Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Cytoskeleton and mechanotransduction in the pathophysiology of ventilator-induced lung injury

Citoesqueleto e mecanotransdução na fisiopatologia da lesão pulmonar induzida por ventilador

Leandro Utino Taniguchi, Elia Garcia Caldini, Irineu Tadeu Velasco, Elnara Márcia Negri

J Bras Pneumol.2010;36(3):-

Abstract PDF PT PDF EN Portuguese Text

Although mechanical ventilation is an important therapy, it can result in complications. One major complication is ventilator-induced lung injury, which is caused by alveolar hyperdistension, leading to an inflammatory process, with neutrophilic infiltration, hyaline membrane formation, fibrogenesis and impaired gas exchange. In this process, cellular mechanotransduction of the overstretching stimulus is mediated by means of the cytoskeleton and its cell-cell and cell-extracellular matrix interactions, in such a way that the mechanical stimulus of ventilation is translated into an intracellular biochemical signal, inducing endothelial activation, pulmonary vascular permeability, leukocyte chemotaxis, cytokine production and, possibly, distal organ failure. Clinical studies have shown the relationship between pulmonary distension and mortality in patients with ventilator-induced lung injury. However, although the cytoskeleton plays a fundamental role in the pathogenesis of ventilator-induced lung injury, there have been few in vivo studies of alterations in the cytoskeleton and in cytoskeleton-associated proteins during this pathological process.

 


Keywords: Respiration, artificial; Cytoskeleton; Cell adhesion molecules; Focal adhesions; Mechanotransduction, cellular

 


Extracorporeal membrane oxygenation in severe hypoxemia: time for reappraisal?

Oxigenação extracorpórea por membrana na hipoxemia grave: hora de revermos nossos conceitos?

Luciano Cesar Pontes Azevedo, Marcelo Park, Eduardo Leite Vieira Costa, Edzângela Vasconcelos Santos, Adriana Hirota, Leandro Utino Taniguchi, Guilherme de Paula Pinto Schettino, Marcelo Brito Passos Amato, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2012;38(1):7-12

Abstract PDF PT PDF EN Portuguese Text

In 2009, during the influenza A (H1N1) epidemic, there were many reported cases of pulmonary infection with severe hypoxemia that was refractory to the ventilatory strategies and rescue therapies commonly used to treat patients with severe acute respiratory distress syndrome. Many of those cases were treated with extracorporeal membrane oxygenation (ECMO), which renewed international interest in the technique. The Extracorporeal Support Study Group was created in order to practice ECMO and to employ it in the treatment of patients with severe hypoxemia. In this article, we discuss the indications for using ECMO and report the case of a patient with refractory hypoxemia who was successfully treated with ECMO.

 


Keywords: : Respiratory Insufficiency; Intensive Care Units; Extracorporeal Membrane Oxygenation.

 


Percutaneous Tracheostomy in Critically-ill Patients: The Experience of a Medical Intensive Care Unit

Traqueostomia percutânea no doente crítico: a experiência de uma unidade de terapia intensiva clínica

Marcelo Park, Leonardo Brauer, Ricardo Reis Sanga, André Carlos Kajdacsy-Balla Amaral, José Paulo Ladeira, Luciano Cesar Pontes de Azevedo, Leandro Utino Taniguchi, Luiz Monteiro da Cruz-Neto

J Bras Pneumol.2004;30(3):237-242

Abstract PDF PT

Background: Tracheostomy is a procedure commonly required in the intensive care unit. In the last two decades, the use of the percutaneous method has increased in parallel with improvements in the technique. Objective: To describe our experience in employing the percutaneous method over the last 3.5 years. Methods: We created, retrospectively, a database of prospective tracheostomy data related to 78 patients evaluated between January 2000 and July 2003. We used the percutaneous tracheostomy techniques of either progressive dilatation (in 36 patients) or forceps dilatation (in 42 patients). Data are expressed as number of occurrences or median with interquartile ranges. Results: The mean age of the patients was 66 (range, 43-75), and the median APACHE II score was 16 (range, 12-21). The median time spent on mechanical ventilation prior to tracheostomy was 14 days (range, 10-17 days). Of the 78 patients studied, 18 (23%) died while in the intensive care unit. The most common cause of admission was acute central nervous system disturbance (in 45%). Most of the tracheostomies performed were indicated due to difficulty in weaning from mechanical ventilation (in 50%) or to Glasgow Coma scores consistently lower than 8 (in 49%). Bronchoscopy was used in all but 6 of the procedures. There were complications in 33% of the procedures. The most common complication was light bleeding, without need for transfusion. No patient died due to complications arising from the procedure. Conclusion: Percutaneous tracheostomy is reasonable and safe when performed in an intensive care unit.

 


Keywords: Tracheostomy/methods. Respiration, Artificial/methods. Respiratory insufficiency/therapy. Respiratory insufficiency/complications.

 


 

 


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CNPq, Capes, Ministério da Educação, Ministério da Ciência e Tecnologia, Governo Federal, Brasil, País Rico é País sem Pobreza
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E-mails: jbp@jbp.org.br
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