Protective Ventilation of Preterm Lambs Exposed to Acute Chorioamnionitis Does Not Reduce Ventilation-Induced Lung or Brain InjuryReport as inadecuate




Protective Ventilation of Preterm Lambs Exposed to Acute Chorioamnionitis Does Not Reduce Ventilation-Induced Lung or Brain Injury - Download this document for free, or read online. Document in PDF available to download.

Background

The onset of mechanical ventilation is a critical time for the initiation of cerebral white matter WM injury in preterm neonates, particularly if they are inadvertently exposed to high tidal volumes VT in the delivery room. Protective ventilation strategies at birth reduce ventilation-induced lung and brain inflammation and injury, however its efficacy in a compromised newborn is not known. Chorioamnionitis is a common antecedent of preterm birth, and increases the risk and severity of WM injury. We investigated the effects of high VT ventilation, after chorioamnionitis, on preterm lung and WM inflammation and injury, and whether a protective ventilation strategy could mitigate the response.

Methods

Pregnant ewes n = 18 received intra-amniotic lipopolysaccharide LPS 2 days before delivery, instrumentation and ventilation at 127±1 days gestation. Lambs were either immediately euthanased and used as unventilated controls LPSUVC; n = 6, or were ventilated using an injurious high VT strategy LPSINJ; n = 5 or a protective ventilation strategy LPSPROT; n = 7 for a total of 90 min. Mean arterial pressure, heart rate and cerebral haemodynamics and oxygenation were measured continuously. Lungs and brains underwent molecular and histological assessment of inflammation and injury.

Results

LPSINJ lambs had poorer oxygenation than LPSPROT lambs. Ventilation requirements and cardiopulmonary and systemic haemodynamics were not different between ventilation strategies. Compared to unventilated lambs, LPSINJ and LPSPROT lambs had increases in pro-inflammatory cytokine expression within the lungs and brain, and increased astrogliosis p<0.02 and cell death p<0.05 in the WM, which were equivalent in magnitude between groups.

Conclusions

Ventilation after acute chorioamnionitis, irrespective of strategy used, increases haemodynamic instability and lung and cerebral inflammation and injury. Mechanical ventilation is a potential contributor to WM injury in infants exposed to chorioamnionitis.



Author: Samantha K. Barton, Timothy J. M. Moss, Stuart B. Hooper, Kelly J. Crossley, Andrew W. Gill, Martin Kluckow, Valerie Zahra, Flora

Source: http://plos.srce.hr/



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