The Effect of Low Tidal Volume Ventilation on Inflammatory Cytokines During Cardiopulmonary Bypass

Abstract

Introduction Halting ventilation during cardiopulmonary bypass (CPB) is implemented to operate in a less bleeding setting. It sustains a better visualization of the operation area and helps to perform the operation much more comfortably. On the other hand, it may lead to a series of postoperative lung complications such as atelectasis and pleural effusion. In this study, we investigated the effects of low tidal volume ventilation on inflammatory cytokines during CPB. Methods Twenty-eight patients undergoing cardiovascular surgery were included in the study. Operation standards and ventilation protocols were determined and patients were divided into two groups: patients ventilated with low tidal volume and non-ventilated patients. Plasma samples were taken from patients preoperatively, perioperatively from the coronary sinus and postoperatively after CPB. IL-6, IL-8, TNF-α and C5a levels in serum samples were studied with enzyme-linked immunosorbent assay (ELISA) kits. Results C5a, IL-6, IL-8 and TNF-α were similar when compared to the low tidal volume ventilated and non-ventilated groups ( P >0.05) Comparing the groups by variables, IL-6 levels were increased during CPB in both groups ( P =0.021 and P =0.001), and IL-8 levels decreased in the ventilation group during CPB ( P =0.018). Conclusion Our findings suggest that low tidal volume ventilation may reduce the inflammatory response during CPB. Although the benefit of low tidal volume ventilation in CPB has been shown to decrease postoperative lung complications such as pleural effusion, atelectasis and pneumonia, we still lack more definitive and clear proofs of inflammatory cytokines encountered during CPB.

Kardiyopulmoner Bypassın Sitokinler Üzerine Etkisi

“…Çalışmalarında ventilasyonlu ve ventilasyonsuz gruplarda C5a, IL-6, IL-8 ve TNF-α seviyelerini karşılaştırdıklarında benzer sonuçlar bulmuşlar (P>0.05). KPB'da düşük tidal hacimli ventilasyonun yararının plevral efüzyon, atelektazi ve pnömoni gibi postoperatif akciğer komplikasyonlarını azalttığı gösterilmiş olmasına rağmen, KPB sırasında karşılaşılan enflamatuvar sitokinlere ilişkin daha kesin ve net kanıtlara sahip olmadıklarını belirtmişlerdir 14 . Yapılan bu çalışmada da, düşük ventilasyonun sonuçlar üzerinde bir etkisinin olmadığı görülmüş, buda bizim çalışmamızı destekler nitelikte olup, KPB cerrahisi geçirmiş hastalarda sitokinlerdeki değişikliklerin daha çok ekstrakorporeal dolaşım ekipmanlarından kaynaklandığını göstermektedir.…”

Strategies to attenuate maladaptive inflammatory response associated with cardiopulmonary bypass

“…It remains unclear whether complement activation portends worse outcomes. While higher levels of C3a have been reported in those requiring prolonged mechanical ventilation, other groups have failed to identify a correlation between complement activation and acute lung injury or adverse hemodynamic responses ( 54 – 56 ). Equivocal findings may be due to the difficulty of parsing out the role of the complement system in the context of the complex inflammatory response associated with CPB ( 57 ).…”