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Renal Function and Pulmonary Fluid Balance in Porcine Models of Acute Lung Injury
Author(s) -
Uyehara Catherine,
Condon Freeman,
Ichimura Wayne,
Murata LeeAnn,
Hernandez Claudia,
Nguyen Scott,
Pati Brooke
Publication year - 2021
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.2021.35.s1.05521
Subject(s) - balance (ability) , medicine , pulmonary function testing , lung , renal function , acute kidney injury , lung function , pulmonary injury , cardiology , physical medicine and rehabilitation , pulmonary fibrosis
Managing pulmonary edema is critical to maintaining blood oxygenation and perfusion for adequate tissue oxygen delivery after acute lung injury. While it is well recognized that renal failure often leads to complications of nephrogenic pulmonary edema, how the regulation of lung fluid is changed during altered renal function in conditions of traumatic injury is poorly understood. We hypothesized that control of lung water balance after a traumatic blunt force lung injury accompanied by a renal response to hemorrhage and hypotension would be different than after simple disruption of the alveolar‐capillary liquid barrier interface. Hence, we compared the changes in effective lung water index (ELWI, measured by the Pulse Ion Contour Cardiac Output (PICCO), Getinge) method in a pig model of Traumatic Acute Lung Injury (TALI, n=9), and a model of diffuse alveolar‐capillary barrier disruption with oleic acid (OA, n=5), versus a control group (n=10). Anesthetized, mechanically ventilated, Yorkshire cross male and female pigs (body weight 27.0 +/‐ 0.6 kg) were catheterized with a Swan Ganz catheter for measurement of pulmonary artery pressure and cardiac output determination by thermodilution. Pulmonary function, hemodynamics, and urinary output were examined before and after localized blunt right chest trauma (TALI), or oleic acid injection into the main pulmonary artery (OA 0.3 ml in 50% w/v ethanol). Pulmonary vasoconstriction was induced in the acute lung injury groups as indicated by an increase in pulmonary to systemic vascular resistance ratios in TALI (0.37 +/‐ 0.03) and OA (0.34 +/‐0.08) compared to controls (0.21+/‐0.02). TALI resulted in a decrease in mean arterial pressure (MAP, 46+/‐4 mmHg) compared to controls (60 +/‐2 mmHg) or OA (62+/‐3 mm Hg). In all groups ELWI remained steady compared to pre‐injury baseline. In the OA and control groups, circulating vasopressin decreased over the time course of the experiment (p<0.01) but did not decrease in the TALI group in accordance with the injury‐induced hemorrhage and decreased MAP. Accordingly, urine flow decreased in the TALI group compared to OA and controls. Fractional excretion of water decreased in the OA and control groups, (p<0.01) but remained unchanged in TALI, indicating retention of water in OA and controls compared to TALI. The overall maintenance of ELWI despite differences in renal water handling in TALI compared to controls suggest that protection against pulmonary edema needs to be considered in treatment of hypotension with fluid resuscitation in traumatic lung injury.