The effects of tidal volume size and driving pressure levels on pulmonary complement activation: an observational study in critically ill patients
Abstract Background Mechanical ventilation can induce or even worsen lung injury, at least in part via overdistension caused by too large volumes or too high pressures. The complement system has been suggested to play a causative role in ventilator-induced lung injury. Aims and methods This was a si...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-12-01
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| Series: | Intensive Care Medicine Experimental |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40635-020-00356-6 |
| _version_ | 1819077064472395776 |
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| author | Friso M. de Beer Luuk Wieske Gerard van Mierlo Diana Wouters Sacha Zeerleder Lieuwe D. Bos Nicole P. Juffermans Marcus J. Schultz Tom van der Poll Wim K. Lagrand Janneke Horn for the BASIC–study group |
| author_facet | Friso M. de Beer Luuk Wieske Gerard van Mierlo Diana Wouters Sacha Zeerleder Lieuwe D. Bos Nicole P. Juffermans Marcus J. Schultz Tom van der Poll Wim K. Lagrand Janneke Horn for the BASIC–study group |
| author_sort | Friso M. de Beer |
| collection | DOAJ |
| description | Abstract Background Mechanical ventilation can induce or even worsen lung injury, at least in part via overdistension caused by too large volumes or too high pressures. The complement system has been suggested to play a causative role in ventilator-induced lung injury. Aims and methods This was a single-center prospective study investigating associations between pulmonary levels of complement activation products and two ventilator settings, tidal volume (V T) and driving pressure (ΔP), in critically ill patients under invasive ventilation. A miniature bronchoalveolar lavage (BAL) was performed for determination of pulmonary levels of C5a, C3b/c, and C4b/c. The primary endpoint was the correlation between BAL fluid (BALF) levels of C5a and V T and ΔP. Levels of complement activation products were also compared between patients with and without ARDS or with and without pneumonia. Results Seventy-two patients were included. Median time from start of invasive ventilation till BAL was 27 [19 to 34] hours. Median V T and ΔP before BAL were 6.7 [IQR 6.1 to 7.6] ml/kg predicted bodyweight (PBW) and 15 [IQR 11 to 18] cm H2O, respectively. BALF levels of C5a, C3b/c and C4b/c were neither different between patients with or without ARDS, nor between patients with or without pneumonia. BALF levels of C5a, and also C3b/c and C4b/c, did not correlate with V T and ΔP. Median BALF levels of C5a, C3b/c, and C4b/c, and the effects of V T and ΔP on those levels, were not different between patients with or without ARDS, and in patients with or without pneumonia. Conclusion In this cohort of critically ill patients under invasive ventilation, pulmonary levels of complement activation products were independent of the size of V T and the level of ΔP. The associations were not different for patients with ARDS or with pneumonia. Pulmonary complement activation does not seem to play a major role in VILI, and not even in lung injury per se, in critically ill patients under invasive ventilation. |
| first_indexed | 2024-12-21T18:51:15Z |
| format | Article |
| id | doaj.art-76689adf65c74db49afeb303ef05194e |
| institution | Directory Open Access Journal |
| issn | 2197-425X |
| language | English |
| last_indexed | 2024-12-21T18:51:15Z |
| publishDate | 2020-12-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Intensive Care Medicine Experimental |
| spelling | doaj.art-76689adf65c74db49afeb303ef05194e2022-12-21T18:53:45ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2020-12-018S111110.1186/s40635-020-00356-6The effects of tidal volume size and driving pressure levels on pulmonary complement activation: an observational study in critically ill patientsFriso M. de Beer0Luuk Wieske1Gerard van Mierlo2Diana Wouters3Sacha Zeerleder4Lieuwe D. Bos5Nicole P. Juffermans6Marcus J. Schultz7Tom van der Poll8Wim K. Lagrand9Janneke Horn10for the BASIC–study groupDepartment of Intensive Care Medicine, Amsterdam UMC, University of AmsterdamDepartment of Intensive Care Medicine, Amsterdam UMC, University of AmsterdamDepartment of Immunopathology, Sanquin Research and Landsteiner LaboratoryDepartment of Immunopathology, Sanquin