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CARDIOVASCULAR ANESTHESIA

The Pulmonary Immune Effects of Mechanical Ventilation in Patients Undergoing Thoracic Surgery

Thomas Schilling, MD, DEAA^*, Alf Kozian, MD^*, Christof Huth, MD, Frank Bühling, MD, Moritz Kretzschmar, cand med^*, Tobias Welte, MD, and Thomas Hachenberg, MD, PhD^*

*Department of Anesthesiology and Intensive Care Medicine, Department of Cardiovascular and Thoracic Surgery, Institute of Immunology, and Department of Cardiology, Angiology, and Pneumology, Otto-von-Guericke-University, Magdeburg, Germany

Address correspondence and reprint requests to Thomas Schilling, MD, DEAA, Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany. Address electronic mail to thomasschilling{at}web.de.

Mechanical ventilation (MV) may induce an inflammatory alveolar response. One-lung ventilation (OLV) with tidal volumes (Vt) as used during two-lung ventilation is a suggested algorithm but may impose mechanical stress of the dependent lung and potentially aggravate alveolar mediator release. We studied whether ventilation with different Vt modifies pulmonary immune function, hemodynamics, and gas exchange. Thirty-two patients undergoing open thoracic surgery were randomized to receive either MV with Vt = 10 mL/kg (n = 16) or Vt = 5 mL/kg (n = 16) adjusted to normal Paco₂ during and after OLV. Fiberoptic bronchoalveolar lavage of the ventilated lung was performed, and cells, protein, tumor necrosis factor (TNF)-, interleukin (IL)-8, soluble intercellular adhesion molecule (sICAM)-1, IL-10, and elastase were determined in the bronchoalveolar lavage. Data were analyzed by parametric or nonparametric tests, as indicated. In all patients, an increase of proinflammatory variables was found. The time courses of intra-alveolar cells, protein, albumin, IL-8, elastase, and IL-10 did not differ between the groups after OLV and postoperatively. TNF- (8.4 versus 5.0 µg/mL) and sICAM-1 (52.7 versus 27.5 µg/mL) concentrations were significantly smaller after OLV with Vt = 5 mL/kg. These results indicate that MV may induce epithelial damage and a proinflammatory response in the ventilated lung. Reduction of tidal volume during OLV may reduce alveolar concentrations of TNF- and of sICAM-1.

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				F. T. Lytle and D. R. Brown Appropriate Ventilatory Settings for Thoracic Surgery: Intraoperative and Postoperative Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2008; 12(2): 97 - 108. [Abstract] [PDF]

				A. Kozian, T. Schilling, F. Freden, E. Maripuu, C. Rocken, C. Strang, T. Hachenberg, and G. Hedenstierna One-lung ventilation induces hyperperfusion and alveolar damage in the ventilated lung: an experimental study Br. J. Anaesth., April 1, 2008; 100(4): 549 - 559. [Abstract] [Full Text] [PDF]

				T. Schilling, A. Kozian, M. Kretzschmar, C. Huth, T. Welte, F. Buhling, G. Hedenstierna, and T. Hachenberg Effects of propofol and desflurane anaesthesia on the alveolar inflammatory response to one-lung ventilation Br. J. Anaesth., September 1, 2007; 99(3): 368 - 375. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999