Pulmonary Levels Of Biomarkers For Inflammation And Lung Injury In Protective Versus Conventional One-Lung Ventilation For Oesophagectomy A Randomised Clinical Trial

BACKGROUND It is uncertain whether protective ventilation reduces ventilation-induced pulmonary inflammation and injury during one-lung ventilation. OBJECTIVE To compare intra-operative protective ventilation with conventional during oesophagectomy with respect to pulmonary levels of biomarkers for inflammation and lung injury. DESIGN Randomised clinical trial. SETTING Tertiary centre for oesophageal diseases. PATIENTS Twenty-nine patients scheduled for one-lung ventilation during oesophagectomy. INTERVENTIONS Low tidal volume (V-T) of 6 ml kg(-1) predicted body weight (pbw) during two-lung ventilation and 3 ml kgpbw(-1) during one-lung ventilation with 5 cmH(2)O positive end expired pressure versus intermediate V-T of 10 ml kgpbw(-1) during two-lung ventilation and 5 ml kgpbw(-1) body weight during one-lung ventilation with no positive end-expiratory pressure. OUTCOME MEASURES The primary outcome was the change in bronchoalveolar lavage (BAL) levels of preselected biomarkers for inflammation (TNF-alpha, IL-6 and IL-8) and lung injury (soluble Receptor for Advanced Glycation End-products, surfactant protein-D, Clara Cell protein 16 and Krebs von den Lungen 6), from start to end of ventilation. RESULTS Median [IQR] V-T in the protective ventilation group (n = 13) was 6.0 [5.7 to 7.8] and 3.1 [3.0 to 3.6] ml kgpbw(-1) during two and one-lung ventilation; V-T in the conventional ventilation group (n = 16) was 9.8 [7.0 to 10.1] and 5.2 [5.0 to 5.5] ml kgpbw(-1) during two and one-lung ventilation. BAL levels of biomarkers for inflammation increased from start to end of ventilation in both groups; levels of soluble Receptor for Advanced Glycation End-products, Clara Cell protein 16 and Krebs von den Lungen 6 did not change, while levels of surfactant protein-D decreased. Changes in BAL biomarkers levels were not significantly different between the two ventilation strategies. CONCLUSION Intra-operative protective ventilation compared with conventional ventilation does not affect changes in pulmonary levels of biomarkers for inflammation and lung injury in patients undergoing one-lung ventilation for oesophagectomy.