Enhanced glomerular thrombosis in pronated animals with ARDS.

IF 2.8 Q2 CRITICAL CARE MEDICINE

Intensive Care Medicine Experimental Pub Date : 2025-03-20 DOI:10.1186/s40635-025-00747-7

Silvia Marchesi, Elin Lundström, Elin Lindström, Jonas Ödmark, Mark Lubberink, Håkan Ahlström, Miklós Lipcsey

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Abstract

Background: Prone positioning is part of the management of acute respiratory distress syndrome (ARDS) and has been demonstrated to successfully improve the ventilation-perfusion match and reduce mortality in patients with severe respiratory failure. However, the effect of pronation on other organs than the lungs has not been widely studied. This study aimed to compare abdominal edema, perfusion and inflammation in supine and prone positioning in a porcine ARDS model.

Methods: Seventeen piglets were randomized into two groups: a supine group (n = 9) and a prone group (n = 8). Both groups received endotoxemic infusion and were observed for 6 h. Three animals per group underwent positron emission tomography-magnetic resonance imaging (PET-MRI) for imaging acquisition. Hemodynamic and respiratory parameters were recorded throughout the protocol. Inflammation was assessed by measuring cytokine concentrations in blood, ascites and the abdominal organs' tissue. The edema in abdominal organs was assessed by wet-dry ratio and pathophysiological analysis of tissue samples and by MRI and PET measurements from volumes of interest (VOIs) delineated in abdominal organ in MRI and PET images. The abdominal organs' perfusion was also assessed by MRI and PET measurements.

Results: The prone group had a faster CO₂ washout and needed a lower positive end-expiratory pressure to maintain the desired oxygenation. In the prone group duodenal edema was lower (measured with wet-dry ratio) and renal perfusion, by both MRI and PET measurements, was lower than half compared to the supine group (MRI, perfusion fraction, f: supine group 0.13; prone group 0.03; p-value 0.002. PET Flow: supine group 1.7; prone group 0.4 ml/cm³/min; p-value 0.002). In addition, the histopathological samples of the kidneys showed a higher incidence and extent of glomerular thrombosis in the prone group.

Conclusions: In a porcine ARDS model, prone positioning was associated with enhanced glomerular thrombosis and low renal perfusion.

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ARDS前翻动物肾小球血栓形成增强。

背景：俯卧位是急性呼吸窘迫综合征（ARDS）治疗的一部分，已被证明可以成功改善严重呼吸衰竭患者的通气灌注匹配，降低死亡率。然而，除肺外，旋前对其他器官的影响尚未得到广泛研究。本研究旨在比较猪ARDS模型中仰卧位和俯卧位的腹部水肿、灌注和炎症。方法：17头仔猪随机分为仰卧位组（n = 9）和俯卧位组（n = 8）。两组均给予内毒素输注，观察6小时。每组3只动物行正电子发射断层扫描-磁共振成像（PET-MRI）成像采集。在整个过程中记录血液动力学和呼吸参数。通过测量血液、腹水和腹部器官组织中的细胞因子浓度来评估炎症。通过组织样本的干湿比和病理生理分析，以及通过MRI和PET图像中腹部器官的感兴趣体积（VOIs）测量来评估腹部器官的水肿。通过MRI和PET测量腹部脏器灌注情况。结果：俯卧组CO2洗脱更快，需要较低的呼气末正压来维持所需的氧合。俯卧组十二指肠水肿较低（以干湿比测量），通过MRI和PET测量，肾脏灌注低于仰卧组的一半(MRI，灌注分数，f：仰卧组0.13；倾向组0.03；假定值0.002。PET流量：仰卧位组1.7；俯卧组0.4 ml/cm3/min；假定值0.002)。此外，肾脏的组织病理学样本显示，肾小球血栓形成的发生率和程度在易感组较高。结论：在猪急性呼吸窘迫综合征模型中，俯卧位与肾小球血栓形成增强和肾灌注降低有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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