title: Potent inflammatory cytokine response following lung volume recruitment maneuvers with HFOV in pediatric acute respiratory distress syndrome.
abstract: OBJECTIVE
  Lung volume recruitment maneuver (LVRM) may improve gas exchange but inflating the lungs to nearly vital capacity may cause further lung injuries. Our aim was to determine the potent inflammatory cytokine response following lung volume recruitment (LVRM) with high frequency oscillator ventilation (HFOV) in pediatric acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  We prospectively recruited pediatric patients (age >1 month - <15 year old) with a diagnosis of ARDS within 72 hrs of PICU admission. They underwent the LVRM protocol combined with HFOV. Any enrolled subject who had a 20% improvement in PaO2/FiO2 (PF ratio) 1 hr after the LVRM we classified as a responder. Baseline clinical data were recorded. Blood was also drawn at baseline, 1 & 24 hrs after LVRM and kept for further sICAM-1, IL-6 & IL-8 analysis.
  
  
  RESULTS
  Eighteen children with ARDS were enrolled. Their mean age was at 6.8 +/- 6.1 years (mean +/- SD). The initial oxygen index (iOI) was at 26.8 +/- 17.8 (11.5-84.9). There was no significant differences in sICAM-1, IL-6 and IL-8 levels at baseline; (34 +/- 17.5, 121.7 +/- 115.15, 601.5 +/- 675 pg/ml); 1 hr (39.6 +/- 28.7, 99.8 +/- 75.5, 617.4 +/- 692.5 pg/ml) and at 24 hrs (44.23 +/- 34.4, 109.4 +/- 63.9, 737.6 +/- 922.3 pg/ml) following LVRMs, respectively. However, there was significant difference in the elevation of sICAM-1 levels (%change) from baseline in responders (-1.8 +/- 12.2%) vs. non-responders (47.65 +/- 43.5%) at 1 hr. Additionally, sICAM-1 levels were also significantly higher at baseline, 1 hr and 24 hrs in non-survivors as compared with survivors.
  
  
  CONCLUSIONS
  There was no significant elevation of potent inflammatory cytokines that may indicate further lung injuries in the majority of our patients. However, there was significant elevation of sICAM-1 levels in non-responders and in those who did not survive that may indicate more lung injuries in these individuals.
authors.affiliation: Division of Pediatric Pulmonary & Critical Care, Chulalongkorn University, Bangkok, Thailand. rujsam@hotmail.com
authors.forename: Rujipat
authors.initials: R
authors.lastname: Samransamruajkit
authors.forename: Kornkamol
authors.initials: K
authors.lastname: Jiraratanawong
authors.forename: Sirirat
authors.initials: S
authors.lastname: Siritantiwat
authors.forename: Somjai
authors.initials: S
authors.lastname: Chottanapan
authors.forename: Jitladda
authors.initials: J
authors.lastname: Deelodejanawong
authors.forename: Suchada
authors.initials: S
authors.lastname: Sritippayawan
authors.forename: Nuanchan
authors.initials: N
authors.lastname: Prapphal
authors.forename: Yong
authors.initials: Y
authors.lastname: Poovorawan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000276:immunology*; D005260:Female; D006612:High-Frequency Ventilation; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000276:immunology; D018799:Intercellular Adhesion Molecule-1 / Q000276:immunology; D015850:Interleukin-6 / Q000276:immunology; D016209:Interleukin-8 / Q000276:immunology; D008168:Lung / Q000276:immunology; D055370:Lung Injury / Q000276:immunology; D008297:Male; D010100:Oxygen / Q000378:metabolism; D010313:Partial Pressure; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000276:immunology; D012128:Respiratory Distress Syndrome / Q000276:immunology* / Q000628:therapy*; D013990:Tidal Volume / Q000276:immunology
chemical_list: D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8; D018799:Intercellular Adhesion Molecule-1; D010100:Oxygen