The authors would like to thank Beatrice Beck-Schimmer (MD) and Erik Schadde (MD) for their critical examination and their valuable contribution for this manuscript.

All experiments presented in this protocol were approved by the Veterinary Authorities of the Canton Zurich, Switzerland (approval numbers 134/2014 and ZH088/19). Moreover, all steps performed in this experiment were in accordance with the Guidelines on Experiments with Animals by the Swiss Academy of Medial Sciences (SAMS) and Guidelines of the Federation of European Laboratory Animal Science Associations (FELASA).
1. Anesthesia induction and animal monitoring
<ol>
	<li>Keep male Wistar rats with a weight of 250-300 gram (g) in ventilated cages under pathogen-free conditions. Provide a 12-12-hour light/dark cycle at an ambient temperature of 22 &#177; 1 &#176;C, and free access to food and water.</li>
	<li>Induce general anesthesia either by volatile induction with isoflurane (concentration of 3-5%) in an anesthesia induction box for 30 seconds (Figure 1A) or alternatively, induce anesthesia with a single-shot injection of ketamine/xylazine (10/1 milligram (mg) per 100 g body weight).</li>
	<li>Transfer the animal to a working place and lay the animal on a heating-mat throughout the entire experiment. Keep the body-temperature between 36.5 and 37 &#176;C.</li>
	<li>Use a nosecone to provide oxygen (600 mL/minute). Add isoflurane 2-3% if volatile anesthesia was chosen for anesthesia maintenance. Make sure that the animal is spontaneously breathing.</li>
	<li>Confirm the level of anesthesia by the absence&#160;of the toe-pinch reflex prior to the installation of tracheostomy and arterial and venous catheters.</li>
	<li>Verify a sufficient oxygenation by peripheral oxygen saturation monitoring (normal oxygen saturation 98 - 100%).</li>
	<li>Use an ointment (Vitamin A ointment) to protect the eyes.</li>
	<li>Prepare sterile surgical instruments and catheters on a side table as displayed in Figure 1B.</li>
	<li>Additionally, prepare pressure and oxygen saturation monitoring as displayed in Figure 1C.</li>
</ol>
2. Intravenous access
<ol>
	<li>Apply a tourniquet at the rat&#39;s proximal tail to facilitate venous access (Figure 2A).</li>
	<li>Disinfect the tail 3 times with alcohol.</li>
	<li>Induce a G26 intravenous catheter into one of the two lateral tail veins. 
	NOTE: From our experience it is easier to place the intravenous access at the distal part of the rat&#39;s tail, because the vein here is located closer to the skin. In addition, in case of a failed cannulation, there is enough space to move proximally.</li>
	<li>Strictly avoid air injection.</li>
	<li>Untie the tourniquet after placing the intravenous catheter.</li>
	<li>Fix the intravenous catheter in place with adhesive tape (Figure 2B).</li>
	<li>Connect syringe-pumps to the intravenous access for continuous fluid and drug application.</li>
	<li>Use 3-way stopcocks for bolus fluid, drug application, and venous blood sampling.</li>
</ol>
3. Tracheostomy
<ol>
	<li>Shave the animal&#39;s anterior neck-area.</li>
	<li>Disinfect the shaved skin 3 times with providone-iodine solution.</li>
	<li>Perform a circa 2 cm longitudinal incision using a scalpel (with a blade number 10).</li>
	<li>Retract the skin with 2-0 silk sutures.</li>
	<li>Bluntly prepare the larynx and the trachea with surgical scissors (Figure 3A).</li>
	<li>Make sure to open the trachea with surgical micro&#160;scissors at the 3-5th tracheal clasp.</li>
	<li>Insert a sterile tracheal cannula into the trachea. Be careful, do not insert the cannula too deeply in order to avoid unilateral ventilation.</li>
	<li>Fix the cannula in place using a 2-0 silk suture.</li>
	<li>Connect the cannula to a ventilator for pressure or volume-controlled ventilation (Figure 3B).</li>
</ol>
4. Arterial access
<ol>
	<li>Disinfect the rat tail 3 times with povidone-iodine solution.</li>
	<li>Cut the skin using a scalpel (with a blade number 10) circa 1 cm longitudinally at the ventral side.</li>
	<li>Take care, do not cut too deeply to avoid an injury of the tail artery.</li>
	<li>Use a surgical microscope to expose the artery carefully. Cut the fascia surrounding the artery with surgical micro scissors.</li>
	<li>Ligate the distal part of the artery using a 6-0 silk suture.</li>
	<li>Prepare a proximal 6-0 silk suture but do not tighten the silk (Figure 4A).</li>
	<li>Introduce a G-26 catheter into the artery between the distal and proximal silk suture.</li>
	<li>Once the catheter is in the artery, tighten the proximal silk suture and fix the catheter in place (Figure 4B).</li>
	<li>Connect the catheter to a pressure transducer to provide continuous arterial pressure measurement (normal mean arterial pressure: 60 - 100 mmHg) (Figure 4C).</li>
	<li>Additionally, place a 3-way stopcock between the catheter connected to the pressure transducer and the G-26 catheter for arterial blood sampling.</li>
</ol>
5. Baseline measurement, sepsis induction and follow-up measurements
<ol>
	<li>After the animal reached a steady state, inject the LPS.</li>
	<li>Collect blood samples when a steady state is reached (usually after 15-30 minutes).</li>
	<li>Replace fluid loss from blood samples by Ringer&#39;s solution in a ratio of 1:4.</li>
	<li>To induce sepsis, inject the LPS as a bolus or as a continuous LPS application.</li>
	<li>For the bolus application, inject 1 mg of LPS/kilogram body weight (kg) dissolved in phosphate buffered saline (PBS) at a concentration of 1 mg/mL.</li>
	<li>For continuous application, inject 300 &#181;g of LPS/kg/hour throughout the entire experiment using a syringe pump (stock solution of LPS: 1 mg/mL in PBS).</li>
	<li>Avoid air-injection at all times in order to prevent air embolism.</li>
	<li>Define fluid replacement protocols, vasoconstrictor application protocols, and abortion criteria (for example hypotension defined as a mean arterial blood pressure below 50 mmHg for more than 30 minutes despite fluid replacement) before setting up the experiment. 
	NOTE: We suggest a continuous infusion of Ringer&#39;s solution at a rate of 10 mL/kg/hour.</li>
	<li>Subtract any continuous administration of fluids (e.g., for continuous LPS application) from the amount infused so that the results are comparable with those of the control groups. 
	NOTE: At the end of the experiment, and prior to harvesting any organs such as liver, kidney or spleen for further analyses such as histological or biochemical examination animals can be euthanized by an incision of the inferior cava vein. The recommended method of euthanasia is to bring the animals to a surgical plane of anesthesia prior to incision of the inferior vena cava and injection of ice-cold saline into the left heart, especially if inflammatory markers in organs are to be assessed. Ensure to comply with the legal requirements and local guidelines. To verify sepsis-related organ failure, pro-apoptosis marker like caspase-3 may be analyzed as well as &#945;1-microglobuline to verify tubular damage in the kidneys. The organ specific analysis&#160;of markers like CINC-1, MCP-1 and IL-6 may also provide information about the organ specific inflammatory response.</li>
</ol>

