Pulmonary Interstitial Matrix and Lung ...
Type de document :
Compte-rendu et recension critique d'ouvrage
Titre :
Pulmonary Interstitial Matrix and Lung Fluid Balance From Normal to the Acutely Injured Lung
Auteur(s) :
Beretta, Egidio [Auteur]
Dipartimento di Medicina e Chirurgia = School of Medicine and Surgery [Monza]
Romano, Francesco [Auteur]
Laboratoire de Mécanique des Fluides de Lille - Kampé de Fériet [LMFL]
Sancini, Giulio [Auteur]
Università degli Studi di Milano-Bicocca = University of Milano-Bicocca [UNIMIB]
Grotberg, James B. [Auteur]
University of Michigan [Ann Arbor]
Nieman, Gary F. [Auteur]
State University of New York [SUNY]
Miserocchi, Giuseppe [Auteur]
Università degli Studi di Milano-Bicocca = University of Milano-Bicocca [UNIMIB]
Dipartimento di Medicina e Chirurgia = School of Medicine and Surgery [Monza]
Romano, Francesco [Auteur]
Laboratoire de Mécanique des Fluides de Lille - Kampé de Fériet [LMFL]
Sancini, Giulio [Auteur]
Università degli Studi di Milano-Bicocca = University of Milano-Bicocca [UNIMIB]
Grotberg, James B. [Auteur]
University of Michigan [Ann Arbor]
Nieman, Gary F. [Auteur]
State University of New York [SUNY]
Miserocchi, Giuseppe [Auteur]
Università degli Studi di Milano-Bicocca = University of Milano-Bicocca [UNIMIB]
Titre de la revue :
Frontiers in Physiology
Éditeur :
Frontiers
Date de publication :
2021-12
ISSN :
1664-042X
Mot(s)-clé(s) :
Physiology (medical)
Physiology
SARS-CoV-2
ARDS
edema
Alveolar pressure
P-SILI
Computational model
Physiology
SARS-CoV-2
ARDS
edema
Alveolar pressure
P-SILI
Computational model
Discipline(s) HAL :
Sciences de l'ingénieur [physics]/Mécanique [physics.med-ph]/Mécanique des fluides [physics.class-ph]
Résumé :
This review analyses the mechanisms by which lung fluid balance is strictly controlled in the air-blood barrier (ABB). Relatively large trans-endothelial and trans-epithelial Starling pressure gradients result in a minimal ...
Lire la suite >This review analyses the mechanisms by which lung fluid balance is strictly controlled in the air-blood barrier (ABB). Relatively large trans-endothelial and trans-epithelial Starling pressure gradients result in a minimal flow across the ABB thanks to low microvascular permeability aided by the macromolecular structure of the interstitial matrix. These edema safety factors are lost when the integrity of the interstitial matrix is damaged. The result is that small Starling pressure gradients, acting on a progressively expanding alveolar barrier with high permeability, generate a high transvascular flow that causes alveolar flooding in minutes. We modeled the trans-endothelial and trans-epithelial Starling pressure gradients under control conditions, as well as under increasing alveolar pressure (Palv) conditions of up to 25 cmH2O. We referred to the wet-to-dry weight (W/D) ratio, a specific index of lung water balance, to be correlated with the functional state of the interstitial structure. W/D averages ∼5 in control and might increase by up to ∼9 in severe edema, corresponding to ∼70% loss in the integrity of the native matrix. Factors buffering edemagenic conditions include: (i) an interstitial capacity for fluid accumulation located in the thick portion of ABB, (ii) the increase in interstitial pressure due to water binding by hyaluronan (the “safety factor” opposing the filtration gradient), and (iii) increased lymphatic flow. Inflammatory factors causing lung tissue damage include those of bacterial/viral and those of sterile nature. Production of reactive oxygen species (ROS) during hypoxia or hyperoxia, or excessive parenchymal stress/strain [lung overdistension caused by patient self-induced lung injury (P-SILI)] can all cause excessive inflammation. We discuss the heterogeneity of intrapulmonary distribution of W/D ratios. A W/D ∼6.5 has been identified as being critical for the transition to severe edema formation. Increasing Palv for W/D > 6.5, both trans-endothelial and trans-epithelial gradients favor filtration leading to alveolar flooding. Neither CT scan nor ultrasound can identify this initial level of lung fluid balance perturbation. A suggestion is put forward to identify a non-invasive tool to detect the earliest stages of perturbation of lung fluid balance before the condition becomes life-threatening.Lire moins >
Lire la suite >This review analyses the mechanisms by which lung fluid balance is strictly controlled in the air-blood barrier (ABB). Relatively large trans-endothelial and trans-epithelial Starling pressure gradients result in a minimal flow across the ABB thanks to low microvascular permeability aided by the macromolecular structure of the interstitial matrix. These edema safety factors are lost when the integrity of the interstitial matrix is damaged. The result is that small Starling pressure gradients, acting on a progressively expanding alveolar barrier with high permeability, generate a high transvascular flow that causes alveolar flooding in minutes. We modeled the trans-endothelial and trans-epithelial Starling pressure gradients under control conditions, as well as under increasing alveolar pressure (Palv) conditions of up to 25 cmH2O. We referred to the wet-to-dry weight (W/D) ratio, a specific index of lung water balance, to be correlated with the functional state of the interstitial structure. W/D averages ∼5 in control and might increase by up to ∼9 in severe edema, corresponding to ∼70% loss in the integrity of the native matrix. Factors buffering edemagenic conditions include: (i) an interstitial capacity for fluid accumulation located in the thick portion of ABB, (ii) the increase in interstitial pressure due to water binding by hyaluronan (the “safety factor” opposing the filtration gradient), and (iii) increased lymphatic flow. Inflammatory factors causing lung tissue damage include those of bacterial/viral and those of sterile nature. Production of reactive oxygen species (ROS) during hypoxia or hyperoxia, or excessive parenchymal stress/strain [lung overdistension caused by patient self-induced lung injury (P-SILI)] can all cause excessive inflammation. We discuss the heterogeneity of intrapulmonary distribution of W/D ratios. A W/D ∼6.5 has been identified as being critical for the transition to severe edema formation. Increasing Palv for W/D > 6.5, both trans-endothelial and trans-epithelial gradients favor filtration leading to alveolar flooding. Neither CT scan nor ultrasound can identify this initial level of lung fluid balance perturbation. A suggestion is put forward to identify a non-invasive tool to detect the earliest stages of perturbation of lung fluid balance before the condition becomes life-threatening.Lire moins >
Langue :
Anglais
Vulgarisation :
Non
Source :
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