Mechanical ventilation alters the immune response in children without lung pathology
| Autor: | Arthur S. Slutsky, Harriet A. E. Vreugdenhil, F. B. Plötz, Cobi Jacoba Johanna Heijnen, Jitske Zijlstra, Hans van Vught |
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| Rok vydání: | 2002 |
| Předmět: |
Cardiac Catheterization
medicine.medical_treatment Inflammation Critical Care and Intensive Care Medicine Statistics Nonparametric Natural killer cell Proinflammatory cytokine Interferon-gamma Immune system medicine Humans Mechanical ventilation Cardiac catheterization Interleukins Tumor necrosis factor α Interferon γ Natural killer cells Volatile anesthetics Lymphocytes Prospective Studies Child Tidal volume Anesthetics Mechanical ventilation Immunity Cellular Lung business.industry Interleukins Infant respiratory system Respiration Artificial Killer Cells Natural medicine.anatomical_structure Cytokine Child Preschool Anesthesia Neonatal and Pediatric Intensive Care Cytokines medicine.symptom business |
| Zdroj: | Intensive Care Medicine |
| ISSN: | 1432-1238 0342-4642 |
| DOI: | 10.1007/s00134-002-1216-7 |
| Popis: | Objective: This study was undertaken to examine the hypothesis that mechanical ventilation in association with anesthesia would alter the cytokine profile in infants without preexisting lung pathology. Design and setting: Prospective observational study in pediatric intensive care unit in a university hospital. Patients: Twelve infants who were subjected to an uncomplicated diagnostic cardiac catheterization procedure were studied. All subjects were ventilated with a volume control mode, 0.3 FIO2, 4 cmH2O PEEP, and 10 ml/kg tidal volume. Volatile (servoflurane) anesthetics were given. Measurements and results: Tracheal aspirates and blood samples were obtained before and after 2 h of mechanical ventilation. In tracheal aspirates and in supernatants of stimulated whole-blood cultures cytokine concentrations were measured. In the tracheal aspirates the immune balance was characterized by a proinflammatory response pattern, with a significant increase in TNF-α and IL-6 concentrations; concentrations of anti-inflammatory mediators remained very low. The functional capacity of peripheral blood leukocytes to produce INF-γ, TNF-α, and IL-6 in vitro was significantly decreased. This was accompanied by a significant decrease in the killing activity of natural killer cells. Conclusions: Two hours of servoflurane and mechanical ventilation using a tidal volume of 10 ml/kg is associated with remarkable changes in the immune response in infants without preexisting lung pathology undergoing cardiac catheterization. In the lungs the immune balance favors a proinflammatory response pattern without detectable concentrations of anti-inflammatory mediators. The Th1 immune response by peripheral blood leukocytes was decreased. The observed change in Th1/Th2 balance in favor of Th2 cytokine activity may be a systemic adaptation to the proinflammatory milieu in the lung. |
| Databáze: | OpenAIRE |
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