Published ahead of print on December 4, 2003, doi:10.1164/rccm.200305-620OC Am. J. Respir. Crit. Care Med., Volume 169, Number 5, March 2004, 638-644 A more recent version of this article appeared on March 1, 2004
Submitted on May 15, 2003 The impact of intravenous fat emulsion administration in acute lung injuryMARILENA E LEKKA1,1 CHEMISTRY, UNIVERSITY OF IOANNINA, IOANNINA, Greece, 2 INTENSIVE CARE UNIT, UNIVERSITY OF IOANNINA, IOANNINA, Greece, 3 ANATOMY AND HISTOLOGY, UNIVERSITY OF IOANNINA, IOANNINA, Greece * To whom correspondence should be addressed. E-mail: gnakos{at}cc.uoi.gr.
The aim of the study was to evaluate the effect of parenteral nutrition containing medium and long-chain triglycerides on the function of the respiratory system, and to investigate mechanisms involved in this process. We studied 13 patients with acute respiratory distress syndrome (ARDS), 8 receiving lipid and 5 placebo, and 6 without ARDS, receiving lipid. Bronchoalveolar lavage was performed before and one hour after administration of lipid or placebo. In ARDS patients, lipid administration resulted in deterioration of oxygenation (PaO2/FiO2: from 129 ± 37 to 95±42), compliance of respiratory system, (from 39.2 ±12 to 33.1 ±9.2 ml/cm H2O) and pulmonary vascular resistance (from 258±47 to 321±58 dyn.s/cm-5). In the BAL fluid of same group, an increase in total protein and phospholipid concentrations, phospholipases activities, Platelet-Activating Factor and neutrophils, as well as alterations in BAL lipid profile were observed. No significant changes were observed in the control or in the ARDS placebo groups. In conclusion, the present study indicates that administration of medium and long-chain triglycerides in patients with ARDS causes alterations in lung function and hemodynamics. Inflammatory cells, possibly activated by lipids, release Phospholipase A2 and Platelet-Activating Factor, enhancing edema formation, inflammation and surfactant alterations. Key words: Parenteral Nutrition, MCT/LCT, Phospholipase A2, PAF-acetylhydrolase, PAF
This article has been cited by other articles:
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
