Effect of lung-protective ventilation on acute lung injury after liver transplantation

Abstract

Objective To evaluate the effects of lung-protective ventilation on acute lung injury after liver transplantation. Methods Sixty patients of both sexes, aged 21-64 yr, with body mass index of 18-28 kg/m2, of American Society of Anesthesiologists physical status Ⅱ-Ⅳ, scheduled for elective orthotopic liver transplantation, were divided into 2 groups(n=30 each)using a random number table: conventional mechanical ventilation group(group CMV)and lung-protective ventilation group(group LPV). In group LPV, the patients were mechanically ventilated(tidal volume 6-8 ml/kg, respiratory rate 10-15 breaths/min, positive end-expiratory pressure 3-10 cmH2O), and lung recruitment maneuver was performed every 2 h. Before skin incision(T1), at 3 h of preanhepatic phase(T2), at 30 min of anhepatic phase(T3)and at 2 and 4 h of neohepatic phase(T4, 5), bronchoalveolar lavage fluid(BALF)was collected and blood samples from the radial artery were simultaneously collected for determination of tumor necrosis factor-alpha and interleukin-8 concentrations in BALF and serum by enzyme-linked immunosorbent assay.At 2 h after operation(T6), before tracheal extubation(T7)and at 2 days after operation(T8), blood samples from the radial artery were collected for blood gas analysis, and oxygenation index was calculated.The concentrations of serum Clara cell secretory protein 16, surfactant protein D and soluble receptor for advanced glycation end-products were determined at T1-T8 using enzyme-linked immunosorbent assay.The postoperative emergence time, extubation time, duration of intensive care unit stay and development of acute lung injury were recorded. Results Compared with group CMV, the extubation time was significantly shortened, serum concentrations of Clara cell secretory protein 16 at T2, T3, T6 and T7, serum surfactant protein D concentrations at T5 and serum concentrations of soluable receptor for advanced glycation end-products at T5 and T6 were decreased(P 0.05). Conclusion Although lung-protective ventilation dose not decrease the development of acute lung injury after liver transplantation, it attenuates lung tissue injury to some extent. Key words: Respiration, artificial; Respiratory distress syndrome, adult; Liver transplantation