Submitted on July 10, 2007
Accepted on December 10, 2007
Lung epithelial injury markers are not influenced by Use of Lower Tidal Volumes during Elective Surgery in Patients without Pre-existing Lung Injury
Rogier M. Determann1*, Esther K. Wolthuis2, Goda Choi1, Paul Bresser3, Alfred M Bernard4, Rene Lutter5, and Marcus J Schultz6
1 Intensive Care Medicine, Academic Medical Center, Amsterdam, Netherlands; Laboratory of Experimental Intensive Care and Anaesthesiology, Academic Medical Center, Amsterdam, Netherlands
2 Intensive Care Medicine, Academic Medical Center, Amsterdam, Netherlands; Laboratory of Experimental Intensive Care and Anaesthesiology, Academic Medical Center, Amsterdam, Netherlands; Anaesthesiology, Academic Medical Center, Amsterdam, Netherlands
3 Pulmonology, Academic Medical Center, Amsterdam, Netherlands
4 Unit of Industrial Toxicology and Occupational Medicine, Universite Catholique de Louvain Brussels, Brussels, Clos Chapelle-aux Champs, Belgium
5 Pulmonology, Academic Medical Center, Amsterdam, Netherlands; Experimental Immunology, Academic Medical Center, Amsterdam, Netherlands
6 Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, Amsterdam, 1243 JX, Netherlands; Laboratory of Experimental Intensive Care and Anaesthesiology, Academic Medical Center, Amsterdam, Netherlands
* To whom correspondence should be addressed. E-mail: r.m.determann{at}amc.uva.nl.
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 (VT) of 12 ml/kg and 0 cm H2O positive end-expiratory pressure (PEEP) or low VT of 6 ml/kg and 10 cm H2O PEEP. Plasma and bronchoalveolar lavage fluid (BALF) was collected directly after intubation and after 5 hours 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 hours (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 hours 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 as compared to conventional mechanical ventilation.
