Analysis of pulmonary vascular injury and repair during Pseudomonas aeruginosa infection‐induced pneumonia and acute respiratory distress syndrome

Herein we describe lung vascular injury and repair using a rodent model of Pseudomonas aeruginosa pneumonia‐induced acute respiratory distress syndrome (ARDS) during: 1) the exudative phase (48‐hour survivors) and 2) the reparative/fibro‐proliferative phase (1‐week survivors). Pneumonia was induced by intratracheal instillation of P. aeruginosa strain PA103, and lung morphology and pulmonary vascular function were determined subsequently. Pulmonary vascular function was assessed in mechanically ventilated animals in vivo (air dead space, P a O 2 , and lung mechanics) and lung permeability was determined in isolated perfused lungs ex vivo (vascular filtration coefficient and extravascular lung water). At 48 hours post infection, histological analyses demonstrated capillary endothelial disruption, diffuse alveolar damage, perivascular cuffs, and neutrophil influx into lung parenchyma. Infected animals displayed clinical hallmarks of ARDS, including increased vascular permeability, increased dead space, impaired gas exchange, and decreased lung compliance. Overall, the animal infection model recapitulated the morphological and functional changes typically observed in lungs from patients during the exudative phase of ARDS. At 1 week post infection, there was lung histological and pulmonary vascular functional evidence of repair when compared with 48 hours post infection; however, some parameters were still impaired when compared with uninfected controls. Importantly, lungs displayed increased fibrosis and cellular hyperplasia reminiscent of lungs from patients during the fibro‐proliferative phase of ARDS. Control, sham inoculated animals showed normal lung histology and function. These data represent the first comprehensive assessment of lung pathophysiology during the exudative and reparative/fibro‐proliferative phases of P. aeruginosa pneumonia‐induced ARDS, and position this pre‐clinical model for use in interventional studies aimed at advancing clinical care.