Low Tidal Volume Ventilation With Low PEEP During Surgery May Induce Lung Inflammation

Hitoshi Sato; Kyota Nakamura; Yasuko Baba; Shoko Terada; Takahisa Goto; Kiyoyasu Kurahashi

BMC Anesthesiol. 2016;16(47)

Conclusion

In conclusion, V_T of 6 mL·kg⁻¹ predicted body weight ventilation with a PEEP of 3 cmH₂O during hepatectomy caused inflammation in the airway and reduced oxygenation after the surgery, whereas V_T of 12 mL·kg⁻¹ ventilation with a PEEP of 3 cmH₂O did not. There appears to be more lung inflammation with low tidal volume with low PEEP, which may be due to repeated alveolar collapse and re-expansion (i.e., atelectrauma). Our study supports the findings of other investigations looking at lung protective ventilation during surgery, mainly that low PEEP levels may be harmful. Careful consideration is warranted when enforcing a lung-protective strategy during major surgery.

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Abbreviations
ANOVA, analysis of variance; ARDS, acute respiratory distress syndrome; BAL, broncho-alveolar lavage; BGA, blood gas analysis; BMS, bronchoscopic microsampling; DF, dilution factor; ELF, epithelial lining fluid; ELISA, enzyme-linked immunosorbent assay; F_IO₂, inspired oxygen fraction; I/E, the ratio of the duration of inspiration to the duration of expiration; ICAM-1, intercellular adhesion molecule-1; IL, interleukin; PaCO₂, arterial partial carbon dioxide pressure; PACU, post-anesthetic care unit; PaO₂, arterial partial oxygen pressure; PEEP, positive end-expiratory pressure; PMN, polymorphonuculear cell; TNF, tumor necrosis factor; TV12, patients ventilated with a V_T of 12 mL per predicted body weight; TV6, patients ventilated with a V_T of 6 mL per predicted body weight; V_T, tidal volume

Acknowledgements
We thank the doctors in the Department of Anesthesiology and the Department of Gastroenterological Surgery, Yokohama City University Hospital, Yokohama, Japan for their helpful assistance.

Funding
This work was supported by the Center for Advanced Medical Promotion of the Yokohama City University Graduate School of Medicine (grant number: 07-021) and the Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (grant number: 26462368).

Availability of data and material
Data supporting our findings are available upon request.

Consent for publication
Not applicable

Ethics approval and consent to participate
This study was reviewed and approved by the review board of Yokohama City University (Date of IRB approval: 08-01-2007; approval number: 07-021), and all the patients provided written, informed consent preoperatively.

Trial registration
The effect of ventilatory tidal volume on lung injury during hepatectomy that requires transient liver blood flow interruption. UMIN000021371 (03/07/2016); retrospectively registered

Table 1. Patient characteristics and the baseline P/F ratio
	TV 12	TV 6	P-value
Age, year^a	69 (60/68)	63 (59/72)	0.3
Gender (male/female)^b	8/3	10/4	0.94
Body weight, kg	57.5 ± 10.2	62.7 ± 10.7	0.25
Height, cm	164.5 ± 10.1	166.1 ± 6.9	0.66
Body mass index, kg·m⁻²	21.2 ± 2.7	22.6 ± 2.6	0.22
Operation time, min	512.8 ± 113.9	419 ± 199.3	0.23
Anesthesia time, min	606.1 ± 128.0	525.2 ± 207.3	0.32
Blood loss, mL	852.0 ± 465.0	852.0 ± 466.4	0.39
Baseline P/F ratio	501.6 ± 23.9	435.8 ± 27.6	0.09
Liver resection amount, %	38.5 ± 8.8	33.0 ± 17.4	0.38
Pringle maneuver, times^c	3 (3/5.5)	4 (3/6)	0.75
Length of hospital stay after operation, days	12.5 ± 5.6	15.2 ± 9.0	0.38

Values are indicated as the mean ± SD otherwise indicated
Age ^ais represented as the mean (range), gender ^bas a number, and Pringle maneuver ^cas median (25^th and 75^th percentiles)

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Low Tidal Volume Ventilation With Low PEEP During Surgery May Induce Lung Inflammation

Conclusion

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