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

Wrigge, Hermann; Zinserling, Jörg; Stüber, Frank; Spiegel, T. von; Hering, R.; Wetegrove, Silke; Hoeft, Andreas; Putensen, Christian

doi:10.1097/00000542-200012000-00012

Cited by 230 publications

(162 citation statements)

References 27 publications

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“…The results of these studies have been mixed, with some investigators showing increases in serum and bronchoalveolar lavage markers of injury 10,[13][14][15][16]19 whereas others have not. 11,12,17,18 There have been remarkably few trials examining clinical outcomes associated with low tidal volume ventilation strategies in otherwise healthy populations. In 1990, Lee et al 29 randomly assigned 103 surgical ICU patients to ventilation with 6 vs. 12 ml/kg tidal volume.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, despite biologic plausibility and considerable retrospective data to support limiting tidal volume in all ventilated patients, equipoise remains regarding optimal tidal volume in non-ALI patients. Although various groups of surgical patients, but especially cardiac surgical patients, have been observed, [8][9][10][11][12][13][14][15][16][17][18][19][20] these investigations have focused primarily on surrogate outcomes measures, leaving a lack of clarity regarding optimal perioperative ventilator strategy.…”

mentioning

confidence: 99%

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Influence of Low Tidal Volume Ventilation on Time to Extubation in Cardiac Surgical Patients

Sundar¹,

Novack²,

Jervis³

et al. 2011

Survey of Anesthesiology

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Background-Low tidal volumes have been associated with improved outcomes in patients with established acute lung injury. The role of low tidal volume ventilation in patients without lung injury is still unresolved. We hypothesized that such a strategy in patients undergoing elective surgery would reduce ventilator-associated lung injury and that this improvement would lead to a shortened time to extubation

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Influence of Low Tidal Volume Ventilation on Time to Extubation in Cardiac Surgical Patients

Sundar¹,

Novack²,

Jervis³

et al. 2011

Survey of Anesthesiology

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“…Local and systemic infl ammatory biomarkers, including IL-8, IL-1, IL-6, IL-10, TNF-α and IL-12, were determined after 3 hours of mechanical ventilation [22]. Both studies were unable to fi nd any signifi cant diff erences in terms of infl ammatory mediators and the authors concluded that, in contrast to patients with acute lung injury in whom there is a systemic infl ammatory reaction during major surgery, in uninjured normal lungs short term mechanical ventilation alone with high V T levels did not increase pulmonary or systemic infl ammation related to surgery [21], [22]. No diff erences in biomarkers of lung epithelial injury were observed after 5 hours in a later study, which compared ventilation with V T 12 ml/kg ideal body weight without PEEP versus V T 6 ml/kg and PEEP 10 cmH 2 O [23].…”

Section: Abdominal Surgerymentioning

confidence: 98%

“…In this context, Wrigge and colleagues investigated in two studies the eff ect of diff erent ventilatory strategies on the release of infl ammatory mediators in patients undergoing elective surgery [21], [22]. In the fi rst study, 39 patients scheduled for extra-thoracic surgery (abdominal, vascular, bone and other) were randomized to one of three mechanical ventilation strategies: 1) V T of 15 ml/kg ideal body weight without PEEP; 2) V T of 6 ml/ kg without PEEP; and 3) V T of 6 ml/kg with PEEP 10 cmH 2 O.…”

Section: Abdominal Surgerymentioning

confidence: 99%

“…In the fi rst study, 39 patients scheduled for extra-thoracic surgery (abdominal, vascular, bone and other) were randomized to one of three mechanical ventilation strategies: 1) V T of 15 ml/kg ideal body weight without PEEP; 2) V T of 6 ml/ kg without PEEP; and 3) V T of 6 ml/kg with PEEP 10 cmH 2 O. Plasma levels of interleukin (IL)-6, IL-10 and tumor necrosis factor (TNF)-α were measured after one hour of mechanical ventilation [21]. In the second study, 64 patients undergoing general anesthesia were randomized to receive mechanical ventilation with a V T of 12-15 ml/kg ideal body weight without PEEP, or with V T of 6 ml/kg and PEEP levels of 10 cmH 2 O.…”

Section: Abdominal Surgerymentioning

confidence: 99%

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Protective Lung Ventilation During General Anesthesia: Is There Any Evidence?

Coppola¹,

Froio²,

Chiumello³

2014

Annual Update in Intensive Care and Emergency Medicine 2014

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IntroductionIn acute respiratory distress syndrome (ARDS) several studies have shown that mechanical ventilation with high tidal volume (V T ) and low levels of positive endexpiratory pressure (PEEP) can promote ventilatorinduced lung injury (VILI), thus increasing morbidity and mortality [1]. An open lung strategy, combining the use of low V T with adequate PEEP levels and recruitment maneuvers, has thus been recommended in ARDS patients [2]-[4]. In patients without ARDS admitted to intensive care units (ICUs), who required mechanical ventilation for at least 12 hours, the use of a high V T signifi cantly increased the infl ammatory response [5], [6]. In contrast to critically ill patients, during general anesthesia, mechanical ventilation is required only for a few hours, thus the benefi cial eff ects of lung-protective ventilation remain questionable. Moreover, there are limited data from few randomized controlled trials with only small cohorts of enrolled patients.Two recent meta-analyses that enrolled patients from ICUs and the operating room (OR) showed that lungprotective ventilation was associated with lower mortality and postoperative complications [2], [7]. However, there are no recommendations regarding optimal ventilatory strategies in patients without lung injury during general anesthesia.In the present article, we provide a comprehensive picture of the current literature on lung-protective ventilation during general anesthesia in patients without ARDS, focusing on the applications of this strategy in patients undergoing abdominal, thoracic and cardiac surgery. How mechanical ventilation is applied in the operating roomAlthough the protective ventilation approach may be benefi cial in a broader population with and without ARDS, the use of high V T without PEEP is still common during general anesthesia. A large French multicenter observational study, in which more than 2,900 patients undergoing general anesthesia were enrolled, showed that 18 % of patients were ventilated with a V T greater than 10 ml/kg body weight and 81 % without PEEP [8]. Moreover, a recruitment maneuver was applied in only 7 % of patients.Similarly a 5-year observational study, in which 45,575 patients were enrolled, reported that although use of a V T less than 10 ml/kg and PEEP levels greater than 5 cmH 2 O increased progressively over time, 16-18 % of patients continued to receive a V T greater than 10 ml/kg without application of PEEP [9]. Th e presence of obesity and a short height were the main risk factors for receiving a large V T during prolonged anesthesia [10]. Rationale for lung-protective ventilation during general anesthesiaGeneral anesthesia aff ects lung function primarily because of the loss of muscle tone, which promotes a reduction in lung volume, an alteration in ventilationperfusion ratio and the onset of lung atelectasis. Th e development of atelectasis is very common and occurs in more than 90 % of subjects undergoing general anesthesia [11], [12]. Atelectasis is mainly due to three basic mechanisms [13], ...

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Pulmonary-Respiratory Medicine

2001

JAMA

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

Cited by 230 publications

References 27 publications

Influence of Low Tidal Volume Ventilation on Time to Extubation in Cardiac Surgical Patients

Influence of Low Tidal Volume Ventilation on Time to Extubation in Cardiac Surgical Patients

Protective Lung Ventilation During General Anesthesia: Is There Any Evidence?

Pulmonary-Respiratory Medicine

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