Effects of Mechanical Ventilation on Release of Cytokines into Systemic Circulation in Patients with Normal Pulmonary Function

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  • Hermann Wrigge
    *#Resident, †Research Associate, ‡Associate Professor, §∥Staff Anesthesiologist, **††Professor.
  • Jörg Zinserling
    *#Resident, †Research Associate, ‡Associate Professor, §∥Staff Anesthesiologist, **††Professor.
  • Frank Stüber
    *#Resident, †Research Associate, ‡Associate Professor, §∥Staff Anesthesiologist, **††Professor.
  • Tilman von Spiegel
    *#Resident, †Research Associate, ‡Associate Professor, §∥Staff Anesthesiologist, **††Professor.
  • Rudolf Hering
    *#Resident, †Research Associate, ‡Associate Professor, §∥Staff Anesthesiologist, **††Professor.
  • Silke Wetegrove
    *#Resident, †Research Associate, ‡Associate Professor, §∥Staff Anesthesiologist, **††Professor.
  • Andreas Hoeft
    *#Resident, †Research Associate, ‡Associate Professor, §∥Staff Anesthesiologist, **††Professor.
  • Christian Putensen
    *#Resident, †Research Associate, ‡Associate Professor, §∥Staff Anesthesiologist, **††Professor.

Description

<jats:sec> <jats:title>Background</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p> </jats:sec>

Journal

  • Anesthesiology

    Anesthesiology 93 (6), 1413-1417, 2000-12-01

    Ovid Technologies (Wolters Kluwer Health)

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