Intensive Care Medicine

, Volume 31, Issue 10, pp 1379–1387

Mechanical ventilation strategies and inflammatory responses to cardiac surgery: a prospective randomized clinical trial

Authors

    • Department of Anesthesiology and Intensive Care MedicineUniversity of Bonn
  • Ulrike Uhlig
    • Division of Pulmonary PharmacologyResearch Center Borstel
  • Georg Baumgarten
    • Department of Anesthesiology and Intensive Care MedicineUniversity of Bonn
  • Jan Menzenbach
    • Department of Anesthesiology and Intensive Care MedicineUniversity of Bonn
  • Jörg Zinserling
    • Department of Anesthesiology and Intensive Care MedicineUniversity of Bonn
  • Martin Ernst
    • Division of Cell BiologyResearch Center Borstel
  • Daniel Drömann
    • Division of Pulmonary PharmacologyResearch Center Borstel
  • Armin Welz
    • Department of Cardiac SurgeryUniversity of Bonn
  • Stefan Uhlig
    • Division of Pulmonary PharmacologyResearch Center Borstel
  • Christian Putensen
    • Department of Anesthesiology and Intensive Care MedicineUniversity of Bonn
Original

DOI: 10.1007/s00134-005-2767-1

Cite this article as:
Wrigge, H., Uhlig, U., Baumgarten, G. et al. Intensive Care Med (2005) 31: 1379. doi:10.1007/s00134-005-2767-1

Abstract

Objective

To examine whether postoperative mechanical ventilation with lower tidal volumes (VT) has protective effects on inflammatory responses induced by cardiopulmonary bypass (CPB) surgery in smokers and nonsmokers.

Design and setting

Prospective, randomized, controlled clinical trial in the intensive care unit of a university hospital.

Patients and participants

We examined 44 patients (22 smokers, 22 nonsmokers) immediately after uncomplicated CPB surgery.

Interventions

Ventilation was applied for 6 h with either VT of either 6 or 12 ml/kg ideal body weight.

Measurements and results

The time course of serum tumor necrosis factor (TNF) α, interleukin (IL) 6, and IL-8 determined 0, 2, 4, and 6 h after randomization did not differ significantly between the ventilatory strategies. By contrast, in bronchoalveolar lavage fluids sampled after 6 h only TNF-α levels were significantly higher in the high VT group than the low VT group (50±111 pg/ml vs. 1±7 pg/ml). IL-6 and IL-8 concentrations did not differ between groups. Subgroup analysis of patients with serum TNF-α level higher than 0 pg/ml after surgery revealed lower TNF-α serum levels during lower VT ventilation. All observed effects were small, independent of patients’ history of smoking, and were not correlated with duration of ventilation and ICU stay.

Conclusions

Ventilation with lower VT had no or only minor effect on systemic and pulmonary inflammatory responses in patients with healthy lungs after uncomplicated CPB surgery. Our data do not suggest a clinical benefit of using low VT ventilation in these selected patients.

Keywords

Ventilator-induced lung injuryCytokinesMechanical ventilationCardiac surgery

Copyright information

© Springer-Verlag 2005