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L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+the+worldwide+burden+of+critical+illness:+the+intensive+care+over+nations+(ICON)+audit.">Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit.</a> Lancet Respiratory Medicine. 2 (5), 380-386 (2014).</li><li>Fleischmann, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+Global+Incidence+and+Mortality+of+Hospital-treated+Sepsis.+Current+Estimates+and+Limitations.">Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations.</a> American Journal of Respiratory and Critical Care Medicine. 193 (3), 259-272 (2016).</li><li>Kumar, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Duration+of+hypotension+before+initiation+of+effective+antimicrobial+therapy+is+the+critical+determinant+of+survival+in+human+septic+shock.">Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock.</a> Critical Care Medicine. 34 (6), 1589-1596 (2006).</li><li>Gotts, J. E., Matthay, M. 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A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Animal+models+of+sepsis+and+shock:+a+review+and+lessons+learned.">Animal models of sepsis and shock: a review and lessons learned.</a> Shock. 9 (1), 1-11 (1998).</li><li>Buras, J. A., Holzmann, B., Sitkovsky, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Animal+models+of+sepsis:+setting+the+stage.">Animal models of sepsis: setting the stage.</a> Nature Reviews Drug Discovery. 4 (10), 854-865 (2005).</li><li>Perretti, M., Duncan, G. S., Flower, R. J., Peers, S. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Serum+corticosterone,+interleukin-1+and+tumour+necrosis+factor+in+rat+experimental+endotoxaemia:+comparison+between+Lewis+and+Wistar+strains.">Serum corticosterone, interleukin-1 and tumour necrosis factor in rat experimental endotoxaemia: comparison between Lewis and Wistar strains.</a> British Journal of Pharmacology. 110 (2), 868-874 (1993).</li><li>Marechal, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endothelial+glycocalyx+damage+during+endotoxemia+coincides+with+microcirculatory+dysfunction+and+vascular+oxidative+stress.">Endothelial glycocalyx damage during endotoxemia coincides with microcirculatory dysfunction and vascular oxidative stress.</a> Shock. 29 (5), 572-576 (2008).</li><li>Thiemermann, C., Ruetten, H., Wu, C. C., Vane, J. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+multiple+organ+dysfunction+syndrome+caused+by+endotoxin+in+the+rat:+attenuation+of+liver+dysfunction+by+inhibitors+of+nitric+oxide+synthase.">The multiple organ dysfunction syndrome caused by endotoxin in the rat: attenuation of liver dysfunction by inhibitors of nitric oxide synthase.</a> British Journal of Pharmacology. 116 (7), 2845-2851 (1995).</li><li>Osuchowski, M. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimum+quality+threshold+in+pre-clinical+sepsis+studies+(MQTiPSS):+an+international+expert+consensus+initiative+for+improvement+of+animal+modeling+in+sepsis.">Minimum quality threshold in pre-clinical sepsis studies (MQTiPSS): an international expert consensus initiative for improvement of animal modeling in sepsis.</a> Intensive Care Medicine Experimental. 6 (1), 26 (2018).</li><li>Fink, M. P., Heard, S. O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laboratory+models+of+sepsis+and+septic+shock.">Laboratory models of sepsis and septic shock.</a> Journal of Surgical Research. 49 (2), 186-196 (1990).</li><li>Buras, J. 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The authors have no conflicts of interests with regard to the presented study. Martin Schl&#228;pfer has submitted a patent to mitigate the negative effects of surgery and/or anesthesia for patients using medical gases, particularly oxygen (O2) and carbon dioxide (CO2). He has received unrestricted research grants from Sedana Medical, Sweden, and from Roche, Switzerland, not related to this work.

