Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial.
V. Marco Ranieri,Peter M. Suter,Cosimo Tortorella,Renato De Tullio,Jean-Michel Dayer,A. Brienza,Francesco Bruno,Arthur S. Slutsky +7 more
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TLDR
Mechanical ventilation can induce a cytokine response that may be attenuated by a strategy to minimize overdistention and recruitment/derecruitment of the lung, and these physiological improvements are associated with improvements in clinical end points.Abstract:
ContextStudies have shown that an inflammatory response may be elicited by
mechanical ventilation used for recruitment or derecruitment of collapsed
lung units or to overdistend alveolar regions, and that a lung-protective
strategy may reduce this response.ObjectiveTo test the hypothesis that mechanical ventilation induces a pulmonary
and systemic cytokine response that can be minimized by limiting recruitment
or derecruitment and overdistention.Design and SettingRandomized controlled trial in the intensive care units of 2 European
hospitals from November 1995 to February 1998, with a 28-day follow-up.PatientsForty-four patients (mean [SD] age, 50 [18] years) with acute respiratory
distress syndrome were enrolled, 7 of whom were withdrawn due to adverse events.InterventionsAfter admission, volume-pressure curves were measured and bronchoalveolar
lavage and blood samples were obtained. Patients were randomized to either
the control group (n=19): tidal volume to obtain normal values of arterial
carbon dioxide tension (35-40 mm Hg) and positive end-expiratory pressure
(PEEP) producing the greatest improvement in arterial oxygen saturation without
worsening hemodynamics; or the lung-protective strategy group (n=18): tidal
volume and PEEP based on the volume-pressure curve. Measurements were repeated
24 to 30 and 36 to 40 hours after randomization.Main Outcome MeasuresPulmonary and systemic concentrations of inflammatory mediators approximately
36 hours after randomization.ResultsPhysiological characteristics and cytokine concentrations were similar
in both groups at randomization. There were significant differences (mean
[SD]) between the control and lung-protective strategy groups in tidal volume
(11.1 [1.3] vs 7.6 [1.1] mL/kg), end-inspiratory plateau pressures (31.0 [4.5]
vs 24.6 [2.4] cm H2O), and PEEP (6.5 [1.7] vs 14.8 [2.7] cm H2O) (P<.001). Patients in the control group
had an increase in bronchoalveolar lavage concentrations of interleukin (IL)
1β, IL-6, and IL-1 receptor agonist and in both bronchoalveolar lavage
and plasma concentrations of tumor necrosis factor (TNF) α, IL-6, and
TNF-α receptors over 36 hours (P<.05 for
all). Patients in the lung-protective strategy group had a reduction in bronchoalveolar
lavage concentrations of polymorphonuclear cells, TNF-α, IL-1β,
soluble TNF-α receptor 55, and IL-8, and in plasma and bronchoalveolar
lavage concentrations of IL-6, soluble TNF-α receptor 75, and IL-1 receptor
antagonist (P<.05). The concentration of the inflammatory
mediators 36 hours after randomization was significantly lower in the lung-protective
strategy group than in the control group (P<.05).ConclusionsMechanical ventilation can induce a cytokine response that may be attenuated
by a strategy to minimize overdistention and recruitment/derecruitment of
the lung. Whether these physiological improvements are associated with improvements
in clinical end points should be determined in future studies.read more
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Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome
Roy G. Brower,Paul N. Lanken,Neil R. MacIntyre,Michael A. Matthay,Alan H. Morris,Marek Ancukiewicz,David A. Schoenfeld,B. Taylor Thompson +7 more
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TL;DR: The probable causes of mechanical ventilation injury and ways to prevent it are reviewed.
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Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial.
Alain Mercat,Jean-Christophe M. Richard,Bruno Vielle,Samir Jaber,David Osman,Jean-Luc Diehl,Jean-Yves Lefrant,Gwenaël Prat,Jack Richecoeur,Ania Nieszkowska,Claude Gervais,Jérôme Baudot,Lila Bouadma,Laurent Brochard +13 more
TL;DR: A strategy for setting PEEP aimed at increasing alveolar recruitment while limiting hyperinflation did not significantly reduce mortality, but it did improve lung function and reduced the duration of mechanical ventilation and theduration of organ failure.
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A trial of intraoperative low-tidal-volume ventilation in abdominal surgery.
Emmanuel Futier,Jean-Michel Constantin,Catherine Paugam-Burtz,Julien Pascal,Mathilde Eurin,Arthur Neuschwander,Emmanuel Marret,Marc Beaussier,Christophe Gutton,Jean-Yves Lefrant,Bernard Allaouchiche,Daniel Verzilli,Marc Leone,Audrey De Jong,Jean-Etienne Bazin,Bruno Pereira,Samir Jaber +16 more
TL;DR: The use of a lung-protective ventilation strategy in intermediate-risk and high-risk patients undergoing major abdominal surgery was associated with improved clinical outcomes and reduced health care utilization.
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Effect of a Protective-Ventilation Strategy on Mortality in the Acute Respiratory Distress Syndrome
Marcelo B. P. Amato,Carmen Silvia Valente Barbas,D Medeiros,R B Magaldi,Guilherme Schettino,Geraldo Lorenzi-Filho,Ronaldo Adib Kairalla,Daniel Deheinzelin,Carlos Munoz,Roselaine Pinheiro de Oliveira,Teresa Yae Takagaki,Carlos Roberto Ribeiro de Carvalho +11 more
TL;DR: As compared with conventional ventilation, the protective strategy was associated with improved survival at 28 days, a higher rate of weaning from mechanical ventilation, and a lower rate of barotrauma in patients with the acute respiratory distress syndrome.
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Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model.
TL;DR: The concept that mechanical ventilation can have a significant influence on the inflammatory/anti-inflammatory milieu of the lung, and thus play a role in initiating or propagating a local, and possibly systemic inflammatory response, is supported.
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