Correlation analysis between mechanical power, transforming growth factor-β1, and connective tissue growth factor levels in acute respiratory distress syndrome patients and their clinical significance in pulmonary structural remodeling

Xie, Yongpeng; Wang, Yangli; Liu, Kexi; Li, Xiaomin

doi:10.1097/md.0000000000016531

Cited by 15 publications

(11 citation statements)

References 21 publications

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“…Animal experiments showed that the level of TGF-β1 in ARDS model rats increased significantly, indicating that it may be involved in the early inflammatory response and suggesting that TGF-β1 plays an important role in pulmonary dysplasia and ARDS interstitial fibrosis [ 17 ]. Recent studies have found that TGF-β1 induces collagen-soluble protein gene expression, leading to collagen curling and fibroplasia, indicating that TGF-β1 plays an important role in the early lung injury and fibroplasia of ARDS [ 18 ]. In infants with infantile respiratory distress syndrome, who may develop chronic lung disease, the level of TGF-β1 activity is 6 times that of other children, and those with high levels of TGF-β1 are associated with higher mortality and shorter survival time [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Rehmannia Radix Extract Relieves Bleomycin-Induced Pulmonary Fibrosis in Mice via Transforming Growth Factor β1 (TGF-β1)

Zhu

2020

Med Sci Monit

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Background Infants and young children with acute respiratory distress syndrome (ARDS) have acute progressive hypoxic respiratory failure caused by a variety of extrapulmonary pathogenic factors and cardiogenic factors. Diffuse alveolar injury and pulmonary fibrosis both are pathological features of ARDS. This study investigated the effect of Rehmannia Radix extract (RRE) on pulmonary fibrosis of infants with ARDS. Material/Methods The human lung fibroblasts cell line HFL1 was treated with various concentrations of Rehmannia Radix extract in different groups for different times. Flow cytometry and TUNEL assay were performed to detect cell apoptosis, and CCK8 assay was utilized to analyze cell proliferation. TGF-β1 expression was detected by real-time quantitative PCR, and protein-level expressions of Caspase3, TGF-β1, Bcl-2, and Smad3 were measured by western blot and immunohistochemical staining in cells or tissues. TGF-β1 was overexpressed by recombinant human TGF-β1 (2 ng/mL) and the treated cells and culture supernatant were harvested for analysis in each step. Bleomycin was used to induce a mouse model of pulmonary fibrosis and was confirmed by HE pathological sections. Results Flow cytometry and TUNEL results showed that RRE promoted the apoptosis of HFL1 cells in a concentration-dependent manner, and it inhibited the proliferation of HFL1 cells. Upregulation of TGF-β1 reversed the effects of RRE in HFL1 cells. RRE alleviated pulmonary fibrosis in mice through downregulating Bcl-2, TGF-β1, and Smad3 expression. Conclusions RRE promoted apoptosis and inhibited proliferation of HFL1, and then arrested the progression of pulmonary fibrosis. RRE had a significant inhibitory effect on TGF-β1 and Smad3. These results suggest that RRE directly prevents the development of pulmonary fibrosis by affecting the expression of TGF-β1 and Smad3.

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Section: Discussionmentioning

confidence: 99%

Rehmannia Radix Extract Relieves Bleomycin-Induced Pulmonary Fibrosis in Mice via Transforming Growth Factor β1 (TGF-β1)

Zhu

2020

Med Sci Monit

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“…In the future, MP may become the new standard to perform lung-protective ventilation in ARDS patients [5]. Studies have shown that when MP exceeds 17 J/min, the 28-day mortality in patients increases significantly, which indicated that the level of MP is related to the prognosis of patients and may be related to the severity of ARDS [6,7]. Whether spontaneous respiration in ARDS is helpful or harmful remains an area of debate [8].…”

Section: Introductionmentioning

confidence: 99%

Effect of Deep Sedation on Mechanical Power in Moderate to Severe Acute Respiratory Distress Syndrome: A Prospective Self‐Control Study

