Short-term one-lung ventilation does not influence local inflammatory cytokine response after lung resection

Abstract

Background: One-lung ventilation (OLV) is a ventilation procedure used for pulmonary resection which may results in lung injury. The aim of this study was to evaluate the local inflammatory cytokine response from the dependent lung after OLV and its correlation to VT. The secondary aim was to evaluate the clinical outcome of each patient. Methods: Twenty-eight consecutive patients were enrolled. Ventilation was delivered in volume-controlled mode with a VT based on predicted body weight (PBW). 5 cmH 2 O positive end-expiratory pressure (PEEP) and FiO 2 0.5 were applied. Bronchoalveolar lavage (BAL) was performed in the dependent lung before and after OLV. The levels of pro-inflammatory interleukins (IL-1α, IL-1β, IL-6, IL-8), tumor necrosis factor alpha (TNFα), vascular endothelial growth factor (VEGF), endothelial growth factor (EGF), monocyte chemoattractant protein-1 (MCP-1) and anti-inflammatory cytokines, such as interleukins (IL-2, IL-4, IL-10) and interferon (IFN-γ), were evaluated. Subgroup analysis: to analyze the VT setting during OLV, all patients were ventilated within a range of 5-10 mL/kg. Thirteen patients, classified as a conventional ventilation (CV) subgroup, received 8-10 mL/kg, while 15 patients, classified as a protective ventilation (PV) subgroup, received 5-7 mL/kg.Results: Cytokine BAL levels after surgery showed no significant increase after OLV, and no significant differences were recorded between the two subgroups. The mean duration of OLV was 64.44±21.68 minutes.No postoperative respiratory complications were recorded. The mean length of stay was for 4.00±1.41 days in the PV subgroup and 4.45±2.07 days in the CV group; no statistically significant differences were recorded between the two subgroups (P=0.511). Conclusions: Localized inflammatory cytokine response after OLV was not influenced by the use of different VT. Potentially, the application of PEEP in both ventilation strategies and the short duration of OLV could prevent postoperative complications.

Duration of one-lung ventilation as a risk factor for postoperative pulmonary complications after McKeown esophagectomy

“…The optimal cutoff value identified was 157.5 minutes for OLV. Fiorelli et al 12 found that short-term OLV does not influence local inflammatory cytokine responses after lung resection. The duration of OLV in that study was about 60 minutes.…”

“…However, different durations of OLV have different effects on the lung injury. For lung resection surgery, Fiorelli et al 12 showed that short-term OLV does not influence the local inflammatory cytokine response, while a retrospective analysis identified the duration of OLV as a risk factor for postoperative acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). 6 There are no trials assessing the effect of duration of OLV on postoperative pulmonary complications after McKeown esophagectomy.…”

Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care

“…A small randomized study in VATS patients found that the combination of protective ventilation with a recruitment maneuver was associated with attenuated inflammatory responses, compared with either conventional ventilation or protective ventilation alone (Kim et al 2019 ). By contrast, a non-randomized study in 28 patients found no significant difference in local inflammatory cytokine responses between lung resection patients receiving protective or conventional ventilation (Fiorelli et al 2018 ).…”

Effects of different positive end-expiratory pressure titrating strategies on oxygenation and respiratory mechanics during one- lung ventilation: a randomized controlled trial

“…However, the intrapulmonary shunt changes during OLV were not considered in previous studies. Furthermore, recent studies have demonstrated that an individualized PEEP adjustment is associated with better oxygenation (2), decreased intrapulmonary shunt (6), lower driving pressure (7), lower or no inflammatory responses (12,13) and lower incidence of postoperative pulmonary complications (14,15). Conversely, an individualized PEEP titration, will not completely prevent atelectasis formation in the particular population (16,17).…”