Appraisal of systemic inflammation and diagnostic markers in a porcine model of VAP : secondary analysis from a study on novel preventive strategies
Li Bassi, Gianluigi (Universitat de Barcelona)
Prats, Raquel Guillamat (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Artigas Raventós, Antoni (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Xiol, Eli Aguilera (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias)
Marti, Joan-Daniel (Hospital Clínic i Provincial de Barcelona)
Ranzani, Otavio T. (Hospital Clínic i Provincial de Barcelona)
Rigol, Montserrat (Hospital Clínic i Provincial de Barcelona)
Fernandez, Laia (Universitat de Barcelona)
Meli, Andrea (Universita degli Studi di Milano. Dipartimento di Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Dipartimento di Scienza e Salute)
Battaglini, Denise (Università degli Studi di Genova. Dipartimento Scienze Chirurgiche e Diagnostiche Integrate (DISC))
Luque, Nestor (Hospital Clínic i Provincial de Barcelona)
Ferrer, Miguel (Universitat de Barcelona)
Martin-Loeches, Ignacio (Multidisciplinary Intensive Care Research Organization (MICRO), Department of Clinical Medicine, Trinity Centre for Health Sciences, St James's University Hospital, Dublin, Ireland)
Póvoa, Pedro (New University of Lisbon. NOVA Medical School, CEDOC)
Chiumello, Davide (Universita degli Studi di Milano. Dipartimento di Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Dipartimento di Scienza e Salute)
Pelosi, Paolo (Università degli Studi di Genova. Dipartimento Scienze Chirurgiche e Diagnostiche Integrate (DISC))
Torres, Antoni (Universitat de Barcelona)
Universitat Autònoma de Barcelona

Fecha:	2018 Support was provided by the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Ministerio de Ciencia e Innovación; European Society of Intensive Care Medicine-ESICM (2009 Alain Harf Award on Applied Respiratory Physiology); Fundació Catalana de Pneumologıa (FUCAP); Sociedad Española de Neumología y Cirugía Torácica (SEPAR); Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, (CIBERES)
Resumen:	We previously evaluated the efficacy of a ventilatory strategy to achieve expiratory flow bias and positive end-expiratory pressure (EFB + PEEP) or the Trendelenburg position (TP) for the prevention of ventilator-associated pneumonia (VAP). These preventive measures were aimed at improving mucus clearance and reducing pulmonary aspiration of bacteria-laden oropharyngeal secretions. This secondary analysis is aimed at evaluating the effects of aforementioned interventions on systemic inflammation and to substantiate the value of clinical parameters and cytokines in the diagnosis of VAP. Twenty female pigs were randomized to be positioned in the semirecumbent/prone position, and ventilated with duty cycle 0. 33 and without PEEP (control); positioned as in the control group, PEEP 5 cmHO, and duty cycle to achieve expiratory flow bias (EFB+PEEP); ventilated as in the control group, but in the Trendelenburg position (Trendelenburg). Following randomization, P. aeruginosa was instilled into the oropharynx. Systemic cytokines and tracheal secretions P. aeruginosa concentration were quantified every 24h. Lung biopsies were collected for microbiological confirmation of VAP. In the control, EFB + PEEP, and Trendelenburg groups, lung tissue Pseudomonas aeruginosa concentration was 2. 4 ± 1. 5, 1. 9 ± 2. 1, and 0. 3 ± 0. 6 log cfu/mL, respectively (p = 0. 020). Whereas, it was 2. 4 ± 1. 9 and 0. 6 ± 0. 9 log cfu/mL in animals with or without VAP (p < 0. 001). Lower levels of interleukin (IL)-1β (p = 0. 021), IL-1RA (p < 0. 001), IL-4 (p = 0. 005), IL-8 (p = 0. 008), and IL-18 (p = 0. 050) were found in Trendelenburg animals. VAP increased IL-10 (p = 0. 035), tumor necrosis factor-α (p = 0. 041), and endotracheal aspirate (ETA) P. aeruginosa concentration (p = 0. 024). A model comprising ETA bacterial burden, IL-10, and TNF-α yielded moderate discrimination for the diagnosis of VAP (area of the receiver operating curve 0. 82, 95% CI 0. 61-1. 00). Our findings demonstrate anti-inflammatory effects associated with the Trendelenburg position. In this reliable model of VAP, ETA culture showed good diagnostic accuracy, whereas systemic IL-10 and TNF-α marginally improved accuracy. Further clinical studies will be necessary to confirm clinical value of the Trendelenburg position as a measure to hinder inflammation during mechanical ventilation and significance of systemic IL-10 and TNF-α in the diagnosis of VAP.
Ayudas:	Ministerio de Ciencia e Innovación PS09-01249
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Trendelenburg ; Semirecumbent ; Inflammation ; Interleukin ; Mechanical ventilation ; Ventilator-associated pneumonia
Publicado en:	Intensive Care Medicine Experimental, Vol. 6 (october 2018) , ISSN 2197-425X

DOI: 10.1186/s40635-018-0206-1
PMID: 30343359

15 p, 964.8 KB

El registro aparece en las colecciones:
Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Instituto de Investigación e Innovación Parc Taulí (I3PT)
Artículos > Artículos de investigación
Artículos > Artículos publicados