Document Detail

Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents alveolar coagulation in patients without lung injury.
MedLine Citation:
PMID:  17006066     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Alveolar fibrin deposition is a hallmark of acute lung injury, resulting from activation of coagulation and inhibition of fibrinolysis. Previous studies have shown that mechanical ventilation with high tidal volumes may aggravate lung injury in patients with sepsis and acute lung injury. The authors sought to determine the effects of mechanical ventilation on the alveolar hemostatic balance in patients without preexistent lung injury. METHODS: Patients scheduled for an elective surgical procedure (lasting > or = 5 h) were randomly assigned to mechanical ventilation with either higher tidal volumes of 12 ml/kg ideal body weight and no positive end-expiratory pressure (PEEP) or lower tidal volumes of 6 ml/kg and 10 cm H2O PEEP. After induction of anesthesia and 5 h later bronchoalveolar lavage fluid and blood samples were obtained, and markers of coagulation and fibrinolysis were measured. RESULTS: In contrast to mechanical ventilation with lower tidal volumes and PEEP (n = 21), the use of higher tidal volumes without PEEP (n = 19) caused activation of bronchoalveolar coagulation, as reflected by a marked increase in thrombin-antithrombin complexes, soluble tissue factor, and factor VIIa after 5 h of mechanical ventilation. Mechanical ventilation with higher tidal volumes without PEEP caused an increase in soluble thrombomodulin in lavage fluids and lower levels of bronchoalveolar activated protein C in comparison with lower tidal volumes and PEEP. Bronchoalveolar fibrinolytic activity did not change by either ventilation strategy. CONCLUSIONS: Mechanical ventilation with higher tidal volumes and no PEEP promotes procoagulant changes, which are largely prevented by the use of lower tidal volumes and PEEP.
Goda Choi; Esther K Wolthuis; Paul Bresser; Marcel Levi; Tom van der Poll; Misa Dzoljic; Margreeth B Vroom; Marcus J Schultz
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  105     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-09-28     Completed Date:  2006-11-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  689-95     Citation Subset:  AIM; IM    
Dept. of Intensive Care Medicine, Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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MeSH Terms
Anesthesia, General
Antithrombins / metabolism
Blood Coagulation Disorders / complications*
Bronchoalveolar Lavage Fluid
Clinical Protocols
Fibrinolysis / physiology
Hemodynamics / physiology
Hemostasis / physiology
Middle Aged
Plasminogen Activators / metabolism
Positive-Pressure Respiration*
Pulmonary Alveoli / blood supply,  physiology*
Pulmonary Circulation / physiology
Respiration, Artificial*
Surgical Procedures, Operative
Thrombin / metabolism
Tidal Volume / physiology*
Reg. No./Substance:
0/Antithrombins; EC 3.4.21.-/Plasminogen Activators; EC
Comment In:
Anesthesiology. 2007 May;106(5):1065-6   [PMID:  17457150 ]

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