H. Wrigge et al., Effects of mechanical ventilation on release of cytokines into systemic circulation in patients with normal pulmonary function, ANESTHESIOL, 93(6), 2000, pp. 1413-1417
Citations number
34
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Background: Mechanical ventilation with high tidal volumes (V-T) in contras
t to mechanical ventilation with low V-T has been shown to increase plasma
levels of proinflammatory and antiinflammatory mediators in patients with a
cute lung injury. The authors hypothesized that, in patients without previo
us lung Injury, a conventional potentially injurious ventilatory strategy w
ith high V-T and zero end-expiratory pressure (ZEEP) will not cause a cytok
ine release into systemic circulation.
Methods: A total of 39 patients with American Society of Anesthesiologists
physical status I-II and without signs of systemic infection scheduled for
elective surgery with general anesthesia were randomized to receive mechani
cal ventilation with either (1) V-T = 15 ml/kg ideal body weight on ZEEP, (
2) V-T = 6 ml/kg ideal body weight on ZEEP, or (3) V-T = 6 ml/kg ideal body
weight on positive end-expiratory pressure of 10 cm H2O. Plasma levels of
proinflammatory and antiinflammatory mediators tumor necrosis factor, inter
leukin (IL)-6, IL-10, and IL-1 receptor antagonist were determined before a
nd 1 h after the initiation of mechanical ventilation.
Results: Plasma levels of all cytokines remained low in all settings. IL-6,
tumor necrosis factor, and IL-1 receptor antagonist did not change signifi
cantly after 1 h of mechanical ventilation. IL-10 was below the detection l
imit (10 pg/ml) in 35 of 39 patients. There were no differences between gro
ups.
Conclusions Initiation of mechanical ventilation for 1 h in patients withou
t previous lung injury caused no consistent changes in plasma levels of stu
died mediators. Mechanical ventilation with high V-T on ZEEP did not result
in higher cytokine levels compared with lung-protective ventilatory strate
gies. Previous lunge damage seems to be mandatory to cause an increase in p
lasma cytokines after 1 h of high V-T mechanical ventilation.