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Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease.
Crit Care. 2010 Mar 18;14(2):R39
Authors: Oliveira RP, Hetzel MP, Silva MA, Dallegrave D, Friedman G
ABSTRACT: INTRODUCTION: Mechanical ventilation (MV) with high tidal volumes may induce or aggravate lung injury in critical ill patients. We compared the effects of a protective versus a conventional ventilatory strategy, on systemic and lung production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-8 (IL-8) in patients without lung disease. METHODS: Patients without lung disease and submitted to mechanical ventilation admitted to one trauma and one general adult intensive care unit of two different university hospitals were enrolled in a prospective randomized-control study. Patients were randomized to receive MV either with tidal volume (VT) of 10-12 ml/kg predicted body weight (high VT group) (n=10) or with VT of 5-7 ml/kg predicted body weight (low VT group) (n=10) with an oxygen inspiratory fraction (FIO2) enough to keep arterial oxygen saturation > 90% with positive end-expiratory pressure (PEEP) of 5 cmH2O during 12 hours after admission to the study. TNF-alpha and IL-8 concentrations were measured in the serum and in the bronchoalveolar lavage fluid (BALF) at admission and after 12 hours of study observation time. RESULTS: Twenty patients were enrolled and analyzed. At admission or after 12 hours there were no differences in serum TNF-alpha and IL-8 between the two groups. While initial analysis did not reveal significant differences, standardization against urea of logarithmic transformed data revealed that TNF-alpha and IL-8 levels in BAL fluid were stable in the low VT group but increased in the high VT group (P=0.04 and P=0.03). After 12 hours, BALF TNF-alpha (P=0.03) and BALF IL-8 concentrations (P=0.03) were higher in the high VT group than in the low VT group. CONCLUSIONS: The use of lower tidal volumes may limit pulmonary inflammation in mechanically ventilated patients even without lung injury. Clinical Trial registration: NCT00935896.
PMID: 20236550 [PubMed - as supplied by publisher]