Advertisement

Intensive Care Medicine

, Volume 28, Issue 4, pp 486–492 | Cite as

Mechanical ventilation alters the immune response in children without lung pathology

  • Frans B. Plötz
  • Harriet A. Vreugdenhil
  • Arthur S. Slutsky
  • Jitske Zijlstra
  • Cobi J. Heijnen
  • Hans van Vught
Neonatal and Pediatric Intensive Care

Abstract.

Objective: This study was undertaken to examine the hypothesis that mechanical ventilation in association with anesthesia would alter the cytokine profile in infants without preexisting lung pathology. Design and setting: Prospective observational study in pediatric intensive care unit in a university hospital. Patients: Twelve infants who were subjected to an uncomplicated diagnostic cardiac catheterization procedure were studied. All subjects were ventilated with a volume control mode, 0.3 FIO2, 4 cmH2O PEEP, and 10 ml/kg tidal volume. Volatile (servoflurane) anesthetics were given. Measurements and results: Tracheal aspirates and blood samples were obtained before and after 2 h of mechanical ventilation. In tracheal aspirates and in supernatants of stimulated whole-blood cultures cytokine concentrations were measured. In the tracheal aspirates the immune balance was characterized by a proinflammatory response pattern, with a significant increase in TNF-α and IL-6 concentrations; concentrations of anti-inflammatory mediators remained very low. The functional capacity of peripheral blood leukocytes to produce INF-γ, TNF-α, and IL-6 in vitro was significantly decreased. This was accompanied by a significant decrease in the killing activity of natural killer cells. Conclusions: Two hours of servoflurane and mechanical ventilation using a tidal volume of 10 ml/kg is associated with remarkable changes in the immune response in infants without preexisting lung pathology undergoing cardiac catheterization. In the lungs the immune balance favors a proinflammatory response pattern without detectable concentrations of anti-inflammatory mediators. The Th1 immune response by peripheral blood leukocytes was decreased. The observed change in Th1/Th2 balance in favor of Th2 cytokine activity may be a systemic adaptation to the proinflammatory milieu in the lung.

Mechanical ventilation Cardiac catheterization Interleukins Tumor necrosis factor α Interferon γ Natural killer cells Volatile anesthetics 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • Frans B. Plötz
    • 1
  • Harriet A. Vreugdenhil
    • 1
  • Arthur S. Slutsky
    • 3
  • Jitske Zijlstra
    • 2
  • Cobi J. Heijnen
    • 2
  • Hans van Vught
    • 1
  1. 1.Pediatric Intensive Care Unit, University Medical Center Utrecht, P.O. Box 85090, 3508 AB UtrechtThe Netherlands
  2. 2.Department of Pediatric Immunology, Section Psycho-neuro-immunology, University Medical Center Utrecht, P.O. Box 85090, 3508 AB UtrechtThe Netherlands
  3. 3.Division of Respiratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, OntarioCanada

Personalised recommendations