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The influence of continuous positive pressure ventilation on the degree of inflammatory reaction and organ function – experimental study


Authors: Kobr Jiří 1;  Fremuth Jiří 1;  Pizingerová Kateřina 1;  Fikrlová Šárka 1;  Jehlička Petr 1;  Honomichl Petr 1;  Šašek Lumír 1;  Racek Jaroslav 2;  Topolčan Ondřej 3
Authors‘ workplace: Dětská klinika JIP, LF UK v Plzni a FN v Plzni 1;  Ústav klinické biochemie a hematologie, LF UK v Plzni a FN v Plzni 2;  Oddělení imunoanalytické diagnostiky, LF UK v Plzni a FN v Plzni 3
Published in: Anest. intenziv. Med., 20, 2009, č. 2, s. 88-95
Category: Intensive Care Medicine - Original Paper

Overview

Objective:
Assessment of the functioning of extra-pulmonary organs during the ventilation of healthy lungs.

Type of study:
Experimental, comparative.

Setting:
Experimental Centre of the University Hospital.

Materials and methods:
15 white piglets weighing 22.7 (18.8–27) kg were identically instrumentated and monitored under general anaesthesia and divided into three equal groups. The pigs in Group A breathed spontaneously, group B pigs were ventilated with VT 6 ml . kg-1 and group C pigs were ventilated with VT 10 ml . kg-1. Measurements and samplings were performed in all the animal groups in the first hour and in groups B and C at 12 hours. The data were compared in groups and between groups, they were statistically analyzed and considered significantly different when p < 0.05.

Results:
The levels of soluble adhesion molecules, left ventricular contractility, FeNa, GFI and Cfw were found to be higher in groups B and C compared with group A in the first hour of the study. Higher levels of inflammatory mediators and BNP, and lower right ventricular performance and Cfw were observed in group C compared to group B. At 12 hours a decline in the ventricular performance and a reduction of inflammatory mediator expression were observed in groups B and C and a reduction of Cfw was observed in group C. Higher values of OI and VI and lower ventricular performance, PaO2/FiO2, Cfw and hourly urine output were found in group C compared to group B.

Conclusions:
The results support the hypothesis that mechanical ventilation of healthy lungs activates early inflammatory response. The neuro-humoral regulation and stabilization of other organs’ function are temporary. Mechanical ventilation with VT 10 ml . kg-1 reduces the treatment effect and its prolonged use has an adverse impact on extra-pulmonary organs.

Keywords:
mechanical ventilation – inflammatory reaction, neuro-humoral regulation – cardiac performance – renal function


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Anaesthesiology, Resuscitation and Inten Intensive Care Medicine

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Anaesthesiology and Intensive Care Medicine

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