Lung epithelial injury markers are not influenced by use of lower tidal volumes during elective surgery in patients without preexisting lung injury
Lung epithelial injury markers are not influenced by use of lower tidal volumes during elective surgery in patients without preexisting lung injury
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DOI：
10.1152/ajplung.00268.2007
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发表时间：
2008-02-01
影响因子：
4.9
通讯作者：
Schultz, Marcus J.
中科院分区：
文献类型：
--
作者：
Determann, Rogier M.;Wolthuis, Esther K.;Schultz, Marcus J.
轻度或亚临床肺损伤患者血浆Clara细胞蛋白水平升高。我们研究了两种机械通气策略对局部和全身Clara细胞蛋白（CC16）水平的影响，并将其与选择性手术患者晚期糖基化终产物可溶性受体（sRAGE）和表面活性剂蛋白(SP)-A和-D水平进行了比较。从先前报道的调查中保存的样本被用于研究。40例计划择期手术的患者随机接受机械通气，常规潮气量（V-T）为12 ml/kg，无呼气末正压（PEEP），或低VT为6 ml/kg， 10 cmH(2)O PEEP。插管后和机械通气5 h后直接收集血浆和支气管肺泡灌洗液（BALF）。虽然SP-A和SP-D的全身水平保持不变，但5 h后两组的CC16和sRAGE的全身水平均显著升高（P < 0.001）。SP-A、SP-D、CC16和sRAGE的半胱氨酸水平未受影响。两种机械通气策略在任何测量的生物标志物方面没有发现差异。综上所述，在择期手术中接受机械通气的患者，全身CC16和sRAGE水平在5小时后升高。与常规机械通气相比，低潮气量和PEEP机械通气对肺上皮损伤生物标志物水平的影响没有差异。
Clara cell protein levels are elevated in plasma of individuals with mild or subclinical lung injury. We studied the influence of two mechanical ventilation strategies on local and systemic levels of Clara cell protein (CC16) and compared them with levels of soluble receptor for advanced glycation end products (sRAGE) and surfactant proteins (SP)-A and -D in patients undergoing elective surgery. Saved samples from a previously reported investigation were used for the study. Forty patients planned for elective surgery were randomized to mechanical ventilation with either a conventional tidal volume (V-T) of 12 ml/kg without positive end-expiratory pressure ( PEEP) or low VT of 6 ml/kg and 10 cmH(2)O PEEP. Plasma and bronchoalveolar lavage fluid (BALF) was collected directly after intubation and after 5 h of mechanical ventilation. While systemic levels of SP-A and SP-D remained unchanged, systemic levels of CC16 and sRAGE increased significantly in both groups after 5 h ( P < 0.001 for both). BALF levels of SP-A, SP-D, CC16, and sRAGE remained unaffected. No differences were found between the two mechanical ventilation strategies regarding any of the measured biological markers. In conclusion, systemic levels of CC16 and sRAGE rise after 5 h in patients receiving mechanical ventilation for elective surgery. Mechanical ventilation with lower tidal volumes and PEEP did not have a different effect on levels of biomarkers of lung epithelial injury compared with conventional mechanical ventilation.