Appearance of fibrosis, improved pulmonary compliance and reduced lung hydroxyproline content. As potential underlying mechanisms

Appearance of fibrosis, improved pulmonary compliance and reduced lung hydroxyproline content. As potential underlying mechanisms for the attenuated fibrotic response we observed an improvement in alveolar surface activity, a decrease in pulmonary fibrin deposition, increased hepatocyte growth factor levels and decreased gelatinase activity in the BAL fluids of transgenic mice as compared with control animals. Conclusions Lung-specific expression of a surfactant protein B rokinase fusion protein protects against ALI after inhalative LPS challenge and prevents fibrosis associated with bleomycininduced lung injury.had significantly lower PEEP values compared with the mini-BAL only group 12 hours after the treatment (3.44 ?0.72 before vs 5.22 ?0.44 mmH2O after treatment, P = 0.025). Conclusion Mini-BAL is efficient in the treatment of recurrent atelectasis in pediatric ICU patients. Beneficial effects of surfactant administration after mini-BAL should be confirmed prospectively in a larger number of patients.P185 Automated mechanical ventilation based on the ARDS Network protocol in porcine acute lung injuryT Meier1, H Luepschen2, M Gro err1, J Karsten1, S Leonhardt2 1MedChemExpress CDZ173 medical University of Schleswig Holstein, Campus L eck, Germany; 2Medical Information Technology, RWTH Aachen, Germany Critical Care 2007, 11(Suppl 2):P185 (doi: 10.1186/cc5345) Introduction The results of the ARDS Network trial [1] demonstrated a significant reduction of mortality by using a mechanical ventilation protocol with tidal PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20740549 volumes (VT) of 6 ml/kg predicated body weight. Additionally, a computer-driven weaning protocol was successfully performed and a reduction of mechanical ventilation duration could be demonstrated [2]. The implementation of the ARDS Network protocol in routine ICU practice remains modest [3]. A possible reason is the increased organisational and temporal burden. An automated execution of the protocol would help to propagate its day-to-day use. To test the ability to automate such a complex protocol, we designed a pilot study in porcine acute lung injury using an experimental medical expert system capable of continuously controlling respiratory parameters and global as well as regional ventilation with electrical impedance tomography (EIT). Methods After induction of saline lavage-induced lung injury in pigs (n = 3), automated mechanical ventilation was initiated. The medical expert system used a closed-loop fuzzy controller with a rule base of if/then rules based on the ARDS Network protocol reference card. The protocol’s algorithmic rules and therapeutic goals (oxygenation, pH, I:E, VT) were continuously controlled and ventilatory settings electronically adjusted accordingly. The medical attendant personnel was constantly informed with status messages about the decisions made. During the trial, all measurements were made using an online blood gas monitor (TrendCare Satellite; Diametrics Medical Inc., UK), a monitor for hemodynamic parameters (Sirecust 1281; Siemens, Germany), a capnograph (CO2SMO+; Respironics, Inc., USA), and an EIT prototype system (EIT Evaluation Kit; Draeger Medical, Germany). Subjects were ventilated for between 40 and 90 minutes. Results The computer-driven ventilator settings could stabilise the ventilation of the lung-injured subject in the predefined thresholds. Compared with the beginning of the study, a reduction in ventilation pressure and PaCO2 could be observed. Despite the initial low PaO2/FiO2 ratio (<200 mmHg).