Lung epithelial injury markers are not influenced by use of lower tidal volumes during elective surgery in patients without preexisting lung injury.
Clara cell protein levels are elevated in plasma of individuals with mild or subclinical lung injury. We studied the influence of two mechanical ventilation strategies on local and systemic levels of Clara cell protein (CC16) and compared them with levels of soluble receptor for advanced glycation end products (sRAGE) and surfactant proteins (SP)-A and -D in patients undergoing elective surgery. Saved samples from a previously reported investigation were used for the study. Forty patients planned for elective surgery were randomized to mechanical ventilation with either a conventional tidal volume (V(T)) of 12 ml/kg without positive end-expiratory pressure (PEEP) or low V(T) of 6 ml/kg and 10 cmH(2)O PEEP. Plasma and bronchoalveolar lavage fluid (BALF) was collected directly after intubation and after 5 h of mechanical ventilation. While systemic levels of SP-A and SP-D remained unchanged, systemic levels of CC16 and sRAGE increased significantly in both groups after 5 h (P < 0.001 for both). BALF levels of SP-A, SP-D, CC16, and sRAGE remained unaffected. No differences were found between the two mechanical ventilation strategies regarding any of the measured biological markers. In conclusion, systemic levels of CC16 and sRAGE rise after 5 h in patients receiving mechanical ventilation for elective surgery. Mechanical ventilation with lower tidal volumes and PEEP did not have a different effect on levels of biomarkers of lung epithelial injury compared with conventional mechanical ventilation.
Determann
Rogier M
RM
Department of Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. r.m.determann@amc.uva.nl
Wolthuis
Esther K
EK
Choi
Goda
G
Bresser
Paul
P
Bernard
Alfred
A
Lutter
Rene
R
Schultz
Marcus J
MJ
D000418:Albumins / Q000378:metabolism; D000510:Alpha-Globulins / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism*; D001992:Bronchoalveolar Lavage Fluid; D017558:Elective Surgical Procedures / Q000379:methods*; D004848:Epithelium / Q000473:pathology*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D037662:Pulmonary Surfactant-Associated Protein A / Q000378:metabolism; D037663:Pulmonary Surfactant-Associated Protein D / Q000378:metabolism; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic / Q000378:metabolism; D012995:Solubility; D013990:Tidal Volume / Q000502:physiology*; D014598:Uteroglobin / Q000378:metabolism
D000418:Albumins; D000510:Alpha-Globulins; D015415:Biomarkers; D037662:Pulmonary Surfactant-Associated Protein A; D037663:Pulmonary Surfactant-Associated Protein D; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic; C556389:SCGB1A1 protein, human; C025500:alpha(2)-microglobulin; D014598:Uteroglobin