Characterization of Pulmonary and Systemic Inflammatory Responses Produced by Lung Re-expansion After One-Lung Ventilation

• Published in: Journal of cardiothoracic and vascular anesthesia 2012-06, Vol.26 (3), p.427-432
• Main Authors: Leite, Camila Ferreira, MD, Calixto, Marina Ciarallo, MD, Toro, Ivan Felizardo Contrera, MD, PhD, Antunes, Edson, MD, PhD, Mussi, Ricardo Kalaf, MD, PhD
• Format: Article
• Language: English
• Subjects: Anesthesia & Perioperative Care; Animals; Bronchoalveolar Lavage Fluid - chemistry; Carbon Dioxide - blood; Critical Care; Cytokines - biosynthesis; inflammation; Inflammation Mediators - metabolism; Lung - metabolism; Male; one-lung ventilation; Oxygen - blood; Partial Pressure; Peroxidase - metabolism; Pneumonia - etiology; Pneumonia - metabolism; Proteins - metabolism; Pulmonary Edema - etiology; Pulmonary Edema - metabolism; Rats; Rats, Wistar; Respiration, Artificial - adverse effects; Respiration, Artificial - methods; Systemic Inflammatory Response Syndrome - etiology; Systemic Inflammatory Response Syndrome - metabolism; thoracic surgery; Time Factors
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2011.09.028

Objectives To characterize the pulmonary and systemic inflammatory responses of rats undergoing 1-hour or 3-hour one-lung ventilation (OLV) with subsequent 1-hour lung re-expansion. Design A prospective, randomized, controlled animal experiment. Setting University laboratory. Participants Thirty male Wistar rats were used. Interventions Rats were subjected to 1- or 3-hour OLV followed or not by 1-hour lung re-expansion. Control rats received no ventilation. Measurements and Main Results Pulmonary protein extravasation, pulmonary myeloperoxidase (MPO) activity, cytokine levels in serum and bronchoalveolar lavage (BAL), counts of total and differential cells in BAL fluid, gasometric data, and mean arterial blood pressure (MABP) were all evaluated. Bronchial occlusion for 1 or 3 hours with no lung re-expansion did not significantly change the protein extravasation in the right and left lungs compared with the control group. However, rats submitted to 1- or 3-hour OLV followed by lung re-expansion exhibited pulmonary edema formation and neutrophil recruitment as well as a higher MPO activity in comparison with control rats. Increased levels of interleukin (IL)-6, IL-1β, and tumor necrosis factor-α in BAL fluid were observed. Increased levels of IL-6 and IL-10 in serum also were detected. Blood gas and MABP did not differ between groups. Conclusions Lung re-expansion after bronchial occlusion evokes an acute lung inflammatory response, which has been shown to be more pronounced in long periods of bronchial occlusion in terms of cytokine inflammatory response. In addition, the magnitude of this inflammatory response also can be detected systemically.