Published ahead of print on February 20, 2004, doi:10.1164/rccm.200312-1779OC
Am. J. Respir. Crit. Care Med., Volume 169, Number 9, May 2004, 1046-1053
A more recent version of this article appeared on May 1, 2004
Submitted on December 30, 2003
Accepted on February 20, 2004
Reducing Atelectasis Attenuates Bacterial Growth and Translocation in Experimental Pneumonia
Anton H van Kaam1*, Robert A Lachmann2, Egbert Herting3, Anne De Jaegere2, Freek van Iwaarden4, L. Arnold Noorduyn5, Joke H Kok6, Jack J Haitsma2, and Burkhard Lachmann2
1 Department of Anesthesiology, Erasmus-MC Faculty, Rotterdam, The Netherlands; Department of Neonatology, Emma Children's Hospital AMC, Amsterdam, The Netherlands,
2 Department of Anesthesiology, Erasmus-MC Faculty, Rotterdam, The Netherlands,
3 Department of Pediatrics, University of Gottingen, Gottingen, Germany,
4 Laboratory of Pediatrics, Erasmus-MC Faculty, Rotterdam, The Netherlands,
5 Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,
6 Department of Neonatology, Emma Children's Hospital AMC, Amsterdam, The Netherlands
* To whom correspondence should be addressed. E-mail: a.h.vankaam{at}amc.uva.nl.
Besides being one of the mechanisms responsible for ventilator-induced lung injury, atelectasis also seems to aggravate the course of experimental pneumonia. In this study, we examined the effect of reducing the degree of atelectasis by natural modified surfactant and/or open lung ventilation, on bacterial growth and translocation in a piglet model of group B streptococcal pneumonia. After creating surfactant-deficiency by whole lung lavage, intratracheal instillation of bacteria induced severe pneumonia with bacterial translocation into the blood stream, resulting in a mortality rate of almost 80%. Treatment with 300 mg/kg exogenous surfactant prior to instillation of streptococci, attenuated both bacterial growth and translocation, and prevented clinical deterioration. This goal was also achieved by reversing atelectasis in lavaged animals via open lung ventilation. Combining both exogenous surfactant and open lung ventilation, prevented bacterial translocation completely, comparable to group B streptococci instillation into healthy animals. We conclude that exogenous surfactant and open lung ventilation attenuate bacterial growth and translocation in experimental pneumonia and that this attenuation is at least in part mediated by a reduction in atelectasis. These findings suggest that minimizing alveolar collapse by exogenous surfactant and open lung ventilation may reduce the risk of pneumonia and subsequent sepsis in ventilated patients.
Key words: open lung ventilation, atelectasis, sepsis
This article has been cited by other articles:
|
|
|
|
 
P. E. Ozcan, N. Cakar, S. Tugrul, O. Akinci, A. Cagatay, D. Yilmazbayhan, F. Esen, L. Telci, and K. Akpir
The Effects of Airway Pressure and Inspiratory Time on Bacterial Translocation
Anesth. Analg.,
February 1, 2007;
104(2):
391 - 396.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Pasquina, M. R. Tramer, J.-M. Granier, and B. Walder
Respiratory Physiotherapy To Prevent Pulmonary Complications After Abdominal Surgery: A Systematic Review
Chest,
December 1, 2006;
130(6):
1887 - 1899.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Tsuchida, D. Engelberts, M. Roth, C. McKerlie, M. Post, and B. P. Kavanagh
Continuous positive airway pressure causes lung injury in a model of sepsis
Am J Physiol Lung Cell Mol Physiol,
October 1, 2005;
289(4):
L554 - L564.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. H. L. C. van Kaam, R. Lutter, R. A. Lachmann, J. J. Haitsma, E. Herting, M. Snoek, A. De Jaegere, J. H. Kok, and B. Lachmann
Effect of ventilation strategy and surfactant on inflammation in experimental pneumonia
Eur. Respir. J.,
July 1, 2005;
26(1):
112 - 117.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Tsangaris, M. Lekka, and G. Nakos
Should We Start Considering Surfactant for Atelectasis?
Am. J. Respir. Crit. Care Med.,
July 1, 2005;
172(1):
141 - 141.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. van Kaam, R. Lachmann, F. van Iwaarden, J. Haitsma, B. Lachmann, A. De Jaegere, A. Noorduyn, J. Kok, and E. Herting
Should We Start Considering Surfactant for Atelectasis?
Am. J. Respir. Crit. Care Med.,
July 1, 2005;
172(1):
141 - 142.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. G. Frangos and D. R. Schwartz
Continuous Positive Airway Pressure and Postoperative Hypoxemia
JAMA,
June 8, 2005;
293(22):
2714 - 2714.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Nemery, W. W. Yew, R. Albert, C. Brun-Buisson, W. MacNee, F. J. Martinez, D. C. Angus, and E. Abraham
Tuberculosis, Nontuberculous Lung Infection, Pleural Disorders, Pulmonary Function, Respiratory Muscles, Occupational Lung Disease, Pulmonary Infections, and Social Issues in AJRCCM in 2004
Am. J. Respir. Crit. Care Med.,
March 15, 2005;
171(6):
554 - 562.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Squadrone, M. Coha, E. Cerutti, M. M. Schellino, P. Biolino, P. Occella, G. Belloni, G. Vilianis, G. Fiore, F. Cavallo, et al.
Continuous Positive Airway Pressure for Treatment of Postoperative Hypoxemia: A Randomized Controlled Trial
JAMA,
February 2, 2005;
293(5):
589 - 595.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Guerin, S. Gaillard, S. Lemasson, L. Ayzac, R. Girard, P. Beuret, B. Palmier, Q. V. Le, M. Sirodot, S. Rosselli, et al.
Effects of Systematic Prone Positioning in Hypoxemic Acute Respiratory Failure: A Randomized Controlled Trial
JAMA,
November 17, 2004;
292(19):
2379 - 2387.
[Abstract]
[Full Text]
[PDF]
|
|
|
Copyright © 2004 American Thoracic Society
|
|
|
