Rouhani Soroush, Gupta Sanchit, Raheel Hira, Gao Aggie Duan, Hanley Ciara, Cao Xingshan, Iansavitchene Alla, Cuthbertson Brian H, Slessarev Marat, Goligher Ewan C, Leligdowicz Aleksandra, Fraser Douglas D, Orser Beverley A, Jerath Angela
Department of Medicine, London Health Sciences Centre, London, ON, Canada.
Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Crit Care Explor. 2025 Jul 10;7(7):e1280. doi: 10.1097/CCE.0000000000001280. eCollection 2025 Jul 1.
Inhaled anesthetics may reduce alveolar and systemic inflammation in surgical and critically ill patients. This study aimed to perform a systematic review and meta-analysis comparing the effect of inhaled volatile and IV anesthetics on alveolar and plasma cytokines in patients with surgical or medical acute lung injury.
Medline, Embase, and Cochrane CENTRAL databases from 2000 to July 2021.
Randomized control trials, prospective, and retrospective observational studies comparing inhaled volatile to IV anesthetics in ventilated adult patients with acute lung injury from lung resection or critical illness.
A systematic review and meta-analysis was performed. Primary outcome was alveolar inflammatory cytokines levels that were meta-analyzed using a random effects model. Secondary outcomes were plasma inflammatory cytokine levels, mortality, pulmonary complications, and duration of hospital and ICU stay. The quality of studies was assessed using the Cochrane Risk of Bias tool for randomized control trials and the Cochrane Risk Of Bias In Non-randomized Studies of Interventions tool for retrospective cohort studies.
From 2522 screened studies, 28 (27 thoracic surgery and 1 ICU, n = 4175) were included. Meta-analysis of patients undergoing lung resection demonstrated lower levels of alveolar tumor necrosis factor-alpha (TNF-α) (standard mean difference 1.04; 95% CI, 0.32-1.77; p < 0.01; I2 82%) and interleukin (IL)-6 (0.64; 95% CI, 0.52-0.75; I2 0%; p < 0.01) at 1-2 hours in the inhaled anesthesia group, with no difference in other cytokines at various time points. The single ICU study demonstrated lower plasma TNF-α and IL-6 and alveolar TNF-α, IL-6, and IL-8 at 48 hours in patients sedated with sevoflurane compared with midazolam. Clinical outcomes were infrequently reported.
Limited evidence suggests that inhaled anesthesia may reduce proinflammatory cytokines TNF-α and IL-6 during lung resection and critical illness. Further studies are needed to clarify its effects on biological markers and clinical outcomes.
吸入麻醉药可能减轻外科手术患者和危重症患者的肺泡及全身炎症反应。本研究旨在进行一项系统评价和荟萃分析，比较吸入挥发性麻醉药和静脉麻醉药对手术或内科急性肺损伤患者肺泡和血浆细胞因子的影响。
2000年至2021年7月的Medline、Embase和Cochrane CENTRAL数据库。
比较吸入挥发性麻醉药与静脉麻醉药对接受肺切除术或危重症的通气成年急性肺损伤患者影响的随机对照试验、前瞻性和回顾性观察性研究。
进行了一项系统评价和荟萃分析。主要结局是肺泡炎性细胞因子水平，采用随机效应模型进行荟萃分析。次要结局包括血浆炎性细胞因子水平、死亡率、肺部并发症以及住院和入住重症监护病房（ICU）的时间。使用Cochrane偏倚风险工具评估随机对照试验的研究质量，使用Cochrane非随机干预研究中的偏倚风险工具评估回顾性队列研究的质量。
在2522项筛选研究中，纳入了28项研究（27项胸外科手术研究和1项ICU研究，n = 4175）。对接受肺切除术患者的荟萃分析表明，吸入麻醉组在1 - 2小时时肺泡肿瘤坏死因子-α（TNF-α）水平较低（标准均差1.04；95%可信区间，0.32 - 1.77；p < 0.01；I² 82%），白细胞介素（IL）-6水平较低（0.64；95%可信区间，0.52 - 0.75；I² 0%；p < 0.01），在各个时间点其他细胞因子无差异。单项ICU研究表明，与咪达唑仑相比，七氟醚镇静的患者在48小时时血浆TNF-α和IL-6以及肺泡TNF-α、IL-6和IL-8水平较低。临床结局的报告较少。
有限的证据表明，吸入麻醉可能在肺切除术和危重症期间降低促炎细胞因子TNF-α和IL-6。需要进一步研究以阐明其对生物标志物和临床结局的影响。
