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Early restrictive fluid strategy impairs the diaphragm force in lambs with acute respiratory distress syndrome. / Ijland, Marloes M.; Ingelse, Saranke A.; van Loon, Lex M.; van Erp, Merijn; Kusters, Benno; Ottenheijm, Coen A. C.; Kox, Matthijs; van der Hoeven, Johannes G.; Heunks, Leo M. A.; Lemson, Joris.

In: Anesthesiology, Vol. 136, No. 5, 01.05.2022, p. 749-762.

Research output: Contribution to journalArticleAcademicpeer-review

Harvard

Ijland, MM, Ingelse, SA, van Loon, LM, van Erp, M, Kusters, B, Ottenheijm, CAC, Kox, M, van der Hoeven, JG, Heunks, LMA & Lemson, J 2022, 'Early restrictive fluid strategy impairs the diaphragm force in lambs with acute respiratory distress syndrome', Anesthesiology, vol. 136, no. 5, pp. 749-762. https://doi.org/10.1097/ALN.0000000000004162

APA

Ijland, M. M., Ingelse, S. A., van Loon, L. M., van Erp, M., Kusters, B., Ottenheijm, C. A. C., Kox, M., van der Hoeven, J. G., Heunks, L. M. A., & Lemson, J. (2022). Early restrictive fluid strategy impairs the diaphragm force in lambs with acute respiratory distress syndrome. Anesthesiology, 136(5), 749-762. https://doi.org/10.1097/ALN.0000000000004162

Vancouver

Ijland MM, Ingelse SA, van Loon LM, van Erp M, Kusters B, Ottenheijm CAC et al. Early restrictive fluid strategy impairs the diaphragm force in lambs with acute respiratory distress syndrome. Anesthesiology. 2022 May 1;136(5):749-762. https://doi.org/10.1097/ALN.0000000000004162

Author

Ijland, Marloes M. ; Ingelse, Saranke A. ; van Loon, Lex M. ; van Erp, Merijn ; Kusters, Benno ; Ottenheijm, Coen A. C. ; Kox, Matthijs ; van der Hoeven, Johannes G. ; Heunks, Leo M. A. ; Lemson, Joris. / Early restrictive fluid strategy impairs the diaphragm force in lambs with acute respiratory distress syndrome. In: Anesthesiology. 2022 ; Vol. 136, No. 5. pp. 749-762.

