Document Detail


Kinetic and reversibility of mechanical ventilation-associated pulmonary and systemic inflammatory response in patients with acute lung injury.
MedLine Citation:
PMID:  12122519     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the kinetic and reversibility of mechanical ventilation-associated pulmonary and systemic inflammatory response in patients with acute lung injury (ALI). DESIGN: Prospective observational cross-over study. SETTING: Intensive care unit of a university hospital. PATIENTS: Twelve mechanically ventilated patients with ALI. INTERVENTIONS: Mechanical ventilation was transiently changed from a lung protective setting with PEEP of 15 cmH(2)O and a V(T) of 5 ml/kg predicted body weight to a more conventional ventilatory setting with PEEP of 5 cmH(2)O and V(T) of 12 ml/kg predicted body weight for a period of 6 h. MEASUREMENTS AND RESULTS: We examined the profile of interleukin (IL)-1beta, IL-1 receptor antagonist, IL-6, IL-10, and tumor necrosis factor in the plasma of all patients, and in the bronchoalveolar lavage (mini-BAL) fluid of six of these patients. Measurements were performed at baseline, 1 h, and 6 h after each change of the ventilatory setting. Switching to conventional mechanical ventilation was associated with a higher PaO(2) ( P < 0.05) and a marked increase ( P < 0.05) of measured plasma cytokines in patients with and without mini-BAL with a maximum after 1 h. Similarly, intraalveolar cytokine concentrations increased with conventional mechanical ventilation. While plasma cytokine levels returned to baseline values, intraalveolar cytokine concentrations further increased when lung protective mechanical ventilation was reestablished. CONCLUSIONS: In patients with ALI, initiation of low PEEP and high V(T) mechanical ventilation is associated with cytokine release into circulation which occurred within 1 h. It is independent from BAL procedures and can be reversed by reinstitution of lung protective mechanical ventilation.
Authors:
F Stüber; H Wrigge; S Schroeder; S Wetegrove; J Zinserling; A Hoeft; C Putensen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2002-06-15
Journal Detail:
Title:  Intensive care medicine     Volume:  28     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-07-17     Completed Date:  2002-11-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  834-41     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
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MeSH Terms
Descriptor/Qualifier:
Bronchoalveolar Lavage Fluid
Cross-Over Studies
Germany
Humans
Inflammation Mediators / blood,  metabolism
Intensive Care Units
Pneumonia / etiology*,  physiopathology
Positive-Pressure Respiration / adverse effects*
Prospective Studies
Respiratory Distress Syndrome, Adult / therapy*
Systemic Inflammatory Response Syndrome / etiology*,  physiopathology
Ventilators, Mechanical / adverse effects*
Chemical
Reg. No./Substance:
0/Inflammation Mediators

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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