Anest. intenziv. Med. 2009;20(2):88-95

The influence of continuous positive pressure ventilation on the degree of inflammatory reaction and organ function - experimental studyIntensive Care Medicine - Original Paper

Kobr Jiří^1,*, Fremuth Jiří¹, Pizingerová Kateřina¹, Fikrlová Šárka¹, Jehlička Petr¹, Honomichl Petr¹, Šašek Lumír¹, Racek Jaroslav², Topolčan Ondřej³

¹ Dětská klinika JIP, LF UK v Plzni a FN v Plzni

² Ústav klinické biochemie a hematologie, LF UK v Plzni a FN v Plzni

³ Oddělení imunoanalytické diagnostiky, LF UK v Plzni a FN v Plzni

Objective:
Assessment of the functioning of extra-pulmonary organs during the ventilation of healthy lungs.


Type of study:
Experimental, comparative.


Setting:
Experimental Centre of the University Hospital.

Materials and methods:
15 white piglets weighing 22.7 (18.8-27) kg were identically instrumentated and monitored under general anaesthesia and divided into three equal groups. The pigs in Group A breathed spontaneously, group B pigs were ventilated with V_T 6 ml . kg^-1 and group C pigs were ventilated with V_T 10 ml . kg^-1. Measurements and samplings were performed in all the animal groups in the first hour and in groups B and C at 12 hours. The data were compared in groups and between groups, they were statistically analyzed and considered significantly different when p < 0.05.

Results:
The levels of soluble adhesion molecules, left ventricular contractility, FeNa, GFI and Cfw were found to be higher in groups B and C compared with group A in the first hour of the study. Higher levels of inflammatory mediators and BNP, and lower right ventricular performance and Cfw were observed in group C compared to group B. At 12 hours a decline in the ventricular performance and a reduction of inflammatory mediator expression were observed in groups B and C and a reduction of Cfw was observed in group C. Higher values of OI and VI and lower ventricular performance, PaO₂/FiO₂, Cfw and hourly urine output were found in group C compared to group B.

Conclusions:
The results support the hypothesis that mechanical ventilation of healthy lungs activates early inflammatory response. The neuro-humoral regulation and stabilization of other organs' function are temporary. Mechanical ventilation with V^T 10 ml . kg^-1 reduces the treatment effect and its prolonged use has an adverse impact on extra-pulmonary organs.

Keywords: mechanical ventilation; inflammatory reaction; neuro-humoral regulation; cardiac performance; renal function

Received: April 14, 2008; Accepted: December 4, 2008; Published: April 1, 2009  Show citation