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Bruinooge AJG, Mao R, Gottschalk TH, Srinathan SK, Buduhan G, Tan L, Halayko AJ, Kidane B. Identifying biomarkers of ventilator induced lung injury during one-lung ventilation surgery: a scoping review. J Thorac Dis 2022; 14:4506-4520. [PMID: 36524064 PMCID: PMC9745541 DOI: 10.21037/jtd-20-2301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/14/2022] [Indexed: 10/08/2023]
Abstract
BACKGROUND Ventilator-induced lung injury (VILI) can occur as a result of mechanical ventilation to two lungs. Thoracic surgery often requires one-lung ventilation (OLV). The potential for VILI is likely higher in OLV. The impact of OLV on development of post-operative pulmonary complications is not well understood. We aimed to perform a scoping review to determine reliable biomarkers of VILI after OLV. METHODS A scoping review was performed using Cochrane Collaboration methodology. We searched Medline, EMBASE and SCOPUS. Gray literature was searched. Studies of adult human or animal models without pre-existing lung damage exposed to OLV, with biomarker responses analyzed were included. RESULTS After screening 5,613 eligible papers, 89 papers were chosen for full text review, with 29 meeting inclusion. Approximately half (52%, n=15) of studies were conducted in humans in an intra-operative setting. Bronchoalveolar lavage (BAL) & serum analyses with enzyme-linked immunosorbent assay (ELISA)-based assays were most commonly used. The majority of analytes were investigated by a single study. Of the analytes that were investigated by two or more studies (n=31), only 16 were concordant in their findings. Across all sample types and studies 84% (n=66) of the 79 inflammatory markers and 75% (n=6) of the 8 anti-inflammatory markers tested were found to increase. Half (48%) of all studies showed an increase in TNF-α or IL-6. CONCLUSIONS A scoping review of the state of the evidence demonstrated that candidate biomarkers with the most evidence and greatest reliability are general markers of inflammation, such as IL-6 and TNF-α assessed using ELISA assays. Studies were limited in the number of biomarkers measured concurrently, sample size, and studies using human participants. In conclusion these identified markers can potentially serve as outcome measures for studies on OLV.
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Affiliation(s)
- Allan J. G. Bruinooge
- Section of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada
- University of Manitoba, Winnipeg, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
| | | | | | - Sadeesh K. Srinathan
- Section of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada
- University of Manitoba, Winnipeg, Canada
| | - Gordon Buduhan
- Section of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada
- University of Manitoba, Winnipeg, Canada
| | - Lawrence Tan
- Section of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada
- University of Manitoba, Winnipeg, Canada
| | - Andrew J. Halayko
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada
- University of Manitoba, Winnipeg, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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Wang YP, Wei Y, Chen XY, Zhang LX, Zhou M, Wang J. Comparison between pressure-controlled ventilation with volume-guaranteed mode and volume-controlled mode in one-lung ventilation in infants undergoing video-assisted thoracoscopic surgery. Transl Pediatr 2021; 10:2514-2520. [PMID: 34765475 PMCID: PMC8578778 DOI: 10.21037/tp-21-421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The appropriate ventilation mode for one-lung ventilation (OLV) in infants undergoing video-assisted thoracoscopic surgery (VATS) remains controversial. Here we investigated the effect of ventilatory mode "pressure-controlled ventilation-volume guaranteed" (PCV-VG) on the airway pressures and oxygenation parameters by comparing it with volume-controlled ventilation (VCV). METHODS We retrospectively analyzed the clinical data of infants aged 2 to 12 months who underwent extratracheal bronchial blockage for OLV in our center between January 2017 and August 2020. The infants were divided into two groups according to the OLV pattern: group G (n=30, receiving PCV-VG) and group V (n=28, receiving VCV). Mean arterial pressure (MAP), heart rate (HR), maximum inspiratory pressure (Ppeak), mean airway pressure (Pmean), dynamic compliance (Cdyn), partial arterial pressure of oxygen (PaO2) was measured and compared between these two groups 10 min before OLV (T1), 30 min after the onset of OLV (T2) and 15 min after OLV (T3). The possible occurrence of hypoxemia and hypotension during OLV was monitored. RESULTS Compared to group V, group G had significantly higher PaO2and Cdyn (both P<0.05) and significantly lower Ppeak and Pmean (both P<0.05) in T2. However, all indicators did not show significant differences between these two groups at T1 and T3 (all P>0.05). The incidence of hypoxemia was significantly higher in group V than in group G (P<0.05), while the difference in the incidence of hypotension was not statistically significant (P>0.05). CONCLUSIONS Mechanical ventilation using the PCV-VG mode is possible in infants when performing OLV during VATS. Compared to VCV, PCV-VG can offer lower Ppeak and Pmean, improve lung compliance, and achieve better oxygenation.
