Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease.
BACKGROUND
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 to 12 ml/kg predicted body weight (high VT group) (n = 10) or with VT of 5 to 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 bronchoalveolar lavage (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.


BACKGROUND



BACKGROUND
NCT00935896.
Central Intensive Care Unit, Complexo Hospitalar Santa Casa, Rua Prof, Annes Dias, Porto Alegre, Brazil. roseuti@plugin.com.br
Roselaine
R
Pinheiro de Oliveira
Marcio Pereira
MP
Hetzel
Mauro
M
dos Anjos Silva
Daniele
D
Dallegrave
Gilberto
G
Friedman
D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid; D016638:Critical Illness; D016207:Cytokines / Q000032:analysis; D005260:Female; D006801:Humans; D007249:Inflammation; D007362:Intensive Care Units; D016209:Interleukin-8 / Q000097:blood; D008171:Lung Diseases / Q000473:pathology*; D055370:Lung Injury / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D013990:Tidal Volume / Q000502:physiology*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D016207:Cytokines; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha