Effects of a single-lung recruitment maneuver on the systemic release of inflammatory mediators

Abstract

Objective: To study the hypothesis, that systemic levels of pro-inflammatory and anti-inflammatory cytokines may be affected by a single recruitment maneuver in mechanically ventilated patients. Design: Prospective, interventional clinical trial. Setting: Intensive care unit of a university hospital. Patients: Sixteen mechanically ventilated patients with clinical and radiological signs of atelectasis. Interventions: A single recruitment maneuver (RM) was performed by elevating the airway pressure to 40 cmH2O for 7 s. Measurements and main results: Plasmatic concentrations of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12p70 and tumor necrosis factor (TNF-α), arterial blood gases and hemodynamic parameters were measured immediately before and 5-360 min after the RM. The RM caused a minor, nevertheless significant improvement of oxygenation (p = 0.02) and carbon dioxide elimination (p = 0.006) as well as a moderate drop of the mean arterial pressure (p = 0.025). In contrast, plasma concentrations remained unaffected by the RM in all six mediators measured. Conclusion: A single inflation with an airway pressure of 40 cmH2O for 7 s improved gas exchange only slightly and did not modify systemic levels of inflammatory mediators in mechanically ventilated patients with radiological evidence of atelectasis. © Springer-Verlag 2006.