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
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