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Randomized Controlled Trial
. 2012 Jun;24(4):263-9.
doi: 10.1016/j.jclinane.2011.08.003. Epub 2011 Oct 15.

The effect of low versus high tidal volume ventilation on inflammatory markers in healthy individuals undergoing posterior spine fusion in the prone position: a randomized controlled trial

Stavros G Memtsoudis  1 , Anna Maria Bombardieri, Yan Ma, Federico P Girardi
Affiliations
Randomized Controlled Trial

The effect of low versus high tidal volume ventilation on inflammatory markers in healthy individuals undergoing posterior spine fusion in the prone position: a randomized controlled trial

Stavros G Memtsoudis et al. J Clin Anesth. 2012 Jun.

Abstract

Study objective: To evaluate the effect of ventilation strategy on markers of inflammation in patients undergoing spine surgery in the prone position.

Design: Randomized controlled trial.

Setting: University-affiliated teaching hospital.

Patients: 26 ASA physical status 1 and 2 patients scheduled for elective primary lumbar decompression and fusion in the prone position.

Interventions: Patients were randomized to receive mechanical ventilation with either a tidal volume (V(T)) of 12 mL/kg ideal body weight with zero positive end-expiratory pressure (PEEP) or V(T) of 6 mL/kg ideal body weight with PEEP of 8 cm H(2)O.

Measurements: Plasma levels of interleukin (IL)-6 and IL-8 were determined at the beginning of ventilation and at 6 and 12 hours later. Urinary levels of desmosine were determined at the beginning of ventilation and on postoperative days 1 and 3.

Main results: A significant increase in IL-6, IL-8, and urine desmosine levels was noted over time compared with baseline (P < 0.01). However, no significant difference in the levels of markers was seen between the groups at any time point when controlling for demographics, ASA physical status, body mass index, duration of ventilation, or estimated blood loss.

Conclusions: Although markers of inflammation are increased after posterior spine fusion surgery, ventilation strategy has minimal impact on markers of systemic inflammation.

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Figures

Fig. 1
Fig. 1
Levels of urinary desmosine/creatinine over time from patients mechanically ventilated with 12 mL/kg [high tidal volume (VT); grey] or with 6 mL/kg and 8 cm H2O of positive end-expiratory pressure (PEEP; low VT; white). In both groups, a significant increase in the levels of urine desmosine-creatinine ratios was noted on postoperative day 1 (D1) versus the day of surgery (DO; P = 0.001); no differences compared with baseline were seen on postoperative day 3 (D3; P = 0.53). No differences between groups were found (P = 0.7).
Fig. 2
Fig. 2
Levels of interleukin (IL)-6 over time from patients mechanically ventilated with 12 mL/kg [high tidal volume (VT); grey] or with 6 mL/kg and 8 cm H2O of positive end-expiratory pressure (PEEP; low VT; white). In both groups, a significant increase compared with baseline was noted at 6 and 12 hours after the start of ventilation (P < 0.0001 and P = 0.001, respectively). No differences between groups were found (P = 0.3). T0, T6, T12=blood sampling: start of ventilation (baseline), at 6 hours, and at 12 hours, respectively.
Fig. 3
Fig. 3
Levels of interleukin (IL)-8 over time from patients mechanically ventilated with 12 mL/kg [high tidal volume (VT); grey] or with 6 mL/kg and 8 cm H2O of positive end-expiratory pressure (PEEP; low VT; white). In both groups, a significant increase compared with baseline was observed at 6 and 12 hours after the beginning of ventilation (P = 0.01). No differences between groups were noted (P = 0.7). T0, T6, T12=blood sampling: start of ventilation (baseline), at 6 hours, and at 12 hours, respectively.
See this image and copyright information in PMC

References

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