Fernandez-Bustamante Ana, Klawitter Jelena, Repine John E, Agazio Amanda, Janocha Allison J, Shah Chirag, Moss Marc, Douglas Ivor S, Tran Zung Vu, Erzurum Serpil C, Christians Uwe, Seres Tamas
From the Department of Anesthesiology and Webb-Waring Center, University of Colorado School of Medicine, Aurora, Colorado (A.F.-B.); Department of Anesthesiology and iC42 Integrated Solutions in Systems Biology, University of Colorado School of Medicine, Aurora, Colorado (J.K., U.C.); Department of Medicine and Webb-Waring Center, University of Colorado School of Medicine, Aurora, Colorado (J.E.R.); Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado (A.A., T.S.); Department of Pathobiology and Lerner Research Institute (NC22), the Cleveland Clinic Foundation and Case Western Reserve University School of Medicine, Cleveland, Ohio (A.J.J., S.C.E.); Case Western Reserve University School of Medicine, Cleveland, Ohio (C.S.); Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado (M.M., I.S.D.); and Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado (Z.V.T.).
Anesthesiology. 2014 Sep;121(3):469-81. doi: 10.1097/ALN.0000000000000301.
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.
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.
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).
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.
短期机械通气对健康肺脏的早期生物学影响尚不清楚。作者旨在描述健康肺且肺部并发症风险较低的患者中，即刻潮气量（VT）相关的肺损伤生物标志物变化。
28例拟行膝关节置换手术的健康患者被前瞻性随机分为两组，分别接受潮气量为6（VT6）或10（VT10）ml/kg预计体重的容量控制通气。两组患者均采用相似的全身麻醉及其他通气参数（呼气末正压5 cmH₂O，吸入氧浓度0.5，根据正常二氧化碳分压滴定呼吸频率）。在通气开始时及60分钟后，收集呼出气冷凝液和血样，检测亚硝酸盐、硝酸盐、肿瘤坏死因子-α、白细胞介素-1β、-6、-8、-10、-11、中性粒细胞弹性蛋白酶和克拉拉细胞蛋白16。
在任何时间点，VT组间生物标志物均未检测到显著差异。通气60分钟后，VT6组呼出气冷凝液中亚硝酸盐和硝酸盐的变异系数降低，而VT10组升高。通气60分钟后，VT6组血浆中性粒细胞弹性蛋白酶水平显著升高（35.2±30.4 vs. 56.4±51.7 ng/ml，P = 0.008），VT10组克拉拉细胞蛋白16水平显著升高（16.4±8.8 vs. 18.7±9.5 ng/ml，P = 0.015）。呼出气冷凝液亚硝酸盐与平台压（r = 0.27，P = 0.042）及血浆中性粒细胞弹性蛋白酶（r = 0.44，P = 0.001）相关。血浆克拉拉细胞蛋白16与顺应性（r = 0.34，P = 0.014）相关。
通气60分钟后，健康肺患者的所选肺损伤生物标志物未观察到与潮气量相关的变化。血浆中性粒细胞弹性蛋白酶和血浆克拉拉细胞蛋白16可能分别提示肺不张伤和肺膨胀。
