title: Effects of protective and conventional mechanical ventilation on pulmonary function and systemic cytokine release after cardiopulmonary bypass.
abstract: OBJECTIVE
  To evaluate the effects of protective and conventional ventilation with or without positive end-expiratory pressure (PEEP), on systemic tumor necrosis factor-alpha, interleukin-6 levels and pulmonary function during open heart surgery.
  
  
  METHODS
  Prospective, randomized clinical study.
  
  
  METHODS
  Single university hospital.
  
  
  METHODS
  Forty-four patients undergoing elective coronary artery bypass grafting surgery with cardiopulmonary bypass.
  
  
  METHODS
  Patients ventilated with (1) protective tidal volumes (6 ml/kg, respiratory rate: 15 breaths/min, PEEP 5 cmH(2)O, n=15) group PV; (2) conventional tidal volumes (10 ml/kg, respiratory rate: 9 breaths/min, PEEP 5 cmH(2)O, n=14) group CV+PEEP and (3) conventional tidal volumes (10 ml/kg, respiratory rate: 9 breaths/min, n=15) without PEEP, group CV+ZEEP. Various pulmonary parameters, systemic TNF-alpha and IL-6 levels were determined throughout the study.
  
  
  RESULTS
  There were no differences among the groups regarding the systemic TNF- alpha and IL-6 levels. The plateau airway pressures of group PV were lower than those of groups CV+PEEP ( p=0.02) and CV+ZEEP ( p=0.001) after cardiopulmonary bypass. The shunt fraction of group PV was significantly lower than that of group CV+ZEEP 24 h after surgery ( p<0.05). Oxygenation and the alveolar-arterial oxygen difference were better in both PEEP groups than in group CV+ZEEP 24 h after the operation.
  
  
  CONCLUSIONS
  We could not find any evidence that protective mechanical ventilation prevents some of the adverse effects of cardiopulmonary bypass on the lung, nor systemic cytokine levels, postoperative pulmonary function or length of hospitalization.
authors.affiliation: Anesthesiology Department, Cardiology Institute, Istanbul University, Haseki caddesi, 34303, Aksaray-Istanbul, Turkey, alikoner@superonline.com
authors.forename: Ozge
authors.initials: O
authors.lastname: Koner
authors.forename: Serdar
authors.initials: S
authors.lastname: Celebi
authors.forename: Huriye
authors.initials: H
authors.lastname: Balci
authors.forename: Gurkan
authors.initials: G
authors.lastname: Cetin
authors.forename: Kamil
authors.initials: K
authors.lastname: Karaoglu
authors.forename: Nahit
authors.initials: N
authors.lastname: Cakar
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D016207:Cytokines / Q000097:blood / Q000378:metabolism*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D015850:Interleukin-6 / Q000097:blood / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods; D011182:Postoperative Care; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012129:Respiratory Function Tests; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D016207:Cytokines; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha