Abstract:
OBJECTIVE:Pulmonary edema is a serious condition following brain injury of diverse etiologies, including large hemispheric infarctions. We have previously shown that treatment with hypertonic saline attenuates cerebral edema associated with experimental ischemic stroke. In a well-characterized animal model of large ischemic stroke, we tested the hypotheses that lung water increases following cerebral ischemia and determined the effects of osmotherapy with hypertonic saline and mannitol on total lung water, as well as on cerebral edema. DESIGN:Prospective laboratory animal study. SETTING:Research laboratory in a university teaching hospital. SUBJECTS:Adult male Wistar rats (300-450 g, n = 103). INTERVENTIONS:Under controlled conditions of normoxia, normocarbia, and normothermia, spontaneously breathing, halothane-anesthetized (1.0-1.5%) rats were subjected to permanent middle cerebral artery occlusion by the intraluminal occlusion technique. MEASUREMENTS AND MAIN RESULTS:Cerebral perfusion was monitored by laser-Doppler flowmetry over ipsilateral parietal cortex to ensure adequate vascular occlusion. At 6 hrs following middle cerebral artery occlusion, rats were treated in a blinded randomized fashion with no intravenous fluids (n = 24), a continuous intravenous infusion (0.3 mL/hr) of 0.9% saline (n = 21), 20% mannitol (2 g/Kg) (n = 20), 5% hypertonic saline (n = 20), or 7.5% hypertonic saline (n = 18) as a chloride/acetate mixture (50:50) until the end of the experiment. Brains and lungs were harvested, and tissue water content was estimated by comparing wet-to-dry weight ratios of ipsilateral and contralateral cerebral hemispheres at 48 hrs postischemia. Sham-operated rats served as controls (n = 20). Serum osmolality was determined at the end of the experiment in all animals. Lung water content was increased significantly in rats subjected to middle cerebral artery occlusion and treated with no intravenous fluids (76.7 +/- 0.7%, 317 +/- 7 mOsm/L) (mean +/- sd) and saline (76.8 +/- 1.2%, 311 +/- 10 mOsm/L), compared with sham-operated controls (74.5 +/- 0.9%, 302 +/- 4 mOsm/L). Treatment with 20% mannitol (74.4 +/- 1.2%, 352 +/- 15 mOsm/L), 5% hypertonic saline (75.6 +/- 1.3%, 339 +/- 16 mOsm/L), and 7.5% hypertonic saline (74.9 +/- 0.7%, 360 +/- 23 mOsm/L) significantly attenuated lung water content. Hemispheric brain water content increased both in the ipsilateral ischemic and contralateral hemispheres treated with saline (ipsilateral, 85.1 +/- 1.7%; contralateral, 80.7 +/- 0.7%), compared with sham-operated controls (ipsilateral, 79.6 +/- 0.9%; contralateral, 79.5 +/- 0.9%), as well as in rats that received no fluids (ipsilateral, 84.6 +/- 1.8%; contralateral, 80.4 +/- 0.9%). Treatment with 5% hypertonic saline (ipsilateral, 83.8 +/- 1.0%; contralateral, 79.7 +/- 0.6%) and 7.5% hypertonic saline (ipsilateral, 82.3 +/- 1.3%; contralateral, 78.6 +/- 0.7%) resulted in attenuation of stroke-associated increases in brain water content to a greater extent than mannitol (ipsilateral, 83.6 +/- 1.6%; contralateral, 79.1 +/- 1.0%). CONCLUSIONS:In a well-characterized animal model of large ischemic stroke, total lung water content increases, which is likely neurogenic in origin. Attenuation of stroke-associated increases in lung and brain water content with continuous infusion of hypertonic saline may have therapeutic implication in the treatment of cerebral and pulmonary edema following ischemic stroke.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Toung TJ,Chang Y,Lin J,Bhardwaj Adoi
10.1097/01.ccm.0000150659.15558.23subject
Has Abstractpub_date
2005-01-01 00:00:00pages
203-8; discussion 259-60issue
1eissn
0090-3493issn
1530-0293pii
00003246-200501000-00030journal_volume
33pub_type
杂志文章abstract::Given the limitations of high-dose diuretics and vasodilators and the increasing literature showing that inotropes, regardless of the dose used, have a detrimental effect on mortality, a variety of new agents are under investigation for the treatment of pulmonary and systemic congestion and restoration of cardiac outp...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
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abstract:OBJECTIVE:Delirium is common in mechanically ventilated patients in the ICU and associated with short- and long-term morbidity and mortality. The use of systemic corticosteroids is also common in the ICU. Outside the ICU setting, corticosteroids are a recognized risk factor for delirium, but their relationship with del...
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pub_type: 临床试验,杂志文章,多中心研究
doi:10.1097/CCM.0000000000000247
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journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-199202000-00015
更新日期:1992-02-01 00:00:00
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doi:10.1097/00003246-199504000-00019
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pub_type: 杂志文章,多中心研究
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pub_type: 杂志文章,多中心研究,随机对照试验
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doi:10.1097/01.CCM.0000065122.55187.22
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pub_type: 杂志文章
doi:10.1097/00003246-199706000-00024
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doi:10.1097/00003246-200010000-00013
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pub_type: 杂志文章,评审
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更新日期:1994-09-01 00:00:00
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doi:10.1097/00003246-200102000-00029
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doi:10.1097/CCM.0000000000000853
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pub_type: 临床试验,杂志文章,随机对照试验
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doi:10.1097/00003246-198511000-00012
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更新日期:1994-08-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2015-09-01 00:00:00
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doi:10.1097/00003246-197908000-00002
更新日期:1979-08-01 00:00:00
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pub_type: 杂志文章,meta分析
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更新日期:2002-07-01 00:00:00
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doi:10.1097/00003246-199610000-00008
更新日期:1996-10-01 00:00:00