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- Title
Low tidal volume ventilation strategy and organ functions in patients with pre-existing systemic inflammatory response.
- Authors
Chugh, Vanya; Tyagi, Asha; Arora, Vandna; Tyagi, Abhay; Das, Shukla; Rai, Gargi; Sethi, Ashok
- Abstract
Background and Aims: Ventilation can induce increase in inflammatory mediators that may contribute to systemic organ dysfunction. Ventilation-induced organ dysfunction is likely to be accentuated if there is a pre-existing systemic inflammatory response. Material and Methods: Adult patients suffering from intestinal perforation peritonitis-induced systemic inflammatory response syndrome and scheduled for emergency laparotomy were randomized to receive intraoperative ventilation with 10 ml.kg-1 tidal volume (Group H) versus lower tidal volume of 6 ml.kg-1 along with positive end-expiratory pressure (PEEP) of 10 cmH2O (Group L), (n = 45 each). The primary outcome was postoperative organ dysfunction evaluated using the aggregate Sepsis-related Organ Failure Assessment (SOFA) score. The secondary outcomes were, inflammatory mediators viz. interleukin-6, tumor necrosis factor-α, procalcitonin, and C-reactive protein, assessed prior to (basal) and 1 h after initiation of mechanical ventilation, and 18 h postoperatively. Results: The aggregate SOFA score (3[1–3] vs. 1[1–3]); and that on the first postoperative day (2[1–3] vs. 1[0–3]) were higher for group L as compared to group H (P < 0.05). All inflammatory mediators were statistically similar between both groups at all time intervals (P > 0.05). Conclusions: Mechanical ventilation with low tidal volume of 6 ml/kg-1 along with PEEP of 10 cmH2O is associated with significantly worse postoperative organ functions as compared to high tidal volume of 10 ml.kg-1 in patients of perforation peritonitis-induced systemic inflammation undergoing emergency laparotomy.
- Subjects
SYSTEMIC inflammatory response syndrome; POSITIVE end-expiratory pressure; CALCITONIN; INFLAMMATORY mediators; INTERLEUKIN-6; INTESTINAL perforation; C-reactive protein
- Publication
Journal of Anaesthesiology Clinical Pharmacology, 2019, Vol 35, Issue 4, p460
- ISSN
0970-9185
- Publication type
Article
- DOI
10.4103/joacp.JOACP_112_18