PMID- 18768578
OWN - NLM
STAT- MEDLINE
DCOM- 20090508
LR  - 20130523
IS  - 1399-3003 (Electronic)
IS  - 0903-1936 (Linking)
VI  - 32
IP  - 6
DP  - 2008 Dec
TI  - Ventilator-induced coagulopathy in experimental Streptococcus pneumoniae 
      pneumonia.
PG  - 1599-606
LID - 10.1183/09031936.00045908 [doi]
AB  - Pneumonia, the main cause of acute lung injury, is characterised by a local 
      pro-inflammatory response and coagulopathy. Mechanical ventilation (MV) is often 
      required. However, MV can lead to additional injury: so-called ventilator-induced 
      lung injury (VILI). Therefore, the current authors investigated the effect of 
      VILI on alveolar fibrin turnover in Streptococcus pneumoniae pneumonia. Pneumonia 
      was induced in rats, followed 48 h later by either lung-protective MV (lower 
      tidal volumes (LV(T)) and positive end-expiratory pressure (PEEP)) or MV causing 
      VILI (high tidal volumes (HV(T)) and zero end-expiratory pressure (ZEEP)) for 3 
      h. Nonventilated pneumonia rats and healthy rats served as controls. 
      Thrombin-antithrombin complexes (TATc), as a measure for coagulation, and 
      plasminogen activator activity, as a measure of fibrinolysis, were determined in 
      bronchoalveolar lavage fluid (BALF) and serum. Pneumonia was characterised by 
      local (BALF) activation of coagulation, resulting in elevated TATc levels and 
      attenuation of fibrinolysis compared with healthy controls. LV(T)-PEEP did not 
      influence alveolar coagulation or fibrinolysis. HV(T)-ZEEP did intensify the 
      local procoagulant response: TATc levels rose significantly and levels of the 
      main inhibitor of fibrinolysis, plasminogen activator inhibitor-1, increased 
      significantly. HV(T)-ZEEP also resulted in systemic elevation of TATc compared 
      with LV(T)-PEEP. Mechanical ventilation causing ventilator-induced lung injury 
      increases pulmonary coagulopathy in an animal model of Streptococcus pneumoniae 
      pneumonia and results in systemic coagulopathy.
FAU - Haitsma, J J
AU  - Haitsma JJ
AD  - Interdepartmental Division of Critical Care Medicine, University of Toronto, 
      Keenan Research Center, Li Ka Shing Knowledge Institute, St Michael's Hospital, 
      30 Bond Street, Queen Wing 4-042, Toronto, ON, M5B 1W8 Canada. 
      jack.haitsma@utoronto.ca
FAU - Schultz, M J
AU  - Schultz MJ
FAU - Hofstra, J-J H
AU  - Hofstra JJ
FAU - Kuiper, J W
AU  - Kuiper JW
FAU - Juco, J
AU  - Juco J
FAU - Vaschetto, R
AU  - Vaschetto R
FAU - Levi, M
AU  - Levi M
FAU - Zhang, H
AU  - Zhang H
FAU - Slutsky, A S
AU  - Slutsky AS
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20080903
PL  - England
TA  - Eur Respir J
JT  - The European respiratory journal
JID - 8803460
RN  - 0 (Antithrombins)
RN  - 0 (Lipopolysaccharides)
RN  - EC 3.4.21.5 (Thrombin)
SB  - IM
MH  - Animals
MH  - Antithrombins/chemistry
MH  - Blood Coagulation Disorders/complications/*diagnosis
MH  - Bronchoalveolar Lavage Fluid
MH  - Disease Models, Animal
MH  - Fibrinolysis
MH  - Lipopolysaccharides/metabolism
MH  - Male
MH  - Pneumonia, Bacterial/complications/*therapy
MH  - Pulmonary Gas Exchange
MH  - Rats
MH  - Rats, Sprague-Dawley
MH  - Streptococcus pneumoniae/*metabolism
MH  - Thrombin/chemistry
MH  - Ventilator-Induced Lung Injury/*diagnosis/etiology
EDAT- 2008/09/05 09:00
MHDA- 2009/05/09 09:00
CRDT- 2008/09/05 09:00
PHST- 2008/09/05 09:00 [pubmed]
PHST- 2009/05/09 09:00 [medline]
PHST- 2008/09/05 09:00 [entrez]
AID - 09031936.00045908 [pii]
AID - 10.1183/09031936.00045908 [doi]
PST - ppublish
SO  - Eur Respir J. 2008 Dec;32(6):1599-606. doi: 10.1183/09031936.00045908. Epub 2008 
      Sep 3.