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This Article Full Text Full Text (PDF) All Versions of this Article: 294/2/L344    most recent 00268.2007v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Determann, R. M. Articles by Schultz, M. J. Search for Related Content PubMed PubMed Citation Articles by Determann, R. M. Articles by Schultz, M. J.

Lung epithelial injury markers are not influenced by use of lower tidal volumes during elective surgery in patients without preexisting lung injury

Departments of ¹Intensive Care Medicine, ³Anesthesiology, ⁴Pulmonology, and ⁶Experimental Immunology, Academic Medical Center, and ²Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam, The Netherlands; ⁵Unit of Industrial Toxicology and Occupational Medicine, Department of Public Health, Catholic University of Louvain, Brussels, Belgium

Submitted 10 July 2007 ; accepted in final form 10 December 2007

Clara cell protein levels are elevated in plasma of individuals with mild or subclinical lung injury. We studied the influence of two mechanical ventilation strategies on local and systemic levels of Clara cell protein (CC16) and compared them with levels of soluble receptor for advanced glycation end products (sRAGE) and surfactant proteins (SP)-A and -D in patients undergoing elective surgery. Saved samples from a previously reported investigation were used for the study. Forty patients planned for elective surgery were randomized to mechanical ventilation with either a conventional tidal volume (V_T) of 12 ml/kg without positive end-expiratory pressure (PEEP) or low V_T of 6 ml/kg and 10 cmH₂O PEEP. Plasma and bronchoalveolar lavage fluid (BALF) was collected directly after intubation and after 5 h of mechanical ventilation. While systemic levels of SP-A and SP-D remained unchanged, systemic levels of CC16 and sRAGE increased significantly in both groups after 5 h (P < 0.001 for both). BALF levels of SP-A, SP-D, CC16, and sRAGE remained unaffected. No differences were found between the two mechanical ventilation strategies regarding any of the measured biological markers. In conclusion, systemic levels of CC16 and sRAGE rise after 5 h in patients receiving mechanical ventilation for elective surgery. Mechanical ventilation with lower tidal volumes and PEEP did not have a different effect on levels of biomarkers of lung epithelial injury compared with conventional mechanical ventilation.

Clara cell protein; receptor for advanced glycation end products; pulmonary inflammation