The protocol described here allows for a highly reproducible, yet simple to learn sepsis model, which can be adapted according the research question. Essential in vivo data referring to organ function such as heart rate, blood pressure, and peripheral arterial oxygen saturation may be collected continuously, and blood sampling may be performed repetitively throughout the experiment. In addition, modifications with regard to fluid replacement protocols and vasopressor support can be installed. Given the hemodynamic stabil...

Sepsis and its more severe form, septic shock, are syndromes on the ground of an infection, resulting in an overshooting inflammatory reaction with the release of cytokines, leading to physiological and biochemical changes with a suppressed immune defense and fatal results1,2. This unbalanced inflammatory reaction results in organ dysfunction and organ failure in various vital organs such as lung, kidney, and liver. With 37%3, sepsis is one of the most common reasons for a patient to be admitted to an intensive care unit (ICU). Mortality of sepsis currently ranges around 20-30%4. Early and effective antibiotic treatment is of utmost importance5. Fluid and vasopressor resuscitation need to be installed early, other than that, treatment is purely supportive6.
Sepsis is defined as a proven or suspected infection with bacteria, fungi, viruses, or parasites, which is accompanied by organ dysfunction. Septic shock criteria are met when a further cardiovascular collapse irresponsive to fluid treatment alone, and a lactate level of more than 2 millimole/liter is present2. Sepsis related organ failure may occur in any organ, but is very common in the cardiovascular system, the brain, the kidney, the liver, and the lung. Most patients suffering from sepsis require endotracheal intubation to secure the patient&#39;s airway, to protect from aspiration, and to apply positive end expiratory ventilation with a high fraction of inspired oxygen to prevent or overcome hypoxia. In order to tolerate a tracheal tube and mechanical ventilation, patients usually require sedation.
Endotoxins, such as lipopolysaccharides (LPS) as a component of the membrane of gram negative bacteria induce a strong inflammatory reaction via the toll-like receptor (TLR) 47. Activation of a defined pathway ensures a stable inflammatory reaction. Cytokines like cytokine induced neutrophil chemoattractant protein 1 (CINC-1), monocyte chemoattractant protein 1 (MCP-1), and interleukin 6 (IL-6) are known as prognostic factors for severity and outcome in this model8. Intravenous LPS application has been successfully used to study various aspects of sepsis in rats8,9.
Treatment of sepsis is still a challenge, particularly due to the lack of predictive animal models. If endotoxemia with activation of systemic inflammation is an adequate model for the development of pharmacological therapies is debatable. However, with the well-known LPS-induced TLR 4 pathway important knowledge can be gained.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>2-0 silk sutures</td>
			<td>Ethicon, Sommerville, NJ</td>
			<td>K833</td>
			<td>Standard surgical</td>
		</tr>
		<tr>
			<td>26 intravenous catheter</td>
			<td>Becton Dickinson, Franklin Lakes, NJ</td>
			<td>391349</td>
			<td>Standard anesthesia equipment</td>
		</tr>
		<tr>
			<td>6-0 LOOK black braided silk</td>
			<td>Surgical Specalities Corporation, Wyomissing, PA</td>
			<td>SP114</td>
			<td>Standard surgical</td>
		</tr>
		<tr>
			<td>Alaris Syringe Pump</td>
			<td>Bencton Dickinson</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Betadine</td>
			<td>Mundipharma, Basel, Switzerland</td>
			<td>7.68034E+12</td>
			<td>GTIN-number</td>
		</tr>
		<tr>
			<td>Curved fine tips microforceps</td>
			<td>World precision instruments (WPI), Sarasota, FL</td>
			<td>504513</td>
			<td>Facilitates vascular preparation</td>
		</tr>
		<tr>
			<td>Fine tips microforceps</td>
			<td>World precision instruments (WPI), Sarasota, FL</td>
			<td>501976</td>
			<td>Tips need to be polished regularly</td>
		</tr>
		<tr>
			<td>Infinity Delta XL Anesthesia monitoring</td>
			<td>Draeger, L&#252;beck, Germany</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Isoflurane, 250 mL bottles</td>
			<td>Attane, Piramal, Mumbai, India</td>
			<td>LDNI 22098</td>
			<td>Standard vet. equipment</td>
		</tr>
		<tr>
			<td>Ketamine (Ketalar)</td>
			<td>Pfitzer, New York, NY</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Lipopolysaccharide (LPS) from Escherichia coli, serotype 055:B5</td>
			<td>Sigma, Buchs, Switzerland</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Q-tips small</td>
			<td>Carl Roth GmbH, Karlsruhe, Germany</td>
			<td>EH11.1</td>
			<td>Standard surgical</td>
		</tr>
		<tr>
			<td>Ringerfundin</td>
			<td>Bbraun, Melsungen, Germany</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Tec-3 Isofluorane Vaporizer</td>
			<td>Ohmeda, GE-Healthcare, Chicago, IL</td>
			<td>not available anymore</td>
			<td>Standard vet. equipment</td>
		</tr>
		<tr>
			<td>Xylazine (Xylazin Streuli)</td>
			<td>Streuli AG, Uznach, Switzerland</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

