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Eur J Cardiothorac Surg 2005;28:889-895
© 2005 Elsevier Science NL

Ventilation according to the open lung concept attenuates pulmonary inflammatory response in cardiac surgery

^a Department of Anesthesiology, Erasmus MC, Dr Molewaterplein 40, 3015 DG Rotterdam, The Netherlands
^b Department of Cardio-thoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
^c Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
^d Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands

Received 4 August 2005; received in revised form 20 September 2005; accepted 3 October 2005.

^_* Corresponding author. Tel.: +31 10 4633713; fax: +31 10 4633722. (Email: d.dosreismiranda{at}erasmusmc.nl).

Objective: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a systemic inflammatory response, which is correlated with outcome. We hypothesized that ventilation according to the open lung concept (OLC) attenuates cytokine release. Methods: A prospective, single center randomized controlled clinical study containing 62 patients scheduled for elective coronary artery bypass graft and/or valve surgery with cardiopulmonary bypass. Before surgery, patients were randomly assigned to three groups: (1) conventional mechanical ventilation (CV), (2) OLC started after arrival on the ICU (late open lung, LOL), and (3) OLC started directly after intubation (early open lung, EOL). In both OLC groups, recruitment maneuvers were applied until PaO₂/FiO₂ > 50. The CV group received no recruitment maneuvers. Interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF)-, and interferon (IFN)- were measured preoperatively, immediately after cessation of CPB, and 3 h, 5 h, 24 h, 2, and 3 days after cessation of CPB. Results: CPB caused a significant increase of IL-6, IL-8, and IL-10 in all groups. Thereafter, IL-8 decreased significantly more rapidly in both OLC groups compared to CV. IL-10 decreased significantly more rapidly after CPB only in the EOL group, compared with CV. Three hours after cessation of the CPB, IL-10 was already comparable with preoperative levels in the EOL group, but not in the LOL or CV group. IL-6, TNF-, and IFN- did not differ significantly between groups. Conclusions: OLC ventilation leads to an attenuated inflammatory response, presumably by reducing additional lung injury after cardiac surgery. Studies on cytokines after cardiac surgery should take these findings into account.

Key Words: Myocardial infarction • Postoperative care • Inflammation • Inflammatory mediators (e.g. cytokines • cytotoxins) • Ventilation, intubation

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