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Affiliation(s)
- Yu-Ping Wang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Anesthesiology, Fujian Children's Hospital, Fuzhou, China
| | - Ying Wei
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Anesthesiology, Fujian Children's Hospital, Fuzhou, China
| | - Xiu-Ying Chen
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Anesthesiology, Fujian Children's Hospital, Fuzhou, China
| | - Long-Xin Zhang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Anesthesiology, Fujian Children's Hospital, Fuzhou, China
| | - Min Zhou
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Anesthesiology, Fujian Children's Hospital, Fuzhou, China
| | - Jing Wang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Anesthesiology, Fujian Children's Hospital, Fuzhou, China
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Fiorelli S, Defraia V, Cipolla F, Menna C, Ibrahim M, Andreetti C, Simmaco M, Rocco M, Rendina EA, Borro M, Massullo D. Short-term one-lung ventilation does not influence local inflammatory cytokine response after lung resection. J Thorac Dis 2018; 10:1864-1874. [PMID: 29707341 DOI: 10.21037/jtd.2018.03.50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background One-lung ventilation (OLV) is a ventilation procedure used for pulmonary resection which may results in lung injury. The aim of this study was to evaluate the local inflammatory cytokine response from the dependent lung after OLV and its correlation to VT. The secondary aim was to evaluate the clinical outcome of each patient. Methods Twenty-eight consecutive patients were enrolled. Ventilation was delivered in volume-controlled mode with a VT based on predicted body weight (PBW). 5 cmH2O positive end-expiratory pressure (PEEP) and FiO2 0.5 were applied. Bronchoalveolar lavage (BAL) was performed in the dependent lung before and after OLV. The levels of pro-inflammatory interleukins (IL-1α, IL-1β, IL-6, IL-8), tumor necrosis factor alpha (TNFα), vascular endothelial growth factor (VEGF), endothelial growth factor (EGF), monocyte chemoattractant protein-1 (MCP-1) and anti-inflammatory cytokines, such as interleukins (IL-2, IL-4, IL-10) and interferon (IFN-γ), were evaluated. Subgroup analysis: to analyze the VT setting during OLV, all patients were ventilated within a range of 5-10 mL/kg. Thirteen patients, classified as a conventional ventilation (CV) subgroup, received 8-10 mL/kg, while 15 patients, classified as a protective ventilation (PV) subgroup, received 5-7 mL/kg. Results Cytokine BAL levels after surgery showed no significant increase after OLV, and no significant differences were recorded between the two subgroups. The mean duration of OLV was 64.44±21.68 minutes. No postoperative respiratory complications were recorded. The mean length of stay was for 4.00±1.41 days in the PV subgroup and 4.45±2.07 days in the CV group; no statistically significant differences were recorded between the two subgroups (P=0.511). Conclusions Localized inflammatory cytokine response after OLV was not influenced by the use of different VT. Potentially, the application of PEEP in both ventilation strategies and the short duration of OLV could prevent postoperative complications.
