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CRITICAL CARE AND TRAUMA

The Effects of Different Ventilatory Settings on Pulmonary and Systemic Inflammatory Responses During Major Surgery

Hermann Wrigge, MD^*, Ulrike Uhlig, MSc PhD, Jörg Zinserling, MSc^*, Elisabeth Behrends-Callsen^*, Gunther Ottersbach^*, Matthias Fischer, MD PhD^*, Stefan Uhlig, MSc PhD, and Christian Putensen, MD PhD^*

*Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn; and Division of Pulmonary Pharmacology, Research Center, Borstel, Germany

Address correspondence and reprint requests to Hermann Wrigge, MD, Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Strasse 25, D-53105 Bonn, Germany. Address e-mail to hermann.wrigge{at}ukb.uni-bonn.de

Mechanical ventilation with high tidal volumes (V_T) and zero or low positive end-expiratory pressure increased mediator release to inflammatory stimuli or acute lung injury. We studied whether mechanical ventilation modifies the inflammatory responses during major thoracic or abdominal surgery. Sixty-four patients undergoing elective thoracotomy (n = 34) or laparotomy (n = 30) were randomized to receive either mechanical ventilation with V_T = 12 or 15 mL/kg ideal body weight, respectively, and zero end-expiratory pressure, or V_T = 6 mL/kg ideal body weight with positive end-expiratory pressure of 10 cm H₂O. In 62 patients who completed the study, arterial oxygena- tion was not different between groups. Tumor necrosis factor, interleukin (IL)-1, IL-6, IL-8, IL-10, and IL-12 were determined by cytometric bead array in plasma after 0, 1, 2, and 3 h and in tracheal aspirates after 3 h of mechanical ventilation. Data were log-transformed and analyzed using parametric or nonparametric tests, as indicated. All plasma mediators increased more during abdominal than during thoracic surgery, although the differences were small. However, neither time course nor concentrations of pulmonary or systemic mediators differed between the two ventilatory settings. Our data suggest that the ventilatory settings we studied do not affect inflammatory reactions during major surgery within 3 h.

IMPLICATIONS: In 62 patients undergoing elective major thoracic or abdominal surgery, mechanical ventilation with low tidal volumes and positive end-expiratory pressure or high tidal volumes and zero end-expiratory pressure did not result in different pulmonary or systemic levels of measured inflammatory markers.

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