Effects of mechanical ventilation on release of cytokines into systemic circulation in patients with normal pulmonary function

被引:170
作者
Wrigge, H [1 ]
Zinserling, J [1 ]
Stüber, F [1 ]
von Spiegel, T [1 ]
Hering, R [1 ]
Wetegrove, S [1 ]
Hoeft, A [1 ]
Putensen, C [1 ]
机构
[1] Univ Bonn, Dept Anesthesiol & Intens Care Med, D-53105 Bonn, Germany
关键词
inflammation; lung; mediators; ventilator-associated lung injury;
D O I
10.1097/00000542-200012000-00012
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Mechanical ventilation with high tidal volumes (V-T) in contrast to mechanical ventilation with low V-T has been shown to increase plasma levels of proinflammatory and antiinflammatory mediators in patients with acute lung injury. The authors hypothesized that, in patients without previous lung Injury, a conventional potentially injurious ventilatory strategy with high V-T and zero end-expiratory pressure (ZEEP) will not cause a cytokine 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 mechanical 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, interleukin (IL)-6, IL-10, and IL-1 receptor antagonist were determined before and 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 significantly after 1 h of mechanical ventilation. IL-10 was below the detection limit (10 pg/ml) in 35 of 39 patients. There were no differences between groups. Conclusions Initiation of mechanical ventilation for 1 h in patients without previous lung injury caused no consistent changes in plasma levels of studied mediators. Mechanical ventilation with high V-T on ZEEP did not result in higher cytokine levels compared with lung-protective ventilatory strategies. Previous lunge damage seems to be mandatory to cause an increase in plasma cytokines after 1 h of high V-T mechanical ventilation.
引用
收藏
页码:1413 / 1417
页数:5
相关论文
共 34 条
[11]  
IBA T, 1991, CIRC SHOCK, V35, P193
[12]  
*INT CONS C INT CA, 1999, AM J RESP CRIT CARE, V160, P2118, DOI DOI 10.1164/AJRCCM.160.6.ATS16060
[13]   Volatile anesthetics augment expression of proinflammatory cytokines in rat alveolar macrophages during mechanical ventilation [J].
Kotani, N ;
Takahashi, S ;
Sessler, DI ;
Hashiba, E ;
Kubota, T ;
Hashimoto, H ;
Matsuki, A .
ANESTHESIOLOGY, 1999, 91 (01) :187-197
[14]  
Marini J J, 1993, New Horiz, V1, P489
[15]   STRESS DISTRIBUTION IN LUNGS - A MODEL OF PULMONARY ELASTICITY [J].
MEAD, J ;
TAKISHIMA, T ;
LEITH, D .
JOURNAL OF APPLIED PHYSIOLOGY, 1970, 28 (05) :596-+
[16]   TIDAL VENTILATION AT LOW AIRWAY PRESSURES CAN AUGMENT LUNG INJURY [J].
MUSCEDERE, JG ;
MULLEN, JBM ;
GAN, K ;
SLUTSKY, AS .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1994, 149 (05) :1327-1334
[17]   Positive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration [J].
Neumann, P ;
Rothen, HU ;
Berglund, JE ;
Valtysson, J ;
Magnusson, A ;
Hedenstierna, G .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 1999, 43 (03) :295-301
[18]   MECHANISMS OF VENTILATOR-INDUCED LUNG INJURY [J].
PARKER, JC ;
HERNANDEZ, LA ;
PEEVY, KJ .
CRITICAL CARE MEDICINE, 1993, 21 (01) :131-143
[19]   THE INFLUENCE OF ANESTHETIC TECHNIQUE UPON THE IMMUNE-RESPONSE TO HYSTERECTOMY - A COMPARISON OF PROPOFOL INFUSION AND ISOFLURANE [J].
PIRTTIKANGAS, CO ;
SALO, M ;
MANSIKKA, M ;
GRONROOS, J ;
PULKKI, K ;
PELTOLA, O .
ANAESTHESIA, 1995, 50 (12) :1056-1061
[20]   Activation of human macrophages by mechanical ventilation in vitro [J].
Pugin, J ;
Dunn, I ;
Jolliet, P ;
Tassaux, D ;
Magnenat, JL ;
Nicod, LP ;
Chevrolet, JC .
AMERICAN JOURNAL OF PHYSIOLOGY-LUNG CELLULAR AND MOLECULAR PHYSIOLOGY, 1998, 275 (06) :L1040-L1050