BibTeX

@article{cc9da55a7d644da4882d74ac289fc325,
title = "Early restrictive fluid strategy impairs the diaphragm force in lambs with acute respiratory distress syndrome",
abstract = "Background: The effect of fluid management strategies in critical illness–associated diaphragm weakness are unknown. This study hypothesized that a liberal fluid strategy induces diaphragm muscle fiber edema, leading to reduction in diaphragmatic force generation in the early phase of experimental pediatric acute respiratory distress syndrome in lambs. Methods: Nineteen mechanically ventilated female lambs (2 to 6 weeks old) with experimental pediatric acute respiratory distress syndrome were randomized to either a strict restrictive fluid strategy with norepinephrine or a liberal fluid strategy. The fluid strategies were maintained throughout a 6-h period of mechanical ventilation. Transdiaphragmatic pressure was measured under different levels of positive end-expiratory pressure (between 5 and 20 cm H2O). Furthermore, diaphragmatic microcirculation, histology, inflammation, and oxidative stress were studied. results: Transdiaphragmatic pressures decreased more in the restrictive group (–9.6 cm H2O [95% CI, –14.4 to –4.8]) compared to the liberal group (–0.8 cm H2O [95% CI, –5.8 to 4.3]) during the application of 5 cm H2O positive end-expiratory pressure (P = 0.016) and during the application of 10 cm H2O positive end-expiratory pressure (–10.3 cm H2O [95% CI, –15.2 to –5.4] vs. –2.8 cm H2O [95% CI, –8.0 to 2.3]; P = 0.041). In addition, diaphragmatic microvessel density was decreased in the restrictive group compared to the liberal group (34.0 crossings [25th to 75th percentile, 22.0 to 42.0] vs. 46.0 [25th to 75th percentile, 43.5 to 54.0]; P = 0.015). The application of positive end-expiratory pressure itself decreased the diaphragmatic force generation in a dose-related way; increasing positive end-expiratory pressure from 5 to 20 cm H2O reduced transdiaphragmatic pressures with 27.3% (17.3 cm H2O [95% CI, 14.0 to 20.5] at positive end-expiratory pressure 5 cm H2O vs. 12.6 cm H2O [95% CI, 9.2 to 15.9] at positive end-expiratory pressure 20 cm H2O; P < 0.0001). The diaphragmatic histology, markers for inflammation, and oxidative stress were similar between the groups. Conclusions: Early fluid restriction decreases the force-generating capacity of the diaphragm and diaphragmatic microcirculation in the acute phase of pediatric acute respiratory distress syndrome. In addition, the application of positive end-expiratory pressure decreases the force-generating capacity of the diaphragm in a dose-related way. These observations provide new insights into the mechanisms of critical illness–associated diaphragm weakness.",
author = "Ijland, {Marloes M.} and Ingelse, {Saranke A.} and {van Loon}, {Lex M.} and {van Erp}, Merijn and Benno Kusters and Ottenheijm, {Coen A. C.} and Matthijs Kox and {van der Hoeven}, {Johannes G.} and Heunks, {Leo M. A.} and Joris Lemson",
note = "Funding Information: Dr. Heunks has received funding from Getinge (Gothenburg, Sweden), Fisher and Paykel (Tilburg, The Netherlands), and Liberate Medical (Crestwood, Kentucky). The other authors declare no competing interests. Publisher Copyright: Copyright {\textcopyright} 2022, the American Society of Anesthesiologists. All Rights Reserved.",
year = "2022",
month = may,
day = "1",
doi = "10.1097/ALN.0000000000004162",
language = "English",
volume = "136",
pages = "749--762",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

RIS

TY - JOUR

T1 - Early restrictive fluid strategy impairs the diaphragm force in lambs with acute respiratory distress syndrome

AU - Ijland, Marloes M.

AU - Ingelse, Saranke A.

AU - van Loon, Lex M.

AU - van Erp, Merijn

AU - Kusters, Benno

AU - Ottenheijm, Coen A. C.

AU - Kox, Matthijs

AU - van der Hoeven, Johannes G.

AU - Heunks, Leo M. A.

AU - Lemson, Joris

N1 - Funding Information: Dr. Heunks has received funding from Getinge (Gothenburg, Sweden), Fisher and Paykel (Tilburg, The Netherlands), and Liberate Medical (Crestwood, Kentucky). The other authors declare no competing interests. Publisher Copyright: Copyright © 2022, the American Society of Anesthesiologists. All Rights Reserved.

PY - 2022/5/1

Y1 - 2022/5/1

N2 - Background: The effect of fluid management strategies in critical illness–associated diaphragm weakness are unknown. This study hypothesized that a liberal fluid strategy induces diaphragm muscle fiber edema, leading to reduction in diaphragmatic force generation in the early phase of experimental pediatric acute respiratory distress syndrome in lambs. Methods: Nineteen mechanically ventilated female lambs (2 to 6 weeks old) with experimental pediatric acute respiratory distress syndrome were randomized to either a strict restrictive fluid strategy with norepinephrine or a liberal fluid strategy. The fluid strategies were maintained throughout a 6-h period of mechanical ventilation. Transdiaphragmatic pressure was measured under different levels of positive end-expiratory pressure (between 5 and 20 cm H2O). Furthermore, diaphragmatic microcirculation, histology, inflammation, and oxidative stress were studied. results: Transdiaphragmatic pressures decreased more in the restrictive group (–9.6 cm H2O [95% CI, –14.4 to –4.8]) compared to the liberal group (–0.8 cm H2O [95% CI, –5.8 to 4.3]) during the application of 5 cm H2O positive end-expiratory pressure (P = 0.016) and during the application of 10 cm H2O positive end-expiratory pressure (–10.3 cm H2O [95% CI, –15.2 to –5.4] vs. –2.8 cm H2O [95% CI, –8.0 to 2.3]; P = 0.041). In addition, diaphragmatic microvessel density was decreased in the restrictive group compared to the liberal group (34.0 crossings [25th to 75th percentile, 22.0 to 42.0] vs. 46.0 [25th to 75th percentile, 43.5 to 54.0]; P = 0.015). The application of positive end-expiratory pressure itself decreased the diaphragmatic force generation in a dose-related way; increasing positive end-expiratory pressure from 5 to 20 cm H2O reduced transdiaphragmatic pressures with 27.3% (17.3 cm H2O [95% CI, 14.0 to 20.5] at positive end-expiratory pressure 5 cm H2O vs. 12.6 cm H2O [95% CI, 9.2 to 15.9] at positive end-expiratory pressure 20 cm H2O; P < 0.0001). The diaphragmatic histology, markers for inflammation, and oxidative stress were similar between the groups. Conclusions: Early fluid restriction decreases the force-generating capacity of the diaphragm and diaphragmatic microcirculation in the acute phase of pediatric acute respiratory distress syndrome. In addition, the application of positive end-expiratory pressure decreases the force-generating capacity of the diaphragm in a dose-related way. These observations provide new insights into the mechanisms of critical illness–associated diaphragm weakness.