Research and Landsteiner LaboratoryDepartment of Hematology, Amsterdam UMC, University of AmsterdamDepartment of Intensive Care Medicine, Amsterdam UMC, University of AmsterdamDepartment of Intensive Care Medicine, Amsterdam UMC, University of AmsterdamDepartment of Intensive Care Medicine, Amsterdam UMC, University of AmsterdamDepartment of Internal Medicine, Amsterdam UMC, University of AmsterdamDepartment of Intensive Care Medicine, Amsterdam UMC, University of AmsterdamDepartment of Intensive Care Medicine, Amsterdam UMC, University of AmsterdamAbstract Background Mechanical ventilation can induce or even worsen lung injury, at least in part via overdistension caused by too large volumes or too high pressures. The complement system has been suggested to play a causative role in ventilator-induced lung injury. Aims and methods This was a single-center prospective study investigating associations between pulmonary levels of complement activation products and two ventilator settings, tidal volume (V T) and driving pressure (ΔP), in critically ill patients under invasive ventilation. A miniature bronchoalveolar lavage (BAL) was performed for determination of pulmonary levels of C5a, C3b/c, and C4b/c. The primary endpoint was the correlation between BAL fluid (BALF) levels of C5a and V T and ΔP. Levels of complement activation products were also compared between patients with and without ARDS or with and without pneumonia. Results Seventy-two patients were included. Median time from start of invasive ventilation till BAL was 27 [19 to 34] hours. Median V T and ΔP before BAL were 6.7 [IQR 6.1 to 7.6] ml/kg predicted bodyweight (PBW) and 15 [IQR 11 to 18] cm H2O, respectively. BALF levels of C5a, C3b/c and C4b/c were neither different between patients with or without ARDS, nor between patients with or without pneumonia. BALF levels of C5a, and also C3b/c and C4b/c, did not correlate with V T and ΔP. Median BALF levels of C5a, C3b/c, and C4b/c, and the effects of V T and ΔP on those levels, were not different between patients with or without ARDS, and in patients with or without pneumonia. Conclusion In this cohort of critically ill patients under invasive ventilation, pulmonary levels of complement activation products were independent of the size of V T and the level of ΔP. The associations were not different for patients with ARDS or with pneumonia. Pulmonary complement activation does not seem to play a major role in VILI, and not even in lung injury per se, in critically ill patients under invasive ventilation.https://doi.org/10.1186/s40635-020-00356-6Intensive careCritical careMechanical ventilationTidal volumeDriving pressureBronchoalveolar lavage |
| spellingShingle | Friso M. de Beer Luuk Wieske Gerard van Mierlo Diana Wouters Sacha Zeerleder Lieuwe D. Bos Nicole P. Juffermans Marcus J. Schultz Tom van der Poll Wim K. Lagrand Janneke Horn for the BASIC–study group The effects of tidal volume size and driving pressure levels on pulmonary complement activation: an observational study in critically ill patients Intensive Care Medicine Experimental Intensive care Critical care Mechanical ventilation Tidal volume Driving pressure Bronchoalveolar lavage |
| title | The effects of tidal volume size and driving pressure levels on pulmonary complement activation: an observational study in critically ill patients |
| title_full | The effects of tidal volume size and driving pressure levels on pulmonary complement activation: an observational study in critically ill patients |
| title_fullStr | The effects of tidal volume size and driving pressure levels on pulmonary complement activation: an observational study in critically ill patients |
| title_full_unstemmed | The effects of tidal volume size and driving pressure levels on pulmonary complement activation: an observational study in critically ill patients |
| title_short | The effects of tidal volume size and driving pressure levels on pulmonary complement activation: an observational study in critically ill patients |
| title_sort | effects of tidal volume size and driving pressure levels on pulmonary complement activation an observational study in critically ill patients |
| topic | Intensive care Critical care Mechanical ventilation Tidal volume Driving pressure Bronchoalveolar lavage |
| url | https://doi.org/10.1186/s40635-020-00356-6 |
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