Hyaluronic acid plasma levels during high versus low tidal volume ventilation in a porcine sepsis model

Rainer Thomas; Tanghua Liu; Arno Schad; Robert Ruemmler; Jens Kamuf; René Rissel; Thomas Ott; Matthias David; Erik K Hartmann; Alexander Ziebart

doi:10.7717/peerj.12649

Hyaluronic acid plasma levels during high versus low tidal volume ventilation in a porcine sepsis model

PeerJ. 2022 Jan 5:9:e12649. doi: 10.7717/peerj.12649. eCollection 2022.

Authors

Affiliations

¹ Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany.
² Institute of Pathology, Medical Center of the Johannes Gutenberg-University, Mainz, Germany.

Abstract

Background: Shedding of the endothelial glycocalyx can be observed regularly during sepsis. Moreover, sepsis may be associated with acute respiratory distress syndrome (ARDS), which requires lung protective ventilation with the two cornerstones of application of low tidal volume and positive end-expiratory pressure. This study investigated the effect of a lung protective ventilation on the integrity of the endothelial glycocalyx in comparison to a high tidal volume ventilation mode in a porcine model of sepsis-induced ARDS.

Methods: After approval by the State and Institutional Animal Care Committee, 20 male pigs were anesthetized and received a continuous infusion of lipopolysaccharide to induce septic shock. The animals were randomly assigned to either low tidal volume ventilation, high tidal volume ventilation, or no-LPS-group groups and observed for 6 h. In addition to the gas exchange parameters and hematologic analyses, the serum hyaluronic acid concentrations were determined from central venous blood and from pre- and postpulmonary and pre- and postcerebral circulation. Post-mortem analysis included histopathological evaluation and determination of the pulmonary and cerebral wet-to-dry ratios.

Results: Both sepsis groups developed ARDS within 6 h of the experiment and showed significantly increased serum levels of hyaluronic acid in comparison to the no-LPS-group. No significant differences in the hyaluronic acid concentrations were detected before and after pulmonary and cerebral circulation. There was also no significant difference in the serum hyaluronic acid concentrations between the two sepsis groups. Post-mortem analysis showed no significant difference between the two sepsis groups.

Conclusion: In a porcine model of septic shock and ARDS, the serum hyaluronic acid levels were significantly elevated in both sepsis groups in comparison to the no-LPS-group. Intergroup comparison between lung protective ventilated and high tidal ventilated animals revealed no significant differences in the serum hyaluronic acid levels.

Keywords: ARDS; Acute respiratory distress syndrome; Glycocalyx; High tidal volume ventilation; Hyaluronic acid; Lung protective ventilation; Pig; Sepsis.

Grants and funding

The study was funded by the German Research Council (DFG DA 842/2–2). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.