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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
['Verhage|R J J|RJ|', 'Boone|J|J|', 'Rijkers|G T|GT|', 'Cromheecke|G J|GJ|', 'Kroese|A C|AC|', 'Weijs|T J|TJ|', 'Borel Rinkes|I H M|IH|', 'van Hillegersberg|R|R|']
D000368:Aged D054405:Chemokine CCL3 D018925:Chemokines D019742:Chemokines, CC D045422:Continuous Positive Airway Pressure D016207:Cytokines D016629:Esophagectomy D005260:Female D006801:Humans D007109:Immunity D007249:Inflammation D007375:Interleukin-1 D016753:Interleukin-10 D016209:Interleukin-8 D008297:Male D008875:Middle Aged D061810:One-Lung Ventilation D014409:Tumor Necrosis Factor-alpha
one-lung ventilation cytokines clinical trial esophageal neoplasm esophagectomy