a reproducible intensive care unit-oriented endotoxin model in rats

Sepsis and septic shock remain the leading cause of death in intensive care units. Despite significant improvements in sepsis management, mortality still ranges between 20 and 30%. Novel treatment approaches in order to reduce sepsis-related multiorgan failure and death are urgently needed. Robust animal models allow for one or multiple treatment approaches as well as for testing their effect on physiological and molecular parameters. In this article, a simple animal model is presented.
First, general anesthesia is induced in animals either with the use of volatile or by intraperitoneal anesthesia. After placement of an intravenous catheter (tail vein), tracheostomy, and insertion of an intraarterial catheter (tail artery), mechanical ventilation is started. Baseline values of mean arterial blood pressure, arterial blood oxygen saturation, and heart rate are recorded.
The injection of lipopolysaccharides (1 milligram/kilogram body weight) dissolved in phosphate-buffered saline induces a strong and reproducible inflammatory response via the toll-like receptor 4. Fluid corrections as well as the application of norepinephrine are performed based on well-established protocols.
The animal model presented in this article is easy to learn and strongly oriented towards clinical sepsis treatment in an intensive care unit with sedation, mechanical ventilation, continuous blood pressure monitoring, and repetitive blood sampling. Also, the model is reliable, allowing for reproducible data with a limited number of animals in accordance with the 3R (reduce, replace, refine) principles of animal research. While animal experiments in sepsis research cannot easily replaced, repetitive measurements allow for a reduction of animals and keeping septic animals anesthetized diminishes suffering.

The system presented allows for endotoxemia with hemodynamically stable animals as reported previously9. While the mean arterial pressure remains stable in animals with, and without LPS stimulation LPS treated animal develop characteristics of sepsis such as a negative base excess and a strong inflammatory reaction measured by plasma cytokines (6 hours after application) such as CINC-1 (867 ng/mL), MCP-1 (5027 ng/mL), and IL-6 (867 ng/mL)8, Figure 5</st...

Watch this Scientific Journal Video about A Reproducible Intensive Care Unit-Oriented Endotoxin Model in Rats at JoVE.com

A Reproducible Intensive Care Unit-Oriented Endotoxin Model in Rats

Here, we present a reproducible intensive care unit-oriented endotoxin model in rats.

Sepsis and septic shock remain the leading cause of death in intensive care units. Despite significant improvements in sepsis management, mortality still ...

a-reproducible-intensive-care-unit-oriented-endotoxin-model-in-rats

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2.0K Views.  University of Zurich. Here, we present a reproducible intensive care unit-oriented endotoxin model in rats.