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Affiliation(s)
- Silvia Fiorelli
- Department of Anesthesiology and Intensive Care, Sapienza University of Rome, Italy
| | - Veronica Defraia
- Department of Anesthesiology and Intensive Care, Sapienza University of Rome, Italy
| | - Fabiola Cipolla
- The Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Italy
| | - Cecilia Menna
- Department of Thoracic Surgery; Sapienza University of Rome, Italy
| | - Mohsen Ibrahim
- Department of Thoracic Surgery; Sapienza University of Rome, Italy
| | | | - Maurizio Simmaco
- The Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Italy
| | - Monica Rocco
- Department of Anesthesiology and Intensive Care, Sapienza University of Rome, Italy
| | | | - Marina Borro
- The Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Italy
| | - Domenico Massullo
- Department of Anesthesiology and Intensive Care, Sapienza University of Rome, Italy
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Mahmoud K, Ammar A, Kasemy Z. Comparison Between Pressure-Regulated Volume-Controlled and Volume-Controlled Ventilation on Oxygenation Parameters, Airway Pressures, and Immune Modulation During Thoracic Surgery. J Cardiothorac Vasc Anesth 2017; 31:1760-1766. [DOI: 10.1053/j.jvca.2017.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Indexed: 11/11/2022]
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Bastin AJ, Davies N, Lim E, Quinlan GJ, Griffiths MJ. Systemic inflammation and oxidative stress post-lung resection: Effect of pretreatment with N-acetylcysteine. Respirology 2015; 21:180-7. [PMID: 26503312 DOI: 10.1111/resp.12662] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/03/2015] [Accepted: 07/28/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE N-acetylcysteine has been used to treat a variety of lung diseases, where is it thought to have an antioxidant effect. In a randomized placebo-controlled double-blind study, the effect of N-acetylcysteine on systemic inflammation and oxidative damage was examined in patients undergoing lung resection, a human model of acute lung injury. METHODS Eligible adults were randomized to receive preoperative infusion of N-acetylcysteine (240 mg/kg over 12 h) or placebo. Plasma thiols, interleukin-6, 8-isoprostane, ischaemia-modified albumin, red blood cell glutathione and exhaled breath condensate pH were measured pre- and post-operatively as markers of local and systemic inflammation and oxidative stress. RESULTS Patients undergoing lung resection and one-lung ventilation exhibited significant postoperative inflammation and oxidative damage. Postoperative plasma thiol concentration was significantly higher in the N-acetylcysteine-treated group. However, there was no significant difference in any of the measured biomarkers of inflammation or oxidative damage, or in clinical outcomes, between N-acetylcysteine and placebo groups. CONCLUSION Preoperative administration of N-acetylcysteine did not attenuate postoperative systemic or pulmonary inflammation or oxidative damage after lung resection. CLINICAL TRIAL REGISTRATION NCT00655928 at ClinicalTrials.gov.
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Affiliation(s)
| | - Nathan Davies
- Liver Failure Group, UCL Institute for Liver and Digestive Health, Royal Free Hospital Campus, University College of London (UCL), London, UK
| | - Eric Lim
- Academic Division of Thoracic Surgery, Royal Brompton & Harefield NHS Foundation Trust, UK National Heart and Lung Division, Imperial College, London, UK
| | - Greg J Quinlan
- National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK.,Vascular Biology, National Heart and Lung Institute, Imperial College London, London, UK
| | - Mark J Griffiths
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK.,National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK.,Leukocyte Biology, National Heart and Lung Institute, Imperial College London, London, UK
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6
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Lohser J, Slinger P. Lung Injury After One-Lung Ventilation: A Review of the Pathophysiologic Mechanisms Affecting the Ventilated and the Collapsed Lung. Anesth Analg 2015. [PMID: 26197368 DOI: 10.1213/ane.0000000000000808] [Citation(s) in RCA: 231] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Lung injury is the leading cause of death after thoracic surgery. Initially recognized after pneumonectomy, it has since been described after any period of 1-lung ventilation (OLV), even in the absence of lung resection. Overhydration and high tidal volumes were thought to be responsible at various points; however, it is now recognized that the pathophysiology is more complex and multifactorial. All causative mechanisms known to trigger ventilator-induced lung injury have been described in the OLV setting. The ventilated lung is exposed to high strain secondary to large, nonphysiologic tidal volumes and loss of the normal functional residual capacity. In addition, the ventilated lung experiences oxidative stress, as well as capillary shear stress because of hyperperfusion. Surgical manipulation and/or resection of the collapsed lung may induce lung injury. Re-expansion of the collapsed lung at the conclusion of OLV invariably induces duration-dependent, ischemia-reperfusion injury. Inflammatory cytokines are released in response to localized injury and may promote local and contralateral lung injury. Protective ventilation and volatile anesthesia lessen the degree of injury; however, increases in biochemical and histologic markers of lung injury appear unavoidable. The endothelial glycocalyx may represent a common pathway for lung injury creation during OLV, because it is damaged by most of the recognized lung injurious mechanisms. Experimental therapies to stabilize the endothelial glycocalyx may afford the ability to reduce lung injury in the future. In the interim, protective ventilation with tidal volumes of 4 to 5 mL/kg predicted body weight, positive end-expiratory pressure of 5 to 10 cm H2O, and routine lung recruitment should be used during OLV in an attempt to minimize harmful lung stress and strain. Additional strategies to reduce lung injury include routine volatile anesthesia and efforts to minimize OLV duration and hyperoxia.
