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Assessment of the inflammatory effect of low-dose oxygen in mechanically ventilated patients.
MedLine Citation:
PMID:  23296630     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Although low doses of oxygen (FiO(2) <0.50) are considered nontoxic, recent studies have shown that even lower doses increase pulmonary inflammatory mediators. We aimed to evaluate the acute effects of reducing FiO(2) on pulmonary inflammation in mechanically ventilated patients without respiratory failure. METHODS: This study was a prospective, single-center crossover study in a medical/surgical intensive care unit at a university hospital. Hemodynamically stable patients under mechanical ventilation for >24 h without severe respiratory failure (PaO(2)/FiO(2) >250). A basal FiO(2) of 0.40 was reduced to 0.21 provided SpO(2) remained higher than 90 %. Patients who could not tolerate the reduction in FiO(2) to 0.21 were excluded. RESULTS: We screened 40 patients, but only 28 (70 %) tolerated FiO(2) 0.21. We measured common clinical variables and inflammatory mediators in plasma and in exhaled breath condensate (EBC) at the end of three 4-h periods: (1) basal (FiO(2) 0.40), (2) after FiO(2) reduction to 0.21, and (3) after returning FiO(2) 0.40. We used one-way ANOVA for repeated measurements with FiO(2) as the grouping variable. Median values of inflammatory mediators in EBC showed nonsignificant changes among the three periods: NO(2) + NO(3) 17.1, 14.1 and 11.0 μmol/L (p = 0.2), and 8-isoprostane 4.4, 8.2 and 5.3 pg/ml (p = 0.6) for the three periods, respectively. Plasma levels also showed nonsignificant changes during the period of the study: NO(2) + NO(3) 12.6, 16.3 and 15.0 μmol/L (p = 0.9), TNFα 13.5, 18.0 and 14.5 pg/ml (p = 0.8), IL-4 12.9, 18.7 and 23.9 pg/ml (p = 0.1), IL-6 50.9, 35.1 and 28.3 pg/ml (p = 0.6), and IL-10 15.2, 22.2 and 22.2 pg/ml (p = 0.7) for the three periods, respectively. CONCLUSION: FiO(2) 0.40 in mechanically ventilated patients without severe respiratory failure did not increase systemic or pulmonary inflammation.
Authors:
Rafael Fernandez; Gisela Gili; Ana Villagra; Josefina Lopez-Aguilar; Antonio Artigas
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-8
Journal Detail:
Title:  Intensive care medicine     Volume:  -     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Intensive Care Unit, Hospital S. Joan de Deu - Fundacio Althaia, CIBERES, Universitat Internacional de Catalunya, c/ Dr Joan Soler 1, 08242, Manresa, Spain, rfernandezf@althaia.cat.
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