Video: A Reproducible Intensive Care Unit-Oriented Endotoxin Model in Rats

Spectral Karyotyping to Study Chromosome Abnormalities in Humans and Mice with Polycystic Kidney Disease

Conventional method to identify and classify individual chromosomes depends on the unique banding pattern of each chromosome in a specific species being analyzed 1, 2. This classical banding technique, however, is not reliable in identifying complex chromosomal aberrations such as those associated with cancer. To overcome the limitations of the banding technique, Spectral Karyotyping (SKY) is introduced to provide much reliable information on chromosome abnormalities.
SKY is a multicolor fluorescence in-situ hybridization (FISH) technique to detect metaphase chromosomes with spectral microscope 3, 4. SKY has been proven to be a valuable tool for the cytogenetic analysis of a broad range of chromosome abnormalities associated with a large number of genetic diseases and malignancies 5, 6. SKY involves the use of multicolor fluorescently-labelled DNA probes prepared from the degenerate oligonucleotide primers by PCR. Thus, every chromosome has a unique spectral color after in-situ hybridization with probes, which are differentially labelled with a mixture of fluorescent dyes (Rhodamine, Texas Red, Cy5, FITC and Cy5.5). The probes used for SKY consist of up to 55 chromosome specific probes 7-10.
The procedure for SKY involves several steps (Figure 1). SKY requires the availability of cells with high mitotic index from normal or diseased tissue or blood. The chromosomes of a single cell from either a freshly isolated primary cell or a cell line are spread on a glass slide. This chromosome spread is labeled with a different combination of fluorescent dyes specific for each chromosome. For probe detection and image acquisition,the spectral imaging system consists of sagnac interferometer and a CCD camera. This allows measurement of the visible light spectrum emitted from the sample and to acquire a spectral image from individual chromosomes. HiSKY, the software used to analyze the results of the captured images, provides an easy identification of chromosome anomalies. The end result is a metaphase and a karyotype classification image, in which each pair of chromosomes has a distinct color (Figure 2). This allows easy identification of chromosome identities and translocations. For more details, please visit Applied Spectral Imaging website (<a href="http://www.spectral-imaging.com/" target="_blank">http://www.spectral-imaging.com/</a>).
SKY was recently used for an identification of chromosome segregation defects and chromosome abnormalities in humans and mice with Autosomal Dominant Polycystic Kidney Disease (ADPKD), a genetic disease characterized by dysfunction in primary cilia 11-13. Using this technique, we demonstrated the presence of abnormal chromosome segregation and chromosomal defects in ADPKD patients and mouse models 14. Further analyses using SKY not only allowed us to identify chromosomal number and identity, but also to accurately detect very complex chromosomal aberrations such as chromosome deletions and translocations (Figure 2).

Spectral Karyotyping (SKY) is an advanced cytogenetics technique to identify genomic and chromosomal aberrations. This technique takes advantage of chromosome painting probes, which allow classification of all chromosomes. SKY can also identify complex chromosome aberrations and segregation defects in mice and humans with various diseases, including polycystic kidney disease.

Conventional method to identify and classify individual chromosomes depends on the unique banding pattern of each chromosome in a specific species being ...

A Murine Closed-chest Model of Myocardial Ischemia and Reperfusion

Surgical trauma by thoracotomy in open-chest models of coronary ligation induces an immune response which modifies different mechanisms involved in ischemia and reperfusion. Immune response includes cytokine expression and release or secretion of endogenous ligands of innate immune receptors. Activation of innate immunity can potentially modulate infarct size. We have modified an existing murine closed-chest model using hanging weights which could be useful for studying myocardial pre- and postconditioning and the role of innate immunity in myocardial ischemia and reperfusion. This model allows animals to recover from surgical trauma before onset of myocardial ischemia.
Volatile anesthetics have been intensely studied and their preconditioning effect for the ischemic heart is well known. However, this protective effect precludes its use in open chest models of coronary artery ligation. Thus, another advantage could be the use of the well controllable volatile anesthetics for instrumentation in a chronic closed-chest model, since their preconditioning effect lasts up to 72 hours. Chronic heart diseases with intermittent ischemia and multiple hit models are other possible applications of this model.
For the chronic closed-chest model, intubated and ventilated mice undergo a lateral blunt thoracotomy via the 4th intercostal space. Following identification of the left anterior descending a ligature is passed underneath the vessel and both suture ends are threaded through an occluder. Then, both suture ends are passed through the chest wall, knotted to form a loop and left in the subcutaneous tissue. After chest closure and recovery for 5 days, mice are anesthetized again, chest skin is reopened and hanging weights are hooked up to the loop under ECG control.
At the end of the ischemia/reperfusion protocol, hearts can be stained with TTC for infarct size assessment or undergo perfusion fixation to allow morphometric studies in addition to histology and immunohistochemistry.