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Affiliation(s)
- Jens Lohser
- From the *Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada; and †Department of Anesthesia, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
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7
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Walsh BK, Davis MD, Hunt JF, Kheir JN, Smallwood CD, Arnold JH. The effects of lung recruitment maneuvers on exhaled breath condensate pH. J Breath Res 2015; 9:036009. [PMID: 26333431 DOI: 10.1088/1752-7155/9/3/036009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Exhaled breath condensate (EBC) pH serves as a surrogate marker of airway lining fluid (ALF) pH and can be used to evaluate airway acidification (AA). AA is known to be present in acute respiratory distress syndrome (ARDS) and can be evaluated via continuous EBC pH measurement during mechanical ventilation. Lung recruitment maneuvers (LRMs) are utilized in the treatment of ARDS, however, their impact on EBC pH has never been explored. Here we described the acute effects of two commonly used LRMs on EBC pH. In a prospective, non-randomized, serial exposure study, 10 intubated pediatric subjects with acute respiratory distress syndrome sequentially underwent: a period of baseline ventilation, sustained inflation (SI) maneuver of 40 cm H2O for 40 s, open lung ventilation, staircase recruitment strategy (SRS) (which involves a systematic ramping of plateau pressures in 5 cm H2O increments, starting at 30 cm H2O), and PEEP titration. Maximum lung recruitment during the SRS is defined as a PaO2 + PaCO2 of >400 mmHg. Following lung recruitment, PEEP titration was conducted from 20 cm H2O in 2 cm H2O decrements until a PaO2 + PaCO2 was <380 and then increased by 2 cm H2O. EBC pH, arterial blood gases, lung mechanics, hemodynamics, and function residual capacity were obtained following each phase of the LRM and observational period. Seven out of 10 patients were able to reach maximum lung recruitment. Baseline EBC pH (6.38 ± 0.37) did not correlate with disease severity defined by PaO2/FiO2 ratio or oxygenation index (OI). Average EBC pH differed between phases and decreased after LRM (p = 0.001). EBC pH is affected by LRMs. EBC acidification following LRMs may represent a washout effect of opening acidic lung units and ventilating them or acute AA resulting from LRM.
