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Lethal systemic capillary leak syndrome associated with severe ventilator-induced lung injury: an experimental study.
[systemic capillary leak syndrome]
We
report
the
evolution
of
severe
ventilator-induced
lung
injury
associated
with
lethal
systemic
capillary
leak
syndrome
,
when
sheep
were
ventilated
at
a
peak
inspiratory
pressure
of
50
cm
H
2
O
,
at
a
respiratory
rate
of
8
breaths
.
min
,
with
an
inspiratory
time
of
2
.
5
secs
.
A
prospective
laboratory
animal
study
.
Experimental
animal
research
laboratory
.
Mixed
breed
sheep
.
Sheep
were
anesthetized
,
paralyzed
,
and
mechanically
ventilated
.
This
sheep
model
was
characterized
by
a
rapidly
evolving
massive
anasarca
,
hemoconcentration
,
cardiac
dysfunction
,
multiple
system
organ
failure
,
and
severe
ventilator-induced
lung
injury
.
Cardiovascular
changes
and
profound
hemoconcentration
developed
within
6
hrs
from
the
start
of
mechanical
ventilation
,
along
with
a
major
decline
in
pulmonary
compliance
and
deterioration
in
arterial
blood
gases
.
When
total
static
lung
compliance
decreased
to
0
.
15
mL
(
cm
H
2
O
)
(
-
1
)
x
kg
(
-
1
)
(
7
-
30
hrs
)
,
the
sheep
were
randomized
to
two
groups
.
Group
I
received
high
(
recruitive
)
positive
end-expiratory
pressure
(
9
-
20
cm
H
2
O
)
,
adjusted
as
needed
;
group
II
received
low
(
supportive
)
positive
end-expiratory
pressure
(
2
-
6
cm
H
2
O
)
.
Sheep
in
both
groups
progressively
deteriorated
and
died
with
cardiocirculatory
failure
and
multiple
system
organ
failure
within
12
-
24
hrs
from
start
of
treatment
.
This
model
of
lethal
systemic
capillary
leak
syndrome
with
multiple
system
organ
failure
differs
greatly
from
our
previous
sheep
model
of
acute
ventilator-induced
lung
injury
in
which
sheep
were
ventilated
with
a
peak
inspiratory
pressure
of
50
cm
H
2
O
,
a
respiratory
rate
of
4
breaths
x
min
(
-
1
)
,
and
an
inspiratory
time
of
1
.
35
secs
,
without
inducing
capillary
leak
syndrome
.
The
mere
change
of
respiratory
rate
from
4
to
8
breaths
x
min
(
-
1
)
,
with
a
near
doubling
of
the
inspiratory
time
to
2
.
5
secs
,
although
maintaining
eucapnia
,
resulted
in
lethal
systemic
capillary
leak
syndrome
and
multiple
system
organ
failure
with
both
gross
and
microscopic
pathology
of
lungs
greatly
different
from
our
previous
model
of
mechanical
ventilation-induced
acute
respiratory
distress
syndrome
.
Diseases
Validation
Diseases presenting
"systemic capillary leak syndrome"
symptom
systemic capillary leak syndrome
This symptom has already been validated