title: Recruitment Maneuver Does not Increase the Risk of Ventilator Induced Lung Injury.
abstract: BACKGROUND
  Mechanical ventilation (MV) may induce lung injury.
  
  
  OBJECTIVE
  To assess and evaluate the role of different mechanical ventilation strategies on ventilator-induced lung injury (VILI) in comparison to a strategy which includes recruitment manoeuvre (RM).
  
  
  METHODS
  Randomized animal experiment.
  
  
  METHODS
  Thirty male Sprague-Dawley rats were anaesthetised, tracheostomised and divided into 5 groups randomly according to driving pressures; these were mechanically ventilated with following peak alveolar opening (Pao) and positive end-expiratory pressures (PEEP) for 1 hour: Group 15-0: 15 cmH2O Pao and 0 cmH2O PEEP; Group 30-10: 30 cmH2O Pao and 10 cmH2O PEEP; Group 30-5: 30 cmH2O Pao and 5 cmH2O PEEP; Group 30-5&RM: 30 cmH2O Pao and 5 cmH2O PEEP with additional 45 cmH2O CPAP for 30 seconds in every 15 minutes; Group 45-0: 45 cmH2O Pao and 0 cmH2O PEEP Before rats were sacrificed, blood samples were obtained for the evaluation of cytokine and chemokine levels; then, the lungs were subsequently processed for morphologic evaluation.
  
  
  RESULTS
  Oxygenation results were similar in all groups; however, the groups were lined as follows according to the increasing severity of morphometric evaluation parameters: Group 15-0: (0±0.009) < Group 30-10: (0±0.14) < Group 30-5&RM: (1±0.12) < Group 30-5: (1±0.16) < Group 45-0: (2±0.16). Besides, inflammatory responses were the lowest in 30-5&RM group compared to all other groups. TNF-α, IL-1β, IL-6, MCP-1 levels were significantly different between group 30-5&RM and group 15-0 vs. group 45-0 in each group.
  
  
  CONCLUSIONS
  RM with low PEEP reduces the risk of ventilator-induced lung injury with a lower release of systemic inflammatory mediators in response to mechanical ventilation.
authors.affiliation: Department of Anaesthesiology and Intensive care, İstanbul University İstanbul Medical Faculty, İstanbul, Turkey.
authors.forename: Ibrahim Özkan
authors.initials: IÖ
authors.lastname: Akıncı
authors.affiliation: Department of Anaesthesiology and Intensive care, İstanbul University İstanbul Medical Faculty, İstanbul, Turkey.
authors.forename: Korkut
authors.initials: K
authors.lastname: Atalan
authors.affiliation: Department of Anaesthesiology and Intensive care, İstanbul University İstanbul Medical Faculty, İstanbul, Turkey.
authors.forename: Simru
authors.initials: S
authors.lastname: Tuğrul
authors.affiliation: Department of Anaesthesiology and Intensive care, İstanbul University İstanbul Medical Faculty, İstanbul, Turkey.
authors.forename: Perihan Ergin
authors.initials: PE
authors.lastname: Ozcan
authors.affiliation: Department of Pathology, İstanbul University İstanbul Medical Faculty, İstanbul, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Yılmazbayhan
authors.affiliation: Department of Immunology, Experimental Medicine Research Institute, İstanbul University İstanbul Medical Faculty, İstanbul, Turkey.
authors.forename: Bayram
authors.initials: B
authors.lastname: Kıran
authors.affiliation: Department of Anaesthesiology and Intensive care, İstanbul University İstanbul Medical Faculty, İstanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Basel
authors.affiliation: Department of Anaesthesiology and Intensive care, İstanbul University İstanbul Medical Faculty, İstanbul, Turkey.
authors.forename: Lutfi
authors.initials: L
authors.lastname: Telci
authors.affiliation: Department of Anaesthesiology and Intensive care, İstanbul University İstanbul Medical Faculty, İstanbul, Turkey.
authors.forename: Nahit
authors.initials: N
authors.lastname: Cakar
keywords: IL-1β; IL-6; MCP-1; Recruitment manoeuvre; TNF-α; ventilator-induced lung injury