AB - Background: The effect of fluid management strategies in critical illness–associated diaphragm weakness are unknown. This study hypothesized that a liberal fluid strategy induces diaphragm muscle fiber edema, leading to reduction in diaphragmatic force generation in the early phase of experimental pediatric acute respiratory distress syndrome in lambs. Methods: Nineteen mechanically ventilated female lambs (2 to 6 weeks old) with experimental pediatric acute respiratory distress syndrome were randomized to either a strict restrictive fluid strategy with norepinephrine or a liberal fluid strategy. The fluid strategies were maintained throughout a 6-h period of mechanical ventilation. Transdiaphragmatic pressure was measured under different levels of positive end-expiratory pressure (between 5 and 20 cm H2O). Furthermore, diaphragmatic microcirculation, histology, inflammation, and oxidative stress were studied. results: Transdiaphragmatic pressures decreased more in the restrictive group (–9.6 cm H2O [95% CI, –14.4 to –4.8]) compared to the liberal group (–0.8 cm H2O [95% CI, –5.8 to 4.3]) during the application of 5 cm H2O positive end-expiratory pressure (P = 0.016) and during the application of 10 cm H2O positive end-expiratory pressure (–10.3 cm H2O [95% CI, –15.2 to –5.4] vs. –2.8 cm H2O [95% CI, –8.0 to 2.3]; P = 0.041). In addition, diaphragmatic microvessel density was decreased in the restrictive group compared to the liberal group (34.0 crossings [25th to 75th percentile, 22.0 to 42.0] vs. 46.0 [25th to 75th percentile, 43.5 to 54.0]; P = 0.015). The application of positive end-expiratory pressure itself decreased the diaphragmatic force generation in a dose-related way; increasing positive end-expiratory pressure from 5 to 20 cm H2O reduced transdiaphragmatic pressures with 27.3% (17.3 cm H2O [95% CI, 14.0 to 20.5] at positive end-expiratory pressure 5 cm H2O vs. 12.6 cm H2O [95% CI, 9.2 to 15.9] at positive end-expiratory pressure 20 cm H2O; P < 0.0001). The diaphragmatic histology, markers for inflammation, and oxidative stress were similar between the groups. Conclusions: Early fluid restriction decreases the force-generating capacity of the diaphragm and diaphragmatic microcirculation in the acute phase of pediatric acute respiratory distress syndrome. In addition, the application of positive end-expiratory pressure decreases the force-generating capacity of the diaphragm in a dose-related way. These observations provide new insights into the mechanisms of critical illness–associated diaphragm weakness.

UR - http://www.scopus.com/inward/record.url?scp=85128488396&partnerID=8YFLogxK

U2 - 10.1097/ALN.0000000000004162

DO - 10.1097/ALN.0000000000004162

M3 - Article

C2 - 35320344

VL - 136

SP - 749

EP - 762

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 5

ER -

ID: 23218272