Lung-Protective Ventilation Strategies for Relief from Ventilator-Associated Lung Injury in Patients Undergoing Craniotomy: A Bicenter Randomized, Parallel, and Controlled Trial

Abstract

Current evidence indicates that conventional mechanical ventilation often leads to lung inflammatory response and oxidative stress, while lung-protective ventilation (LPV) minimizes the risk of ventilator-associated lung injury (VALI). This study evaluated the effects of LPV on relief of pulmonary injury, inflammatory response, and oxidative stress among patients undergoing craniotomy. Sixty patients undergoing craniotomy received either conventional mechanical (12 mL/kg tidal volume [V_T] and 0 cm H₂O positive end-expiratory pressure [PEEP]; CV group) or protective lung (6 mL/kg V_T and 10 cm H₂O PEEP; PV group) ventilation. Hemodynamic variables, lung function indexes, and inflammatory and oxidative stress markers were assessed. The PV group exhibited greater dynamic lung compliance and lower respiratory index than the CV group during surgery (P < 0.05). The PV group exhibited higher plasma interleukin- (IL-) 10 levels and lower plasma malondialdehyde and nitric oxide and bronchoalveolar lavage fluid, IL-6, IL-8, tumor necrosis factor-α, IL-10, malondialdehyde, nitric oxide, and superoxide dismutase levels (P < 0.05) than the CV group. There were no significant differences in hemodynamic variables, blood loss, liquid input, urine output, or duration of mechanical ventilation between the two groups (P > 0.05). Patients receiving LPV during craniotomy exhibited low perioperative inflammatory response, oxidative stress, and VALI.

Figure 1

Flow diagram of patient recruitment.

Figure 2

Changes in hemodynamic variables among patients who were administered conventional mechanical ventilation with 12 mL/kg tidal volume (V_T) and 0 cm H₂O positive end-expiratory pressure (PEEP) (CV group) or protective lung ventilation with 6 mL/kg V_T and 10 cm H₂O PEEP (PV group) during surgery. Bars indicate the standard deviation. The time points for measurements were T1—just before changing the ventilation strategy following stabilization of hemodynamic parameters after intubation; T2 and T3—1 and 3 h, respectively, after changing the ventilation strategy; T4—end of surgery; and T5—immediately after extubation.

Figure 3

Changes in Ppeak, Cldyn, OI, and RI levels among patients receiving conventional mechanical or protective lung ventilation during surgery. Values are given as mean ± standard error of the mean. Ppeak, peak inspiratory pressure; Cldyn, dynamic lung compliance; OI, oxygen index; RI, respiratory index; CV group, conventional mechanical ventilation with 12 mL/kg tidal volume (V_T) and 0 cm H₂O positive end-expiratory pressure (PEEP); PV group, protective lung ventilation with 6 mL/kg V_T and 10 cm H₂O PEEP.

Figure 4

Changes in plasma interleukin- (IL-) 6, IL-8, tumor necrosis factor-alpha (TNF-α), and IL-10 levels among patients receiving conventional mechanical or protective lung ventilation during surgery. Values are expressed as mean ± standard error of the mean. CVS, continuous ventilatory support; SIMV, synchronized intermittent mechanical ventilation; CV group, conventional mechanical ventilation with 12 mL/kg tidal volume (V_T) and 0 cm H₂O positive end-expiratory pressure (PEEP); PV group, protective lung ventilation with 6 mL/kg V_T and 10 cm H₂O PEEP.

Figure 5

Changes in plasma malondialdehyde (MDA), nitric oxide (NO), and superoxide dismutase (SOD) levels among patients receiving conventional mechanical or protective lung ventilation during surgery. Values are given as means ± standard error of the mean. CVS, continuous ventilatory support; SIMV, synchronized intermittent mechanical ventilation; CV group, conventional mechanical ventilation with 12 mL/kg tidal volume (V_T) and 0 cm H₂O positive end-expiratory pressure (PEEP); PV group, protective lung ventilation with 6 mL/kg V_T and 10 cm H₂O PEEP.

Figure 6

Changes in interleukin- (IL-) 6, IL-8, tumor necrosis factor-alpha (TNF-α), and IL-10 levels in bronchoalveolar lavage fluid among patients receiving conventional mechanical or protective lung ventilation during surgery. Values are expressed as mean ± standard error of the mean. CVS, continuous ventilatory support; SIMV, synchronized intermittent mechanical ventilation; CV group, conventional mechanical ventilation with 12 mL/kg tidal volume (V_T) and 0 cm H₂O positive end-expiratory pressure (PEEP); PV group, protective lung ventilation with 6 mL/kg V_T and 10 cm H₂O PEEP.

Figure 7

Changes in malondialdehyde (MDA), nitric oxide (NO), and superoxide dismutase (SOD) levels in bronchoalveolar lavage fluid among patients receiving conventional mechanical or protective lung ventilation during surgery. Values are given as mean ± standard error of the mean. CVS, continuous ventilatory support; SIMV, synchronized intermittent mechanical ventilation; CV group, conventional mechanical ventilation with 12 mL/kg tidal volume (V_T) and 0 cm H₂O positive end-expiratory pressure (PEEP); PV group, protective lung ventilation with 6 mL/kg V_T and 10 cm H₂O PEEP.