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Published on: April 5, 2018
Mechanical ventilation strategies and inflammatory responses to cardiac surgery: a prospective randomized clinical
Hermann Wrigge1, Ulrike Uhlig, Georg Baumgarten
1Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. hermann.wrigge@ukb.uni-bonn.de
Objective:
To examine whether postoperative mechanical ventilation with lower tidal volumes (V(T)) has protective effects on inflammatory responses induced by cardiopulmonary bypass (CPB) surgery in smokers and nonsmokers.
Design And Setting:
Prospective, randomized, controlled clinical trial in the intensive care unit of a university hospital.
Patients And Participants:
We examined 44 patients (22 smokers, 22 nonsmokers) immediately after uncomplicated CPB surgery.
Interventions:
Ventilation was applied for 6 h with either V(T) of either 6 or 12 ml/kg ideal body weight.
Measurements And Results:
The time course of serum tumor necrosis factor (TNF) alpha, interleukin (IL) 6, and IL-8 determined 0, 2, 4, and 6 h after randomization did not differ significantly between the ventilatory strategies. By contrast, in bronchoalveolar lavage fluids sampled after 6 h only TNF-alpha levels were significantly higher in the high V(T) group than the low V(T) group (50+/-111 pg/ml vs. 1+/-7 pg/ml). IL-6 and IL-8 concentrations did not differ between groups. Subgroup analysis of patients with serum TNF-alpha level higher than 0 pg/ml after surgery revealed lower TNF-alpha serum levels during lower V(T) ventilation. All observed effects were small, independent of patients' history of smoking, and were not correlated with duration of ventilation and ICU stay.
Conclusions:
Ventilation with lower V(T) had no or only minor effect on systemic and pulmonary inflammatory responses in patients with healthy lungs after uncomplicated CPB surgery. Our data do not suggest a clinical benefit of using low V(T) ventilation in these selected patients.
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