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Critical Care
Published in: Critical Care 2/2010

Open Access 01-04-2010 | Research

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

Authors: Roselaine Pinheiro de Oliveira, Marcio Pereira Hetzel, Mauro dos Anjos Silva, Daniele Dallegrave, Gilberto Friedman

Published in: Critical Care | Issue 2/2010

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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-α (TNF-α) 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 randomized-control 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 end-expiratory pressure (PEEP) of 5 cmH2O during 12 hours after admission to the study. TNF-α 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-α 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-α 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-α (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
Appendix
Available only for authorised users
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Metadata
Title
Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease
Authors
Roselaine Pinheiro de Oliveira
Marcio Pereira Hetzel
Mauro dos Anjos Silva
Daniele Dallegrave
Gilberto Friedman
Publication date
01-04-2010
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2010
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc8919

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