Surgical trauma induces an inflammatory response. Cytokines and endogenous ligands are known to modulate myocardial infarct size following ischemia and reperfusion. We present a modified closed-chest model of murine ischemia and reperfusion using hanging weights to minimize effects of thoracotomy.

Surgical trauma by thoracotomy in open-chest models of coronary ligation induces an immune response which modifies different mechanisms involved in ...

Lavage-induced Surfactant Depletion in Pigs As a Model of the Acute Respiratory Distress Syndrome (ARDS)

Various animal models of lung injury exist to study the complex pathomechanisms of human acute respiratory distress syndrome (ARDS) and evaluate future therapies. Severe lung injury with a reproducible deterioration of pulmonary gas exchange and hemodynamics can be induced in anesthetized pigs using repeated lung lavages with warmed 0.9% saline (50 ml/kg body weight). Including standard respiratory and hemodynamic monitoring with clinically applied devices in this model allows the evaluation of novel therapeutic strategies (drugs, modern ventilators, extracorporeal membrane oxygenators, ECMO), and bridges the gap between bench and bedside. Furthermore, induction of lung injury with lung lavages does not require the injection of pathogens/endotoxins that impact on measurements of pro- and anti-inflammatory cytokines. A disadvantage of the model is the high recruitability of atelectatic lung tissue. Standardization of the model helps to avoid pitfalls, to ensure comparability between experiments, and to reduce the number of animals needed.

Lavage-induced Surfactant Depletion in Pigs As a Model of the Acute Respiratory Distress Syndrome ARDS

Repeated pulmonary lavages in anesthetized pigs induce lung injury resembling major aspects of human acute respiratory distress syndrome (ARDS). For this purpose the lungs are repeatedly lavaged with 0.9% saline at 37 &#176;C. The goal of the protocol is a reproducible mitigation of gas exchange and hemodynamics for research in ARDS.

Various animal models of lung injury exist to study the complex pathomechanisms of human acute respiratory distress syndrome (ARDS) and evaluate future ...

A Model to Simulate Clinically Relevant Hypoxia in Humans

In case of apnea, arterial partial pressure of oxygen (pO2) decreases, while partial pressure of carbon dioxide (pCO2) increases. To avoid damage to hypoxia sensitive organs such as the brain, compensatory circulatory mechanisms help to maintain an adequate oxygen supply. This is mainly achieved by increased cerebral blood flow. Intermittent hypoxia is a commonly seen phenomenon in patients with obstructive sleep apnea. Acute airway obstruction can also result in hypoxia and hypercapnia. Until now, no adequate model has been established to simulate these dynamics in humans. Previous investigations focusing on human hypoxia used inhaled hypoxic gas mixtures. However, the resulting hypoxia was combined with hyperventilation and is therefore more representative of high altitude environments than of apnea. Furthermore, the transferability of previously performed animal experiments to humans is limited and the pathophysiological background of apnea induced physiological changes is poorly understood. In this study, healthy human apneic divers were utilized to mimic clinically relevant hypoxia and hypercapnia during apnea. Additionally, pulse-oximetry and Near Infrared Spectroscopy (NIRS) were used to evaluate changes in cerebral and peripheral oxygen saturation before, during, and after apnea.

Hypoxia simulation in humans has usually been performed by inhaling hypoxic gas mixtures. For this study, apneic divers were used to simulate dynamic hypoxia in humans. Additionally, physiological changes in desaturation and re-saturation kinetics were evaluated with non-invasive tools such as Near-Infrared-Spectroscopy (NIRS) and peripheral oxygenation saturation (SpO2).

In case of apnea, arterial partial pressure of oxygen (pO2) decreases, while partial pressure of carbon dioxide (pCO2) increases. To avoid damage to ...

Use of a Central Venous Line for Fluids, Drugs and Nutrient Administration in a Mouse Model of Critical Illness

This protocol describes a centrally catheterized mouse model of prolonged critical illness. We combine the cecal ligation and puncture method to induce sepsis with the use of a central venous line for fluids, drugs and nutrient administration to mimic the human clinical setting. Critically ill patients require intensive medical support in order to survive. While the majority of patients will recover within a few days, about a quarter of the patients need prolonged intensive care and are at high risk of dying from non-resolving multiple organ failure. Furthermore, the prolonged phase of critical illness is hallmarked by profound muscle weakness, and endocrine and metabolic changes, of which the pathogenesis is currently incompletely understood. The most widely used animal model in critical care research is the cecal ligation and puncture model to induce sepsis. This is a very reproducible model, with acute inflammatory and hemodynamic changes similar to human sepsis, which is designed to study the acute phase of critical illness. However, this model is hallmarked by a high lethality, which is different from the clinical human situation, and is not developed to study the prolonged phase of critical illness. Therefore, we adapted the technique by placing a central venous catheter in the jugular vein allowing us to administer clinically relevant supportive care, to better mimic the human clinical situation of critical illness. This mouse model requires an extensive surgical procedure and daily intensive care of the animals, but it results in a relevant model of the acute and prolonged phase of critical illness.

