Work completed in the Nemours Department of Biomedical Research and Department of Anesthesiology and Critical Care at the Alfred I. duPont Hospital for Children.
Protective ventilation to reduce inflammatory injury from one lung ventilation in a piglet model
Article first published online: 16 NOV 2009
© 2009 Blackwell Publishing Ltd
Volume 20, Issue 4, pages 356–364, April 2010
How to Cite
THEROUX, M. C., FISHER, A. O., HORNER, L. M., RODRIGUEZ, M. E., COSTARINO, A. T., MILLER, T. L. and SHAFFER, T. H. (2010), Protective ventilation to reduce inflammatory injury from one lung ventilation in a piglet model. Pediatric Anesthesia, 20: 356–364. doi: 10.1111/j.1460-9592.2009.03195.x
This manuscript is being submitted as a Translational Research article of an intervention to reduce inflammation during one lung ventilation.
- Issue published online: 8 MAR 2010
- Article first published online: 16 NOV 2009
- Accepted 9 October 2009
- one lung ventilation;
- thoracic anesthesia;
- protective ventilation;
Objectives: To test the hypothesis that protective ventilation strategy (PVS) as defined by the use of low stretch ventilation (tidal volume of 5 ml·kg−1 and employing 5 cm of positive end expiratory pressure (PEEP) during one lung ventilation (OLV) in piglets would result in reduced injury compared to a control group of piglets who received the conventional ventilation (tidal volume of 10 ml·kg−1 and no PEEP).
Background: PVS has been found to be beneficial in adults to minimize injury from OLV. We designed the current study to test the beneficial effects of PVS in a piglet model of OLV.
Methods: Ten piglets each were assigned to either ‘Control’ group (tidal volume of 10 ml·kg−1 and no PEEP) or ‘PVS’ group (tidal volume of 5 ml·kg−1 during the OLV phase and PEEP of 5 cm of H2O throughout the study). Experiment consisted of 30 min of baseline ventilation, 3 h of OLV, and again 30 min of bilateral ventilation. Respiratory parameters and proinflammatory markers were measured as outcome.
Results: There was no difference in PaO2 between groups. PaCO2 (P < 0.01) and ventilatory rate (P < 0.01) were higher at 1.5 h OLV and at the end point in the PVS group. Peak inflating pressure (PIP) and pulmonary resistance were higher (P < 0.05) in the control group at 1.5 h OLV. tumor necrosis factor-alpha (P < 0.04) and IL-8 were less (P < 0.001) in the plasma from the PVS group, while IL-6 and IL-8 were less (P < 0.04) in the lung tissue from ventilated lungs in the PVS group.
Conclusions: Based on this model, PVS decreases inflammatory injury both systemically and in the lung tissue with no adverse effect on oxygenation, ventilation, or lung function.