Document Detail


Ventilation according to the open lung concept attenuates pulmonary inflammatory response in cardiac surgery.
MedLine Citation:
PMID:  16271479     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a systemic inflammatory response, which is correlated with outcome. We hypothesized that ventilation according to the open lung concept (OLC) attenuates cytokine release. METHODS: A prospective, single center randomized controlled clinical study containing 62 patients scheduled for elective coronary artery bypass graft and/or valve surgery with cardiopulmonary bypass. Before surgery, patients were randomly assigned to three groups: (1) conventional mechanical ventilation (CV), (2) OLC started after arrival on the ICU (late open lung, LOL), and (3) OLC started directly after intubation (early open lung, EOL). In both OLC groups, recruitment maneuvers were applied until PaO(2)/FiO(2)>50. The CV group received no recruitment maneuvers. Interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF)-alpha, and interferon (IFN)-gamma were measured preoperatively, immediately after cessation of CPB, and 3h, 5h, 24h, 2, and 3 days after cessation of CPB. RESULTS: CPB caused a significant increase of IL-6, IL-8, and IL-10 in all groups. Thereafter, IL-8 decreased significantly more rapidly in both OLC groups compared to CV. IL-10 decreased significantly more rapidly after CPB only in the EOL group, compared with CV. Three hours after cessation of the CPB, IL-10 was already comparable with preoperative levels in the EOL group, but not in the LOL or CV group. IL-6, TNF-alpha, and IFN-gamma did not differ significantly between groups. CONCLUSIONS: OLC ventilation leads to an attenuated inflammatory response, presumably by reducing additional lung injury after cardiac surgery. Studies on cytokines after cardiac surgery should take these findings into account.
Authors:
Dinis Reis Miranda; Diederik Gommers; Ard Struijs; Rien Dekker; Joris Mekel; Richard Feelders; Burkhard Lachmann; Ad J J C Bogers
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2005-11-03
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  28     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-05     Completed Date:  2006-03-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  889-95     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Erasmus MC, Dr Molewaterplein 40, 3015 DG Rotterdam, The Netherlands. d.dosreismiranda@erasmusmc.nl
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MeSH Terms
Descriptor/Qualifier:
Aged
C-Reactive Protein / metabolism
Cardiac Surgical Procedures*
Cardiopulmonary Bypass*
Coronary Artery Bypass
Cytokines / blood
Female
Forced Expiratory Volume
Heart Valves / surgery
Humans
Inflammation Mediators / blood*
Male
Middle Aged
Positive-Pressure Respiration
Postoperative Care / methods
Postoperative Complications / prevention & control
Prospective Studies
Respiration, Artificial / methods*
Respiratory Distress Syndrome, Adult / etiology,  prevention & control*
Vital Capacity
Chemical
Reg. No./Substance:
0/Cytokines; 0/Inflammation Mediators; 9007-41-4/C-Reactive Protein

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


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