Mechanical ventilation alters the immune response in children without lung pathology.
OBJECTIVE
This study was undertaken to examine the hypothesis that mechanical ventilation in association with anesthesia would alter the cytokine profile in infants without preexisting lung pathology.


METHODS
Prospective observational study in pediatric intensive care unit in a university hospital.


METHODS
Twelve infants who were subjected to an uncomplicated diagnostic cardiac catheterization procedure were studied. All subjects were ventilated with a volume control mode, 0.3 FIO(2), 4 cmH(2)O PEEP, and 10 ml/kg tidal volume. Volatile (servoflurane) anesthetics were given.


RESULTS
Tracheal aspirates and blood samples were obtained before and after 2 h of mechanical ventilation. In tracheal aspirates and in supernatants of stimulated whole-blood cultures cytokine concentrations were measured. In the tracheal aspirates the immune balance was characterized by a proinflammatory response pattern, with a significant increase in TNF-alpha and IL-6 concentrations; concentrations of anti-inflammatory mediators remained very low. The functional capacity of peripheral blood leukocytes to produce INF-gamma, TNF-alpha, and IL-6 in vitro was significantly decreased. This was accompanied by a significant decrease in the killing activity of natural killer cells.


CONCLUSIONS
Two hours of servoflurane and mechanical ventilation using a tidal volume of 10 ml/kg is associated with remarkable changes in the immune response in infants without preexisting lung pathology undergoing cardiac catheterization. In the lungs the immune balance favors a proinflammatory response pattern without detectable concentrations of anti-inflammatory mediators. The Th1 immune response by peripheral blood leukocytes was decreased. The observed change in Th1/Th2 balance in favor of Th2 cytokine activity may be a systemic adaptation to the proinflammatory milieu in the lung.
Plötz
Frans B
FB
Pediatric Intensive Care Unit, University Medical Center Utrecht, The Netherlands. f.plotz@antonius.net
Vreugdenhil
Harriet A E
HA
Slutsky
Arthur S
AS
Zijlstra
Jitske
J
Heijnen
Cobi J
CJ
van Vught
Hans
H
D000777:Anesthetics / Q000009:adverse effects*; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood / Q000378:metabolism*; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects; D007223:Infant; D007371:Interferon-gamma / Q000378:metabolism; D007378:Interleukins / Q000378:metabolism; D007694:Killer Cells, Natural / Q000276:immunology; D008214:Lymphocytes / Q000187:drug effects / Q000378:metabolism*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D018709:Statistics, Nonparametric
D000777:Anesthetics; D016207:Cytokines; D007378:Interleukins; D007371:Interferon-gamma