Mairi Ziaka is associate director, Department of Internal Medicine, Clinic Barmelweid, Switzerland, and lecturer, School of Dentistry, Danube Private University, Krems, Austria; during the study, she was specialized in intensive care medicine, Critical Care Department, University of Thessaly, Larissa, Greece.
Demosthenes Makris is an associate professor.
Am J Crit Care. 2020 Jan 1;29(1):15-21. doi: 10.4037/ajcc2020161.
This study was conducted to investigate whether high-tidal-volume mechanical ventilation is associated with increased lung inflammation compared with low-tidal-volume mechanical ventilation in critically ill patients with no evidence of lung injury.
In this prospective, single-blind, randomized (1:1), parallel-group study, 18 critically ill patients with normal lungs were randomly assigned to receive mechanical ventilation with a tidal volume of either 6 mL/kg (low tidal volume) or 12 mL/kg (high tidal volume) during the first 4 days in the intensive care unit.
At baseline and at 24, 48, and 96 hours, exhaled breath condensate was collected to measure interleukin 1β, interleukin 10, tumor necrosis factor α, and total nitric oxide metabolites. Interleukin 1β levels in exhaled breath condensate were significantly increased at 24 hours compared with baseline in the high-tidal-volume group but not in the low-tidal-volume group. The interleukin 1β increase in the high-tidal-volume group was transient. Exhaled breath condensate levels of interleukin 1β, interleukin 10, tumor necrosis factor α, and total nitric oxide metabolites did not differ significantly between the high-tidal-volume and low-tidal-volume groups at any time point.
Short-term mechanical ventilation with a tidal volume of 12 mL/kg may trigger inflammatory responses in the lungs of intensive care unit patients without preexisting lung injury.
本研究旨在探讨对于无肺损伤证据的危重症患者，与低潮气量机械通气相比，高潮气量机械通气是否会导致肺部炎症增加。
在这项前瞻性、单盲、随机（1:1）、平行组研究中，18 例肺部正常的危重症患者在 ICU 期间的前 4 天内随机接受潮气量分别为 6 mL/kg（低潮气量）或 12 mL/kg（高潮气量）的机械通气。
在基线时以及 24、48 和 96 小时，收集呼气冷凝物以测量白细胞介素 1β、白细胞介素 10、肿瘤坏死因子α 和总一氧化氮代谢物。与低潮气量组相比，高潮气量组在 24 小时时呼气冷凝物中的白细胞介素 1β 水平明显高于基线，但在低潮气量组中没有增加。高潮气量组中白细胞介素 1β 的增加是短暂的。在任何时间点，高潮气量和低潮气量组之间呼气冷凝物中白细胞介素 1β、白细胞介素 10、肿瘤坏死因子α 和总一氧化氮代谢物的水平均无显著差异。
对于无预先存在的肺损伤的 ICU 患者，使用 12 mL/kg 的潮气量进行短期机械通气可能会引发肺部炎症反应。