Xie

Cao

Qian

et al. 2020

BioMed Research International

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Mechanical power (MP) is a parameter for assessing ventilator-induced lung injury (VILI) in patients with acute respiratory distress syndrome (ARDS). Deep sedation inhibits the respiratory center and reduces the excessive spontaneous breathing in ARDS patients, thereby reducing transpulmonary pressure (Ptp) and lung injury. However, the effect of sedation on MP in ARDS patients is not yet clear. Therefore, the purpose of this study was to investigate the effect of deep sedation on MP in ARDS patients. Patients with moderate to severe ARDS who required mechanical ventilation were considered. Different degrees of sedation were performed on patients in three stages after 24 hours of mechanical ventilation. The three stages are as follows: stage 1 (H+3): 0 to 3 hours of sedation; patients’ Ramsay score was 2-3 to obtain mild sedation; stage 2 (H+6): 4 to 6 hours of sedation; the sedation depth was adjusted to 5-6 points; and stage 3 (H+9): 7 to 9 hours of sedation; the sedation depth was adjusted to 2-3 points. Under deep sedation (H+6), MP, respiratory rate (RR), and Ptp were significantly lower than the ones in the patients under mild sedation (H+3) (all P<0.01) although PaO2/FiO2 (P/F) and static lung compliance (Cst) were significantly higher (both P<0.01). However, no significant difference in the above parameters was observed between H+3 and H+9. Correlation analysis showed that ΔMP was significantly and positively correlated with ΔRR and ΔPtp (both P<0.001), while no correlation was observed neither between ΔMP and ΔCst nor between ΔMP and ΔP/F. The 28-day Kaplan-Meier survival curve showed the occurrence of 19 deaths, and the overall survival rate was 63.46%. The survival rate was 53.12% in the high-MP (HMP) group and 80.95 in the low-MP (LMP) group (P<0.05). In conclusion, deep sedation significantly reduced MP in patients with moderate to severe ARDS, thereby reducing the occurrence of VILI. In addition, MP monitoring in deep sedation predicted the 28-day survival of patients with moderate to severe ARDS.

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“…In another study, a correlation between power and serum fibrosis biomarkers has been found in ARDS patients. [ 20 ]…”

Section: Mechanical Power As a Promising Indicator Of Vilimentioning

confidence: 99%

Progress of mechanical power in the intensive care unit

Chi

Long

2020

Chinese Medical Journal

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Mechanical power of ventilation, currently defined as the energy delivered from the ventilator to the respiratory system over a period of time, has been recognized as a promising indicator to evaluate ventilator-induced lung injury and predict the prognosis of ventilated critically ill patients. Mechanical power can be accurately measured by the geometric method, while simplified equations allow an easy estimation of mechanical power at the bedside. There may exist a safety threshold of mechanical power above which lung injury is inevitable, and the assessment of mechanical power might be helpful to determine whether the extracorporeal respiratory support is needed in patients with acute respiratory distress syndrome. It should be noted that relatively low mechanical power does not exclude the possibility of lung injury. Lung size and inhomogeneity should also be taken into consideration. Problems regarding the safety limits of mechanical power and contribution of each component to lung injury have not been determined yet. Whether mechanical power-directed lung-protective ventilation strategy could improve clinical outcomes also needs further investigation. Therefore, this review discusses the algorithms, clinical relevance, optimization, and future directions of mechanical power in critically ill patients.

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Correlation analysis between mechanical power, transforming growth factor-β1, and connective tissue growth factor levels in acute respiratory distress syndrome patients and their clinical significance in pulmonary structural remodeling

Cited by 15 publications

References 21 publications

Rehmannia Radix Extract Relieves Bleomycin-Induced Pulmonary Fibrosis in Mice via Transforming Growth Factor β1 (TGF-β1)

Rehmannia Radix Extract Relieves Bleomycin-Induced Pulmonary Fibrosis in Mice via Transforming Growth Factor β1 (TGF-β1)

Effect of Deep Sedation on Mechanical Power in Moderate to Severe Acute Respiratory Distress Syndrome: A Prospective Self‐Control Study

Progress of mechanical power in the intensive care unit

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