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Affiliation(s)
- Brian K Walsh
- Boston Children's Hospital, 300 Longwood Ave, Farley 019, Boston, MA 02115, USA
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8
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Wu Q, Zhang J, Wan Y, Song S, Zhang Y, Zhang G, Liu C, Fu J. Hydrogen water alleviates lung injury induced by one-lung ventilation. J Surg Res 2015; 199:664-70. [PMID: 26182997 DOI: 10.1016/j.jss.2015.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/18/2015] [Accepted: 06/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND With the development of thoracic surgeries, one-lung ventilation (OLV) has been routinely used to facilitate surgical exposure. However, OLV can cause lung injury during the surgical process and becomes an important factor affecting the outcomes. To date, effective treatments for the prevention of lung injury caused by OLV are lacking. Hydrogen has been demonstrated to have effective protection against tissue injuries caused by oxidative stress, inflammation, and apoptosis. This study investigated the efficacy of hydrogen water consumption on the prevention of lung injury induced by OLV in rats. MATERIALS AND METHODS Male Sprague-Dawley rats (n = 32, 240-260 g) were divided randomly into the following four groups: sham group, sham + H2 group, OLV group, OLV + H2 group. The rats drank hydrogen water or degassed hydrogen water for 4 wk before the operation and received OLV for 60 min and two-lung ventilation for 60 min. Lung tissues were assayed for wet-to-dry ratio, oxidative stress variables, proinflammatory cytokines, and hematoxylin-eosin staining. RESULTS Hydrogen water consumption reduced wet-to-dry weight ratio, malondialdehyde and myeloperoxidase activity and decreased the concentration of TNF-α, IL-1β, and IL-6 in the lung tissues compared with sham group and sham + H2 group. Hydrogen water consumption further attenuated NF-κB activation and caused histopathologic alterations. CONCLUSIONS Our data demonstrated that hydrogen water consumption ameliorated OLV-induced lung injury, and it may exert its protective role by its anti-inflammation, antioxidation and reducing NF-κB activity in the lung tissues.
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Affiliation(s)
- Qifei Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingyao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yong Wan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Sidong Song
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yong Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chang Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Junke Fu
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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9
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Early effect of tidal volume on lung injury biomarkers in surgical patients with healthy lungs. Anesthesiology 2014; 121:469-81. [PMID: 24809976 DOI: 10.1097/aln.0000000000000301] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The early biological impact of short-term mechanical ventilation on healthy lungs is unknown. The authors aimed to characterize the immediate tidal volume (VT)-related changes on lung injury biomarkers in patients with healthy lungs and low risk of pulmonary complications. METHODS Twenty-eight healthy patients for knee replacement surgery were prospectively randomized to volume-controlled ventilation with VT 6 (VT6) or 10 (VT10) ml/kg predicted body weight. General anesthesia and other ventilatory parameters (positive end-expiratory pressure, 5 cm H2O, FIO2, 0.5, respiratory rate titrated for normocapnia) were managed similarly in the two groups. Exhaled breath condensate and blood samples were collected for nitrite, nitrate, tumor necrosis factor-α, interleukins-1β, -6, -8, -10, -11, neutrophil elastase, and Clara Cell protein 16 measurements, at the onset of ventilation and 60 min later. RESULTS No significant differences in biomarkers were detected between the VT groups at any time. The coefficient of variation of exhaled breath condensate nitrite and nitrate decreased in the VT6 but increased in the VT10 group after 60-min ventilation. Sixty-minute ventilation significantly increased plasma neutrophil elastase levels in the VT6 (35.2 ± 30.4 vs. 56.4 ± 51.7 ng/ml, P = 0.008) and Clara Cell protein 16 levels in the VT10 group (16.4 ± 8.8 vs. 18.7 ± 9.5 ng/ml, P = 0.015). Exhaled breath condensate nitrite correlated with plateau pressure (r = 0.27, P = 0.042) and plasma neutrophil elastase (r = 0.44, P = 0.001). Plasma Clara Cell protein 16 correlated with compliance (r = 0.34, P = 0.014). CONCLUSIONS No tidal volume-related changes were observed in the selected lung injury biomarkers of patients with healthy lungs after 60-min ventilation. Plasma neutrophil elastase and plasma Clara Cell protein 16 might indicate atelectrauma and lung distention, respectively.
