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J Thorac Cardiovasc Surg 2005;130:378-383
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Mechanical ventilation affects inflammatory mediators in patients undergoing cardiopulmonary bypass for cardiac surgery: A randomized clinical trial

Enrico Zupancich, MD ^{a ,,}, Domenico Paparella, MD ^{b , _* ,}, Franco Turani, MD ^{a , c} , Christopher Munch, MD ^a , Alessandra Rossi, MD ^a , Simone Massaccesi, MD ^a , V. Marco Ranieri, MD ^{b , _*}

^a Servizio di Anestesia e Rianimazione, Azienda Ospedaliera Cardiologico "G.M.Lancisi," Ancona, Italy
^b Anestesiologia e Rianimazione, Dipartimento di Discipline Medico-Chirurgiche, Università di Torino, Ospedale S. Giovanni Battista, Turin, Italy
^c Anestesia e Rianimazione, II Università degli Studi di Roma "Tor Vergata," Rome, Italy

Received for publication June 18, 2004; revisions received November 27, 2004; accepted for publication November 30, 2004.

^_* Address for reprints: V. Marco Ranieri, MD, Università di Torino, Dipartimento di Discipline Medico-Chirurgiche, Sezione di Anestesiologia e Rianimazione, Ospedale S. Giovanni Battista, Corso Dogliotti 14, 10126 Torino, Italy (Email: marco.ranieri{at}unito.it).

OBJECTIVES: Respiratory support for patients recovering from cardiopulmonary bypass and cardiac surgery uses large tidal volumes and a minimal level of positive end-expiratory pressure. Recent data indicate that these ventilator settings might cause pulmonary and systemic inflammation in patients with acute lung injury. We examined the hypothesis that high tidal volumes and low levels of positive end-expiratory pressure might worsen the inflammatory response associated to cardiopulmonary bypass.

METHODS: Forty patients undergoing elective coronary artery bypass were randomized to be ventilated after cardiopulmonary bypass disconnection with high tidal volume/low positive end-expiratory pressure (10–12 mL/kg and 2–3 cm H₂O, respectively) or low tidal volume/high positive end-expiratory pressure (8 mL/kg and 10 cm H₂O, respectively). Interleukin 6 and interleukin 8 levels were measured in the bronchoalveolar lavage fluid and plasma. Samples were taken before sternotomy (time 0), immediately after cardiopulmonary bypass separation (time 1), and after 6 hours of mechanical ventilation (time 2).

RESULTS: Interleukin 6 and interleukin 8 levels in the bronchoalveolar lavage fluid and plasma significantly increased at time 1 in both groups but further increased at time 2 only in patients ventilated with high tidal volume/low positive end-expiratory pressure. Interleukin 6 and interleukin 8 levels in the bronchoalveolar lavage fluid and in the plasma at time 2 were higher with high tidal volume/low positive end-expiratory pressure than with low tidal volume/high positive end-expiratory pressure.

CONCLUSION: Mechanical ventilation might be a cofactor able to influence the inflammatory response after cardiac surgery.

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