Reduced local immune response with continuous positive airway pressure during one-lung ventilation for oesophagectomy

• Published in: British journal of anaesthesia : BJA Vol. 112; no. 5; pp. 920 - 928
• Main Authors: Verhage, R.J.J., Boone, J., Rijkers, G.T., Cromheecke, G.J., Kroese, A.C., Weijs, T.J., Borel Rinkes, I.H.M., van Hillegersberg, R.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-05-2014; Oxford University Press
• Subjects: Aged; Chemokine CCL3 - immunology; Chemokines - immunology; Chemokines, CC - immunology; clinical trial; Continuous Positive Airway Pressure - methods; cytokines; Cytokines - immunology; esophageal neoplasm; esophagectomy; Esophagectomy - methods; Female; Humans; Immunity; Inflammation - immunology; Interleukin-1 - immunology; Interleukin-10 - immunology; Interleukin-8 - immunology; Male; Middle Aged; one-lung ventilation; One-Lung Ventilation - methods; Tumor Necrosis Factor-alpha - immunology; clinical trial; esophagectomy; cytokines; esophageal neoplasm; one-lung ventilation
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aet476

Transthoracic oesophagectomy requires prolonged one-lung ventilation causing systemic and local inflammatory responses. Application of continuous positive airway pressure (CPAP) to the collapsed lung potentially reduces pulmonary damage, hypoxia, and consequent inflammation. This randomized controlled trial studied the influence of CPAP applied to the collapsed right lung during thoracoscopic oesophagectomy on local and systemic inflammatory response.
Broncho-alveolar lavage fluid (BALF) from the right collapsed and left ventilated lung and serum samples were obtained during surgery from 30 patients undergoing thoracolaparoscopic oesophagectomy for cancer who were randomized for one-lung ventilation with or without CPAP applied to the collapsed right lung. Concentrations of cytokines and chemokines, in BALF and serum, were determined with Luminex.
Patients from the control (no CPAP) group had significantly increased concentrations of interleukin (IL)-1α, IL-1β, IL-10, tumour necrosis factor-alpha, macrophage inflammatory protein (MIP)-1α, pulmonary and activation-regulated chemokine (PARC), and IL-8 in the collapsed (right) lung when compared with patients from the CPAP group (P<0.05). The ventilated (left) lung of the control group showed increased concentrations of monocyte chemoattractant protein (MCP)-1 and MIP-1α (P<0.05). Serum concentrations of cytokines and chemokines increased during surgery, but did not differ between the control and CPAP groups.
A significantly lower local immune response was observed during one-lung ventilation when CPAP was applied to the collapsed lung. The findings suggest a beneficial effect of CPAP on the collapsed lung during oesophagectomy with one-lung ventilation.