Identifying biomarkers of ventilator induced lung injury during one-lung ventilation surgery: a scoping review

Abstract

Background: Ventilator-induced lung injury (VILI) can occur as a result of mechanical ventilation to two lungs. Thoracic surgery often requires one-lung ventilation (OLV). The potential for VILI is likely higher in OLV. The impact of OLV on development of post-operative pulmonary complications is not well understood. We aimed to perform a scoping review to determine reliable biomarkers of VILI after OLV.Methods: A scoping review was performed using Cochrane Collaboration methodology. We searched Medline, EMBASE and SCOPUS. Gray literature was searched. Studies of adult human or animal models without pre-existing lung damage exposed to OLV, with biomarker responses analyzed were included.Results: After screening 5,613 eligible papers, 89 papers were chosen for full text review, with 29 meeting inclusion. Approximately half (52%, n=15) of studies were conducted in humans in an intra-operative setting.Bronchoalveolar lavage (BAL) & serum analyses with ELISA-based assays were most commonly used. The majority of analytes were investigated by a single study. Of the analytes that were investigated by two or more studies (n=31), only 16 were concordant in their findings. Across all sample types and studies 84% (n=66) of the 79 inflammatory markers and 75% (n=6) of the 8 anti-inflammatory markers tested were found to increase. Half (48%) of all studies showed an increase in TNF-α or IL-6.Conclusions: A scoping review of the state of the evidence demonstrated that candidate biomarkers with the most evidence and greatest reliability are general markers of inflammation, such as IL-6 and TNF-α assessed using ELISA assays. Studies were limited in the number of biomarkers measured concurrently, sample size, and studies using human participants. In conclusion these identified markers can potentially serve as outcome measures for studies on OLV.

Temporal and Spatial Patterns of Inflammation and Tissue Injury in Patients with Postoperative Respiratory Failure after Lung Resection Surgery: A Nested Case–Control Study

“…Ventilated lung biomarkers: Increasing levels of IL-6 in BALF and plasma sampling is a predominant cytokine response to OLV, and IL-1 receptor agonists have been detected in the BALFs following OLV [ 8 ]. IL-1Ra is an IL-1 receptor antagonist of IL-1β- and IL-1α-mediated inflammation [ 27 , 28 ].…”

“…This decrease may reflect the acute response to injury sustained during OLV and the proximity of our systemic sampling to the OLV procedure. The recruitment of immune cells from circulation in an emergent immune response may account for the temporary drop in the levels of TNF-α typically observed in response to OLV [ 8 ]. Similarly, the VEGF ligand may be rapidly sequestered from circulation in a mechanotransduction response typical of VILI within the lung epithelia [ 40 ].…”

“…However, mechanical ventilation uses positive pressure to push air into the lungs through an endotracheal tube (ETT). Patients undergoing lung surgery are at risk for lung damage/injury for two major reasons [ 8 , 9 , 10 ]. Firstly, the lung being operated on must be deflated so that surgeons can work on it; therefore, unlike for surgeries on other organs, all mechanical ventilation is delivered to only one lung, the one opposite the site of surgery [ 11 ].…”

Effects of individualized positive end-expiratory pressure on intraoperative oxygenation in thoracic surgical patients: study protocol for a prospective randomized controlled trial

“…OLV, on the other hand, is prone to ventilator-induced lung injuries, such as volutrauma, atelectrauma, and oxygen toxicity [ 1 ]. Surgical injury and OLV are also associated with severe inflammatory cytokine release due to the abundant immune cells in the pulmonary endothelium and alveoli [ 2 ]. In response to pro-inflammatory cytokines, excessive accumulation of neutrophils leads to increased pulmonary vascular permeability.…”

Effect of flow-optimized pressure control ventilation-volume guaranteed (PCV-VG) on postoperative pulmonary complications: a consort study

“…Thoracic surgical injury and one-lung breathing traction trigger a potent immunologic response in the lung endothelium and alveoli. The immunologic response causes the release of inflammatory substances that leads to an excessive buildup of neutrophils, which increases pulmonary vascular permeability and ultimately causes lung injury [ 6 ].…”