Preterm Neonates with Respiratory Distress Syndrome: Ventilator-Induced Lung Injury and Oxidative Stress.

Clarissa Gutiérrez Carvalho,Renato Soibelmann Procianoy,Eurico Camargo Neto,Rita C Silveira

doi:10.1155/2018/6963754

Clarissa Gutiérrez Carvalho, Renato Soibelmann Procianoy + Show 2 more

Open Access

https://doi.org/10.1155/2018/6963754

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Abstract

Ventilator-induced lung injury is well recognized, and appropriate arterial saturation target is unknown, so gentle modes of ventilation and minimizing oxidative stress have been well studied. Our objective was to analyze any association between the oxygen levels at blood sampling and plasma levels of the interleukins IL-6, IL-1β, IL-10, and IL-8 and TNF-α in preterm newborns under mechanical ventilation (MV) in their first two days. Methods. Prospective cohort including neonates with severe respiratory distress. Blood samples were collected right before and 2 hours after invasive MV. For analysis purposes, newborns were separated according to oxygen requirement: low oxygen (≤30%) and high oxygen (>30%) groups. Interleukins were measured using a commercially available kit. Results. 20 neonates (gestational age 32.2 ± 3 weeks) were evaluated. Median O2 saturation levels pre-MV were not different in both oxygen groups. In the high oxygen group, IL-6, IL-8, and TNF-α plasma levels increased significantly after two hours under MV. Conclusions. Despite the small sample studied, data showed that there is a relationship between VILI, proinflammatory cytokines, and oxygen-induced lung injury, but a study considering oxidative marker measurements is needed. It seems that less oxygen may keep safer saturation targets playing a less harmful role.

Highlights

It is well recognized that in preterm neonates, the need for invasive mechanical ventilation (MV) is associated with the so-called ventilator-induced lung injury (VILI); lung protection strategies have been intensely studied in the past 20 years
Our objective was to analyze any association between the oxygen levels at blood sampling and plasma levels of interleukin- (IL-) 6, IL-1β, IL-10, IL-8, and tumor necrosis factor- (TNF-) α in preterm infants under MV in their first two days of life. This prospective observational study included preterm infants ranging from 28 to 35 weeks of gestational age (GA) submitted to intubation and MV in the first 48 hours of life who were admitted to the newborn section of Hospital de Clínicas de Porto Alegre (HCPA), a tertiary referral medical center located in Southern Brazil
We demonstrated that even a short period under invasive mechanical ventilation associated with higher oxygen levels may lead to lung inflammation: higher IL-6, IL-8, and TNF-α median levels and lower IL-10 median levels were found

Summary

Introduction

It is well recognized that in preterm neonates, the need for invasive mechanical ventilation (MV) is associated with the so-called ventilator-induced lung injury (VILI); lung protection strategies have been intensely studied in the past 20 years. Superoxide, hydrogen peroxide, and perhydroxyl radicals cause oxygen-induced lung injury, and the premature infant is notably susceptible to free radical-induced injury because antioxidant systems develop late during the gestation. Excessive hyperoxia can lead to lung inflammation, diffuse alveolar injury, progressive pulmonary damage, and death [1]. The suitable arterial saturation target in preterm neonates is unknown, but exposing them to a high concentration of oxygen is related to increased risks of retinopathy of prematurity and bronchopulmonary dysplasia (BPD). Published large multicenter trials have studied this issue [2]

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