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Ventilator-induced coagulopathy in experimental Streptococcus pneumoniae pneumonia

J J Haitsma1, M J Schultz, J-J H Hofstra

  • 1Interdepartmental Division of Critical Care Medicine, University of Toronto, Keenan Research Center, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond Street, Queen Wing 4-042, Toronto, ON, M5B 1W8 Canada. jack.haitsma@utoronto.ca

The European Respiratory Journal
|September 5, 2008
PubMed

Insights

Ventilator-induced lung injury (VILI) worsens lung coagulopathy during Streptococcus pneumoniae pneumonia. High tidal volumes with zero end-expiratory pressure significantly increased clotting markers, unlike lung-protective ventilation.

Area of Science:

  • Pulmonary Medicine
  • Critical Care Medicine
  • Pathophysiology

Background:

  • Pneumonia causes acute lung injury, inflammation, and coagulopathy.
  • Mechanical ventilation (MV) is often necessary but can induce further lung injury (VILI).
  • Understanding VILI's impact on coagulation in pneumonia is crucial.

Purpose of the Study:

  • To investigate the effect of VILI on alveolar fibrin turnover in a rat model of Streptococcus pneumoniae pneumonia.
  • To compare the coagulopathic effects of lung-protective MV versus VILI-inducing MV.

Main Methods:

  • Pneumonia was induced in rats, followed by 3 hours of either lung-protective MV (low tidal volume, PEEP) or VILI-inducing MV (high tidal volume, ZEEP).
  • Non-ventilated pneumonia rats and healthy rats served as controls.
  • Thrombin-antithrombin complexes (TATc) and plasminogen activator activity were measured in bronchoalveolar lavage fluid (BALF) and serum.

Main Results:

  • Pneumonia alone increased local coagulation (elevated TATc) and reduced fibrinolysis in BALF.
  • Lung-protective MV (LV(T)-PEEP) did not alter alveolar coagulation or fibrinolysis.
  • VILI-inducing MV (HV(T)-ZEEP) significantly intensified local coagulation and increased plasminogen activator inhibitor-1 levels.
  • VILI-inducing MV also led to a systemic increase in TATc compared to lung-protective MV.

Conclusions:

  • Mechanical ventilation that causes VILI exacerbates pulmonary coagulopathy in Streptococcus pneumoniae pneumonia.
  • VILI-inducing ventilation strategies can lead to both local and systemic coagulopathy.
  • Lung-protective ventilation strategies may mitigate VILI-associated coagulopathy.

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