Lung-Protective Ventilation Strategies for Relief from Ventilator-Associated Lung Injury in Patients Undergoing Craniotomy: A Bicenter Randomized, Parallel, and Controlled Trial.

Chaoliang Tang,Chaoshi Niu,Zhongyuan Xia,Juan Li,Wenting Huang,Xiaoqing Chai,Zhetao Zhang,Bo Zhao,Si Shi,Shaoqing Lei

doi:10.1155/2017/6501248

Abstract

Current evidence indicates that conventional mechanical ventilation often leads to lung inflammatory response and oxidative stress, while lung-protective ventilation (LPV) minimizes the risk of ventilator-associated lung injury (VALI). This study evaluated the effects of LPV on relief of pulmonary injury, inflammatory response, and oxidative stress among patients undergoing craniotomy. Sixty patients undergoing craniotomy received either conventional mechanical (12 mL/kg tidal volume [VT] and 0 cm H2O positive end-expiratory pressure [PEEP]; CV group) or protective lung (6 mL/kg VT and 10 cm H2O PEEP; PV group) ventilation. Hemodynamic variables, lung function indexes, and inflammatory and oxidative stress markers were assessed. The PV group exhibited greater dynamic lung compliance and lower respiratory index than the CV group during surgery (P < 0.05). The PV group exhibited higher plasma interleukin- (IL-) 10 levels and lower plasma malondialdehyde and nitric oxide and bronchoalveolar lavage fluid, IL-6, IL-8, tumor necrosis factor-α, IL-10, malondialdehyde, nitric oxide, and superoxide dismutase levels (P < 0.05) than the CV group. There were no significant differences in hemodynamic variables, blood loss, liquid input, urine output, or duration of mechanical ventilation between the two groups (P > 0.05). Patients receiving LPV during craniotomy exhibited low perioperative inflammatory response, oxidative stress, and VALI.

Highlights

Mechanical ventilation (MV) is the most effective means of providing respiratory support in the operating room and intensive care unit (ICU)
Three patients in the CV group dropped out from the investigation—while two patients had to be transferred to the ICU after surgery, one experienced postoperative complications
There were no significant differences in demographic data, surgical characteristics, or intraoperative variables between the two groups (Tables 1 and 2)

Summary

Introduction

Mechanical ventilation (MV) is the most effective means of providing respiratory support in the operating room and intensive care unit (ICU). Pulmonary complications—including atelectasis, acute lung injury, pneumonia, and infection—associated with MV are major contributors to increased patient morbidity and mortality [2, 3]. Potential harmful effects of conventional MV with ventilator parameters such as tidal volume (VT) > 6 mL/kg predicted body weight (PBW) and exposure to high airway pressure even during short-term treatment have been shown to be correlated with systemic inflammation and development of ventilatorassociated lung injury (VALI) because of cyclic alveolar atelectasis and strain. General anesthesia with anesthetics and neuromuscular blocking agents can cause changes in pulmonary surfactants and diaphragmatic position, and inappropriate ventilator settings are likely to cause air pressure injury and atelectasis, leading to postoperative inflammation [4, 5].

Methods

Results

Discussion

Conclusion