthanum was associated with increased residual surfactant in postlavaged lung. It is concluded that lanthanum is a potent inhibitor of surfactant secretion stimulated by lung distension.
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PMID:Lanthanum inhibits surfactant secretion stimulated by lung distension in newborn rabbits. 189 65

The intrapulmonary bronchial blood flow of the left lung (systemic arterial blood flow to the left lung via the bronchial artery) was determined in 45 anesthetized and artificially ventilated male Wistar rats, weighing 263 +/- 5 g (mean +/- SEM). The microsphere method was employed and designed so that recirculating microspheres across the peripheral arteriovenous anastomoses were prevented from lodging in the left lung, and disturbances of the isovolemic state of the animals became minimal. Under normal conditions with a mean arterial pressure of 115 +/- 2 mmHg (n = 40), the bronchial blood flow of the left lung was found to be 0.307 +/- 0.033 ml/min on average, and amounted to 0.52 +/- 0.06% of the cardiac output. The flow (ml/min) normalized per kg body weight, 100 g wet lung, or 100 g dry lung was 1.14 +/- 0.12, 76 +/- 8, or 368 +/- 39, respectively. The total intrapulmonary bronchial blood flow of the left and right lungs could be estimated by multiplying the intrapulmonary bronchial flow of the left lung by the weight ratio (total:left) of 2.9. The variability of the flow data was small, as confirmed in a study with simultaneous injection of two differently radiolabeled microspheres. The reproducibility of duplicate measurements was excellent.
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PMID:Intrapulmonary bronchial blood flow of rats as studied by the microsphere method. 207 51

A new sulfur hexafluoride (SF6) washout functional residual capacity (FRC) measurement system has been developed which will work with any mode of mechanical ventilation, as well as with spontaneous respiration. This system was evaluated in three different human studies. In the first two studies, the accuracy of the system was compared with He dilution and body plethysmography in 12 spontaneously breathing normal volunteers and in 12 spontaneously breathing chronic obstructive pulmonary disease (COPD) patients. In the third study, the reproducibility and efficacy of using the system in the ICU was tested in 12 adult respiratory distress syndrome (ARDS) patients who were mechanically ventilated with PEEP. In the normal volunteers, there was no significant difference between the three measurement techniques. In the COPD group, there was an overall significant difference between measurement techniques (F[2,28] = 17.18, p less than .0001) and the rank of the magnitude of the FRC measurements from lowest to highest was SF6 washout, He dilution, and body plethysmography. There was a significant difference in accuracy between the COPD and normal volunteer groups (F[2,28] = 12.24, p less than .0002). There were a total of 1,227 FRC measurements made on the 12 ARDS patients. The number of FRC measurements per patient was 102 +/- 13 (SEM). The "stable" periods were 14 +/- 2 h long and ranged from 60 min to 63.5 h. The reproducibility for all 12 patients was 188 +/- 17 ml or 11.7 +/- 0.7%. This automated SF6 washout system should make routine FRC measurements in patients who are being mechanically ventilated simple and easy to do.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Automated sulfur hexafluoride washout functional residual capacity measurement system for any mode of mechanical ventilation as well as spontaneous respiration. 229 72

During use of i.v. solutions, particulate matter may be introduced into the patient. X-ray analyses have shown that the particulate matter consists mainly of glass from ampules, rubber from stoppers of infusion bottles, and plastic from infusion sets. A new method is introduced: scanning electron microscopy-SEM- in combination with energy-dispersive X-ray analysis-EDX. using this technique all foreign particles larger than 0.8 microns can be detected and analyzed in any tissue. Especially in critically ill patients, particularly matter is deposited in the microcirculation of the lung. The particles cause a variety of pathologic changes (formation of thrombi, thromboembolization of the microcirculation, destruction of the vascular endothelium, formation of granulomas and foreign body giant cells). The adult respiratory distress syndrome could be produced or respiratory insufficiency might be aggravated following circulatory shock. It is therefore recommended that terminal in-line filters with small pore sizes be used for all i.v. solutions.
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PMID:[Particulate contamination of infusion solutions and drug additives within the scope of long-term intensive therapy. 1. Energy dispersion electron images in the scanning electron microscope-REM/EDX]. 251 78


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