Assessing the Impact of Lung Hyperinflation Maneuver on Systemic Inflammatory Response and Lung Collapse in Patients Undergoing Surgeries under Spontaneous Ventilation

作者：Sa Malbouisson Luiz Marcelo; Silva de Souza Elton Lucio; Barbalho Larissa; Massoco Cristina de Oliveira; Carvalho Carmona Maria Jose; Costa Auler Jose Otavio Jr

来源：Revista Brasileira de Anestesiologia, 2010, 60(3): 247-253.

DOI：10.1590/S0034-70942010000300004

• ANESTHETIC TECHNIQUE, Regional: subarachnoid
• COMPLICATIONS: atelectasis
• METABOLISM: systemic inflammatory response syndrome
• VENTILATION, Mechanical: positive pressure, lung hyperinflation maneuver

Malbouisson LMS, Souza ELS, Barbalho L, Massoco CO, Carmona MJC, Auler Jr JOC - Assessing the Impact of Lung Hyperinflation Maneuver on Systemic Inflammatory Response and Lung Collapse in Patients Undergoing Surgeries under Spontaneous Ventilation.
Background and objectives: Lung hyperinflation maneuvers (LHM) reverse intraoperative atelectasis; however, they can lead to pulmonary-induced systemic inflammatory response. The objective of this study was to determine the impact of LHM on systemic inflammatory response and lung structure in patients undergoing subarachnoid block.
Methods: After approval by the Ethics Committee of the institution and signing the informed consent, 20 patients undergoing small and medium surgical procedures were randomly separated into two groups: 1) control (CG), and 2) LHM (LHMG). One hour after the spinal anesthesia, LHM was performed in LHMG by applying bilevel positive pressure in the airways (BIPAP) with an expiratory pressure of 20 cmH(2)O and inspiratory pressure of 20 cmH(2)O for 1 to 2 minutes. Blood levels of TNF alpha, IL-1, IL-6, IL-8, IL-10, and IL-12 were determined by flow cytometry at baseline and at 90, 180, and 780 minutes. Lung volumes and weights were determined using CT scans obtained immediately after the surgery.
Results: The use of LHM resulted in a reduction in the fraction of non-aerated pulmonary parenchyma (7.5 +/- 4.3%, in the Control Group, vs. 4 +/- 2.1%, in the LHM Group, p = 0.02) without changing pulmonary volumes. A progressive increase in plasma levels of IL-1, IL-6, IL-8, and IL-10, similar in both groups, was observed. Plasma levels of TNF alpha and IL-12 were undetectable during the study.
Conclusions: The use of LHM reduced the incidence of atelectasis, but it did not amplify the inflammatory response in patients with normal lungs undergoing small and medium surgeries under subarachnoid block.

• 出版日期2010-6