This protocol describes a centrally catheterized mouse model of prolonged critical illness. We combine the cecal ligation and puncture method to induce sepsis with the use of a central venous line for fluids, drugs and nutrient administration to mimic the human clinical setting.

This protocol describes a centrally catheterized mouse model of prolonged critical illness. We combine the cecal ligation and puncture method to induce ...

Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies

Longitudinal evaluations of critically ill patients by combinations of clinical examination, biochemical analysis and critical care ultrasonography (CCUS) may detect adverse events of interventions such as fluid overload at an early stage. The Simple Intensive Care Studies (SICS) is a research line that focuses on the prognostic and diagnostic value of combinations of clinical variables.
The SICS-I specifically focused on the use of clinical variables obtained within 24 h of acute admission for prediction of cardiac output (CO) and mortality. Its sequel, SICS-II, focuses on repeated evaluations during ICU admission. The first clinical examination by trained researchers is performed within 3 h after admission consisting of physical examination and educated guessing. The second clinical examination is performed within 24 h after admission and includes physical examination and educated guessing, biochemical analysis and CCUS assessments of heart, lungs, inferior vena cava (IVC) and kidney. This evaluation is repeated at days 3 and 5 after admission. CCUS images are validated by an independent expert, and all data is registered in an online secured database. Follow-up at 90 days includes registration of complications and survival status according to patient&#39;s medical charts and the municipal person registry. The primary focus of SICS-II is the association between venous congestion and organ dysfunction.
The purpose of publishing this protocol is to provide details on the structure and methods of this on-going prospective observational cohort study allowing answering multiple research questions. The design of the data collection of combined clinical examination and CCUS assessments in critically ill patients are explicated. The SICS-II is open for other centers to participate and is open for other research questions that can be answered with our data.

Structured protocols are necessary to provide answers on research questions in critically ill patients. The Simple Intensive Care Studies (SICS) provides an infrastructure for repeated measurements in critically ill patients including clinical examination, biochemical analysis and ultrasonography. SICS projects have specific focus but the structure is flexible to other investigations.

Longitudinal evaluations of critically ill patients by combinations of clinical examination, biochemical analysis and critical care ultrasonography (CCUS) ...

A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit

Needle-free connectors were initially designed and promoted to avoid blood exposure for healthcare workers. Some recent data suggest that the latest generation of connectors (with positive displacement) may be of interest for reducing central venous line infections. We have been using needle-free connectors for several years in our intensive care unit and here we present a protocol for installing these connectors on central venous catheters. After insertion of the catheter and control of the permeability of the lines, the connectors must be purged with 0.9% NaCl before being connected. The connectors replace all disposable caps used on infusion stopcocks and manifolds. All the connectors are changed every 7 days as recommended by the manufacturer (except when there is macroscopic contamination, which requires an immediate change of the connector). Before each injection, the connector must be disinfected for at least 3 seconds with 70% isopropyl alcohol. The connectors must not be disconnected (unless changed), as the injection is done through the device. Setting up the connectors slightly increases the total time required to place the catheter and there is no formal evidence that these connectors reduce the incidence of infectious or thrombotic complications. However, these devices simplify the management of central venous lines and prevent the catheter circuit from &#34;opening&#34; once it has been sterilely installed.

We present a protocol to show the installation of a needle-free connector with positive displacement on a central venous catheter.

Needle-free connectors were initially designed and promoted to avoid blood exposure for healthcare workers. Some recent data suggest that the latest ...

Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device

Acute respiratory distress syndrome (ARDS) is a common cause of hypoxemic respiratory failure and death in critically ill patients, and there is an urgent need to find effective therapies. Preclinical studies have shown that inhaled halogenated agents may have beneficial effects in animal models of ARDS. The development of new devices to administer halogenated agents using modern intensive care unit (ICU) ventilators has significantly simplified the dispensing of halogenated agents to ICU patients. Because previous experimental and clinical research suggested potential benefits of halogenated volatiles, such as sevoflurane or isoflurane, for lung alveolar epithelial injury and inflammation, two pathophysiologic landmarks of diffuse alveolar damage during ARDS, we designed an animal model to understand the mechanisms of the effects of halogenated agents on lung injury and repair. After general anesthesia, tracheal intubation, and the initiation of mechanical ventilation, ARDS was induced in piglets via the intratracheal instillation of hydrochloric acid. Then, the piglets were sedated with inhaled sevoflurane or isoflurane using an ICU-type device, and the animals were ventilated with lung-protective mechanical ventilation during a 4 h period. During the study period, blood and alveolar samples were collected to evaluate arterial oxygenation, the permeability of the alveolar-capillary membrane, alveolar fluid clearance, and lung inflammation. Mechanical ventilation parameters were also collected throughout the experiment. Although this model induced a marked decrease in arterial oxygenation with altered alveolar-capillary permeability, it is reproducible and is characterized by a rapid onset, good stability over time, and no fatal complications.
We have developed a piglet model of acid aspiration that reproduces most of the physiological, biological, and pathological features of clinical ARDS, and it will be helpful to further our understanding of the potential lung-protective effects of halogenated agents delivered through devices used for inhaled ICU sedation.

We describe a model of hydrochloric acid-induced acute respiratory distress syndrome (ARDS) in piglets receiving sedation with halogenated agents, isoflurane and sevoflurane, through a device used for inhaled intensive care sedation. This model can be used to investigate the biological mechanisms of halogenated agents on lung injury and repair.

Acute respiratory distress syndrome (ARDS) is a common cause of hypoxemic respiratory failure and death in critically ill patients, and there is an urgent ...

Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome (ARDS)

Various animal models exist to study the complex pathomechanisms of the acute respiratory distress syndrome (ARDS). These models include pulmo-arterial infusion of oleic acid, infusion of endotoxins or bacteria, cecal ligation and puncture, various pneumonia models, lung ischemia/reperfusion models and, of course, surfactant depletion models, among others. Surfactant depletion produces a rapid, reproducible deterioration of pulmonary gas exchange and hemodynamics and can be induced in anesthetized pigs using repeated lung lavages with 0.9% saline (35 mL/kg body weight, 37 &#176;C). The surfactant depletion model supports investigations with standard respiratory and hemodynamic monitoring with clinically applied devices. But the model suffers from a relatively high recruitability and ventilation with high airway pressures can immediately reduce the severity of the injury by reopening atelectatic lung areas. Thus, this model is not suitable for investigations of ventilator regimes that use high airway pressures. A combination of surfactant depletion and injurious ventilation with high tidal volume/low positive end-expiratory pressure (high Tv/low PEEP) to cause ventilator induced lung injury (VILI) will reduce the recruitability of the resulting lung injury. The advantages of a timely induction and the possibility to perform experimental research in a setting comparable to an intensive care unit are preserved.

Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS

A combination of surfactant washout using 0.9% saline (35 mL/kg body weight, 37 &#176;C) and high tidal volume ventilation with low PEEP to cause moderate ventilator induced lung injury (VILI) results in experimental acute respiratory distress syndrome (ARDS). This method provides a model of lung injury with low/limited recruitability to study the effect of various ventilation strategies for extended periods.

Various animal models exist to study the complex pathomechanisms of the acute respiratory distress syndrome (ARDS). These models include pulmo-arterial ...

Protocol for Developing a Femur Osteotomy Model in Wistar Albino Rats

Fracture healing is a physiological process resulting in the regeneration of bone defects by the coordinated action of osteoblasts and osteoclasts. Osteoanabolic drugs have the potential to augment the repair of fractures but have constraints like high costs or undesirable side effects. The bone healing potential of a drug can initially be determined by in vitro studies, but in vivo studies are needed for the final proof of concept. Our objective was to develop a femur osteotomy rodent model that could help researchers understand the development of callus formation following fracture of the shaft of the femur and that could help establish whether a potential drug has bone healing properties. Adult male Wistar albino rats were used after Institutional Animal Ethics Committee clearance. The rodents were anesthetized, and under aseptic conditions, complete transverse fractures at the middle one-third of the shafts of the femurs were created using open osteotomy. The fractures were reduced and internally fixed using intramedullary K-wires, and secondary fracture healing was allowed to take place. After surgery, intraperitoneal analgesics and antibiotics were given for 5 days. Sequential weekly x-rays assessed callus formation. The rats were sacrificed based on radiologically pre-determined time points, and the development of the fracture callus was analyzed radiologically and using immunohistochemistry.

Here, we present a protocol to iatrogenically fracture the shaft of the femur of Wistar albino rats and follow up on the development of the callus. This femur osteotomy model can help researchers evaluate the process of fracture healing and to study how a drug could influence fracture healing.

Fracture healing is a physiological process resulting in the regeneration of bone defects by the coordinated action of osteoblasts and osteoclasts. ...