RESUMO
Objetivo: Evaluar si el pretratamiento con anticuerpos monoclonales antiFNTα y anti-IL-6, administrados de manera independiente, atenúa el daño pulmonar en un modelo experimental de lesión pulmonar inducida por la ventilación mecánica. Materiales y Métodos: Se utilizaron 24 ratas Wistar que fueron separadas en cuatro grupos experimentales: 1) bajo Vt (n = 6): Vt 7 ml/kg, PEEP 5 cmH2O, 2) alto Vt (n = 6): Vt 25 ml/kg, ZEEP (PEEP = 0), 3) anti-IL-6 (n = 6): Vt 25 ml/kg, ZEEP y 30 mg/kg de tocilizumab intraperitoneal 24 h antes de la ventilación mecánica, 4) anti-FNTα (n = 6): Vt 25 ml/kg, ZEEP y 100 ug/kg de adalimumab intraperitoneal 24 h antes de la ventilación mecánica. Se evaluaron el daño histológico cuantificado según el puntaje reportado por Villar et al y la hemodinamia medida con la presión arterial media. Los datos fueron analizados con ANOVA y las pruebas de comparaciones múltiples de Dunn y de Tukey. Resultados: En el grupo tratado con anti-FNTα y en los animales tratados con anti-IL-6, se observó un menor daño histológico pulmonar que en el resto de los grupos. Por otro lado, no se encontraron diferencias en la mecánica pulmonar y en la presión arterial media entre grupos. Conclusiones: Bajo estas condiciones experimentales, los anticuerpos monoclonales anti-FNTα y anti-IL-6 mostraron efectos protectores a nivel pulmonar, lo que postula a estas drogas como estrategias promisorias para atenuar la lesión pulmonar inducida por la ventilación mecánica.(AU)
Objective: To evaluate whether pretreatment with monoclonal antibodies, anti- TNFα and anti-IL-6 administered independently attenuates lung damage in an experimental model of ventilator-induced lung injury. Materials and Methods: Twenty-four Wistar rats were used. Animals were divided into four experimental groups: 1) low Vt (n = 6): Vt 7 mL/kg, PEEP 5 cmH2O; 2) high Vt (n = 6): Vt 25 mL/kg, ZEEP (PEEP = 0); 3) anti-IL-6 (n = 6): Vt 25 mL/kg, ZEEP, and intraperitoneal tocilizumab 30 mg/kg, 24 hours prior to mechanical ventilation; 4) anti-TNFα (n = 6): Vt 25 mL/kg, ZEEP, and intraperitoneal adalimumab 100 µg/kg, 24 hours before the VM. Histological damage measured by Villar score, and hemodynamics measured with mean arterial pressure were evaluated. Data were analyzed using ANOVA, Dunn's multiple comparison test and Tukey's multiple comparison test. Results: In groups treated with anti-TNFα and anti-IL-6, less histological damage was observed in comparison with the rest of groups. On the other hand, no statistically significant differences were found in pulmonary mechanics and mean arterial pressure among groups. Conclusions: Under these experimental conditions, monoclonal antibodies anti-TNFα and anti-IL-6 showed protective effects on lungs, indicating that these drugs are promising strategies to attenuate ventilator-induced lung injury (AU)
Assuntos
Animais , Ratos , Ventilação Pulmonar , Lesão Pulmonar , Anticorpos Monoclonais , Síndrome do Desconforto Respiratório do Recém-Nascido , Técnicas de Laboratório ClínicoRESUMO
Mechanical ventilation is a therapeutic intervention involving the temporary replacement of ventilatory function with the purpose of improving symptoms in patients with acute respiratory failure. Technological advances have facilitated the development of sophisticated ventilators for viewing and recording the respiratory waveforms, which are a valuable source of information for the clinician. The correct interpretation of these curves is crucial for the correct diagnosis and early detection of anomalies, and for understanding physiological aspects related to mechanical ventilation and patient-ventilator interaction. The present study offers a guide for the interpretation of the airway pressure and flow and volume curves of the ventilator, through the analysis of different clinical scenarios.