Submitted on August 3, 2005
Accepted on November 22, 2005
Volutrauma Activates the Clotting Cascade in the Newborn but not Adult Rat
Anthony Chan1, Kusala Jayasuriya1, Leslie Berry2, Matthias Roth-Kleiner1, Martin Post1, and Jaques Belik1*
1 Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
2 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
* To whom correspondence should be addressed. E-mail: jaques.belik{at}sickkids.ca.
Background: Coagulopathy and alveolar fibrin deposition are common in sick neonates and attributed to the primary disease, as opposed to their ventilatory support. Hypothesizing that high tidal volume ventilation activates the extrinsic coagulation pathway, newborn and adult rats were air ventilated at low (10) or high (30 ml/kg) tidal volume and compared to age-matched non-ventilated controls. Methods and Results: Blood was collected at the end of the experiment for measurement of clot time, tissue factor and other coagulation factors content. Similar measurements were obtained from lung lavage material. The newborn clot time (44±1) was lower and plasma tissue factor content higher (103.4±0.4) than adults (88±4 s and 26.6±1.4 units; P<0.01). High, but not low tidal volume ventilation of newborns for as little as 15 min significantly reduced clot time and increased plasma tissue factor content (P<0.01). High volume ventilation increased plasma factor Xa (0.1±0.1 to 1.6±0.4 nM; P<0.01) and thrombin (1.3±0.2 to 2.2±0.4 nM; P<0.05) and decreased antithrombin (0.12±0.01 to 0.05±0.01; P<0.01) in the newborn. Lung lavage material of high volume ventilated newborns showed increased (P<0.01) factor Xa and thrombin. No changes in these parameters were observed in adult rats high volume ventilated for up to 90 min. Conclusions: Compared to adults, newborn rats have a greater propensity for volutrauma-activated intravascular coagulation. These data suggest that mechanical ventilation promotes neonatal thrombosis via lung tissue factor release.
