Body Temperature Effects on Lung Injury in Ventilated Preterm Lambs

Overview

Journal Resuscitation

Specialty Emergency Medicine

Date 2010 Mar 20

PMID 20299144

Citations 11

Authors

Molly K Ball

Noah H Hillman

Suhas G Kallapur

Graeme R Polglase

Alan H Jobe

J Jane Pillow

Affiliations

Soon will be listed here.

Abstract

Aims: Mechanical ventilation causes lung injury in premature infants. Hypothermia may protect against and hyperthermia may augment lung injury. We tested the effects of hypo- and hyperthermia on ventilation induced acute lung injury in preterm lambs.

Methods: Twin sheep fetuses at 128 d GA (term 150 d) were surgically delivered and randomized to unventilated control (UVC), normothermia (38-39 degrees C) without lung injury (NTNI), or to 1 of 3 injurious ventilation groups: hypothermic (33-34 degrees C, LT), normothermic (38-39 degrees C, NT) or hyperthermic (40-41 degrees C, HT). NT, LT and HT groups had 15 min of injurious ventilation (PEEP 0 cmH(2)O, V(T) escalation to 15 mL/kg) following delivery and prior to surfactant. The animals were then gently ventilated (PEEP 5cmH(2)O, V(T) 7.5 mL/kg) for 2h 45 min. NTNI lambs received surfactant at birth prior to gentle ventilation. The lambs were then euthanized, and bronchoalveolar lavage (BAL) fluid and lung tissue were used to evaluate lung injury, inflammatory cell counts, inflammatory markers and cytokine mRNA.

Results: Target temperatures were achieved by 15 min of age and maintained for 3h. All ventilated groups had increased BAL protein, lung inflammation and increased cytokine mRNA. HT animals developed acidosis, premature death, pneumothoraces, impaired lung function and increased inflammatory mRNA expression. LT animals remained clinically stable without pneumothoraces or death, had improved ventilatory efficiency and trended toward lower inflammatory mRNA expression than NT animals.

Conclusion: Hyperthermia exacerbated ventilator induced lung injury, while hypothermia may protect against lung injury in the preterm lamb.

Citing Articles

Design and rationale of the CHILL phase II trial of hypothermia and neuromuscular blockade for acute respiratory distress syndrome.

Shanholtz C, Terrin M, Harrington T, Chan C, Warren W, Walter R Contemp Clin Trials Commun. 2023; 33:101155.

PMID: 37228902 PMC: 10191700. DOI: 10.1016/j.conctc.2023.101155.

Severe Hypercapnia Requiring 48-h Whole-Body Hypothermia in an Infant with Acute Bronchiolitis.

Librandi M, Scapaticci S, Chiavaroli V, Petrucci A, Cicioni P, Cognigni R Children (Basel). 2022; 9(9).

PMID: 36138647 PMC: 9498189. DOI: 10.3390/children9091339.

Molecular and biophysical mechanisms behind the enhancement of lung surfactant function during controlled therapeutic hypothermia.

Autilio C, Echaide M, Cruz A, Garcia-Mouton C, Hidalgo A, Da Silva E Sci Rep. 2021; 11(1):728.

PMID: 33436647 PMC: 7804441. DOI: 10.1038/s41598-020-79025-3.

Body temperature instability and respiratory morbidity in the very low birth weight infant: a multiple case, intensive longitudinal study.

Ralphe J, Silva S, Dail R, Brandon D BMC Pediatr. 2020; 20(1):485.

PMID: 33081746 PMC: 7574536. DOI: 10.1186/s12887-020-02351-y.

Gestational Age Influences the Early Microarchitectural Changes in Response to Mechanical Ventilation in the Preterm Lamb Lung.

Oakley R, Tingay D, McCall K, Perkins E, Sourial M, Dargaville P Front Pediatr. 2019; 7:325.

PMID: 31497582 PMC: 6712425. DOI: 10.3389/fped.2019.00325.

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