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Cheng YD, Gao Y, Zhang H, Duan CJ, Zhang CF. Effects of OLV preconditioning and postconditioning on lung injury in thoracotomy. Asian J Surg 2014; 37:80-5. [DOI: 10.1016/j.asjsur.2013.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 05/17/2013] [Accepted: 09/23/2013] [Indexed: 10/25/2022] Open
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Mineo TC, Tacconi F. From "awake" to "monitored anesthesia care" thoracic surgery: A 15 year evolution. Thorac Cancer 2014; 5:1-13. [PMID: 26766966 DOI: 10.1111/1759-7714.12070] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 07/23/2013] [Indexed: 02/06/2023] Open
Abstract
Although general anesthesia still represents the standard when performing thoracic surgery, the interest toward alternative methods is increasing. These have evolved from the employ of just local or regional analgesia techniques in completely alert patients (awake thoracic surgery), to more complex protocols entailing conscious sedation and spontaneous ventilation. The main rationale of these methods is to prevent serious complications related to general anesthesia and selective ventilation, such as tracheobronchial injury, acute lung injury, and cardiovascular events. Trends toward shorter hospitalization and reduced overall costs have also been indicated in preliminary reports. Monitored anesthesia care in thoracic surgery can be successfully employed to manage diverse oncologic conditions, such as malignant pleural effusion, peripheral lung nodules, and mediastinal tumors. Main non-oncologic indications include pneumothorax, emphysema, pleural infections, and interstitial lung disease. Furthermore, as the familiarity with this surgical practice has increased, major operations are now being performed this way. Despite the absence of randomized controlled trials, there is preliminary evidence that monitored anesthesia care protocols in thoracic surgery may be beneficial in high-risk patients, with non-inferior efficacy when compared to standard operations under general anesthesia. Monitored anesthesia care in thoracic surgery should enter the armamentarium of modern thoracic surgeons, and adequate training should be scheduled in accredited residency programs.
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Affiliation(s)
- Tommaso C Mineo
- Division and Department of Thoracic Surgery, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata University Rome, Italy
| | - Federico Tacconi
- Division and Department of Thoracic Surgery, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata University Rome, Italy
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12
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Translational research: what does it mean, what has it delivered and what might it deliver? Curr Opin Crit Care 2012; 17:495-503. [PMID: 21825976 DOI: 10.1097/mcc.0b013e32834a4b19] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW In this article, we review recent developments in translational research in the fields of acute lung injury, acute kidney injury and sepsis with a focus on emerging biomarkers and outline future advances in the field. RECENT FINDINGS There is currently a significant and unmet need for high quality translational research in critical care. The emergence of '-omics' technologies and sophisticated imaging techniques have resulted in a rapid growth of emerging biomarkers. Biomarkers would ideally provide early and reliable endpoints for proof of concept in clinical trials and inform clinical decision making through earlier and more precise diagnosis and risk stratification. SUMMARY Despite significant investment in basic science and time-consuming clinical trials, the majority of pharmacological interventions developed for critical illness have yet to translate into measurable clinical benefit. Future validation and qualification of emerging biomarkers allied to advances in pharmacogenomic profiling have the potential to provide valuable clinical information while accurately phenotyping patients enrolled in future clinical trials.
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TAKAHASHI KAZUHISA, EVES NEILD, PIPER AMANDA, SONG YUANLIN, MAHER TOBYM. Year in review 2011: Acute lung injury, interstitial lung diseases, physiology, sleep and lung cancer. Respirology 2012; 17:554-62. [DOI: 10.1111/j.1440-1843.2012.02127.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Proudfoot AG, Hind M, Griffiths MJD. Biomarkers of acute lung injury: worth their salt? BMC Med 2011; 9:132. [PMID: 22152131 PMCID: PMC3261814 DOI: 10.1186/1741-7015-9-132] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 12/12/2011] [Indexed: 12/21/2022] Open
Abstract
The validation of biomarkers has become a key goal of translational biomedical research. The purpose of this article is to discuss the role of biomarkers in the management of acute lung injury (ALI) and related research. Biomarkers should be sensitive and specific indicators of clinically important processes and should change in a relevant timeframe to affect recruitment to trials or clinical management. We do not believe that they necessarily need to reflect pathogenic processes. We critically examined current strategies used to identify biomarkers and which, owing to expedience, have been dominated by reanalysis of blood derived markers from large multicenter Phase 3 studies. Combining new and existing validated biomarkers with physiological and other data may add predictive power and facilitate the development of important aids to research and therapy.
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Affiliation(s)
- Alastair G Proudfoot
- Royal Brompton & Harefield NHS Foundation Trust, Adult Intensive Care Unit, Sydney Street, London SW3 6NP, UK
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