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Randomized Controlled Trial
. 2016 Jul 30;16(1):47.
doi: 10.1186/s12871-016-0209-y.

Low tidal volume ventilation with low PEEP during surgery may induce lung inflammation

Hitoshi Sato  1   2 , Kyota Nakamura  1   3 , Yasuko Baba  1   4 , Shoko Terada  1   2 , Takahisa Goto  1 , Kiyoyasu Kurahashi  5   6   7
Affiliations
Randomized Controlled Trial

Low tidal volume ventilation with low PEEP during surgery may induce lung inflammation

Hitoshi Sato et al. BMC Anesthesiol. .

Abstract

Background: Compared to conventional tidal volume ventilation, low tidal-volume ventilation reduces mortality in cased of acute respiratory distress syndrome. The aim of the present study is to determine whether low tidal-volume ventilation reduces the production of inflammatory mediators in the lungs and improves physiological status during hepatic surgery.

Methods: We randomly assigned patients undergoing hepatectomy into 2 groups: conventional tidal-volume vs. low tidal-volume (12 vs. 6 mL•kg(-1) ideal body weight) ventilation with a positive end-expiratory pressure of 3 cm H2O. Arterial blood and airway epithelial lining fluid were sampled immediately after intubation and every 3 h thereafter.

Results: Twenty-five patients were analyzed. No significant changes were found in hemodynamics or acid-base status during the study. Interleukin-8 was significantly elevated in epithelial lining fluid from the low tidal-volume group. Oxygenation evaluated immediately after admission to the post-surgical care unit was significantly worse in the low tidal-volume group.

Conclusions: Low tidal-volume ventilation with low positive end-expiratory pressure may lead to pulmonary inflammation during major surgery such as hepatectomy.

Trial registration: The effect of ventilatory tidal volume on lung injury during hepatectomy that requires transient liver blood flow interruption. UMIN000021371 (03/07/2016); retrospectively registered.

Keywords: Cytokines; Hepatectomy; Micro-sampling Method; Systemic Inflammatory Response Syndrome; Ventilator-Induced Lung Injury.

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Figures

Fig. 1
Fig. 1
Consort flow diagram for the present study
Fig. 2
Fig. 2
Changes in hemodynamics and BGA data. pH (a) and bicarbonate (b) were analyzed by blood gas analyses, whereas heart rate (c) and mean blood pressure (d) were obtained from a bedside monitor. Mean ± standard deviation. No significant differences were observed in BP, HR, or BGA between the groups
Fig. 3
Fig. 3
Changes in arterial blood gases, airway pressure, and ventilation frequency. a Changes in the P/F ratio were calculated by PaO2 analyzed by a blood gas analyzer and FIO2. b Changes in PaCO2 were analyzed by a blood gas analyzer. c, d Changes in peak airway pressure and ventilator frequency. Mean ± standard deviation. Peak airway pressure was significantly higher in the TV12 group. Ventilation frequency was greater in the TV6 group than in the TV12 group
Fig. 4
Fig. 4
Postoperative P/F ratio in the PACU. Mean ± standard deviation. The P/F ratio evaluated just after admission to the PACU was higher in the TV12 group than in the TV6 group (p = 0.009)
Fig. 5
Fig. 5
Plasma concentrations of IL-8 and ICAM-1. Mean ± standard deviation. No significant differences were observed in the plasma concentration of IL-8 between the groups (p = 0.17). Plasma ICAM-1 was significantly higher in the TV6 group than in the TV12 group (p = 0.03)
Fig. 6
Fig. 6
Concentrations of IL-8, ICAM-1, and elastase activity in the ELF. Mean ± standard deviation. The concentration of IL-8 in the ELF was significantly higher in the TV6 group than in the TV12 group (p = 0.04) and the post hoc analysis revealed a significant difference at 6 h (p = 0.03). No significant difference was observed in ICAM-1 (p = 0.31) or elastase activity (p = 0.7) in the ELF
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References

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