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Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease

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Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease

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Título Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease
Autor Oliveira, Roselaine Pinheiro de
Hetzel, Marcio Pereira
Silva, Mauro dos Anjos
Dallegrave, Daniela
Friedman, Gilberto
Abstract Introduction: Mechanical ventilation (MV) with high tidal volumes may induce or aggravate lung injury in critical ill patients. We compared the effects of a protective versus a conventional ventilatory strategy, on systemic and lung production of tumor necrosis factor-a (TNF-a) and interleukin-8 (IL-8) in patients without lung disease. Methods: Patients without lung disease and submitted to mechanical ventilation admitted to one trauma and one general adult intensive care unit of two different university hospitals were enrolled in a prospective randomizedcontrol study. Patients were randomized to receive MV either with tidal volume (VT) of 10 to 12 ml/kg predicted body weight (high VT group) (n = 10) or with VT of 5 to 7 ml/kg predicted body weight (low VT group) (n = 10) with an oxygen inspiratory fraction (FIO2) enough to keep arterial oxygen saturation >90% with positive endexpiratory pressure (PEEP) of 5 cmH2O during 12 hours after admission to the study. TNF-a and IL-8 concentrations were measured in the serum and in the bronchoalveolar lavage fluid (BALF) at admission and after 12 hours of study observation time. Results: Twenty patients were enrolled and analyzed. At admission or after 12 hours there were no differences in serum TNF-a and IL-8 between the two groups. While initial analysis did not reveal significant differences, standardization against urea of logarithmic transformed data revealed that TNF-a and IL-8 levels in bronchoalveolar lavage (BAL) fluid were stable in the low VT group but increased in the high VT group (P = 0.04 and P = 0.03). After 12 hours, BALF TNF-a (P = 0.03) and BALF IL-8 concentrations (P = 0.03) were higher in the high VT group than in the low VT group. Conclusions: The use of lower tidal volumes may limit pulmonary inflammation in mechanically ventilated patients even without lung injury. Trial Registration: Clinical Trial registration: NCT00935896.
Contido em Critical Care. London. Vol. 14, (Mar. 2010), 9 p.
Assunto Inflamação
Pneumopatias
Respiração artificial
Origem Estrangeiro
Tipo Artigo de periódico
URI http://hdl.handle.net/10183/24192
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