Lung-protective ventilation suppresses systemic and hepatic vein levels of cell-free DNA in porcine experimental post-operative sepsis [Elektronisk resurs]

• Background Plasma levels of cell-free DNA (cf-DNA) are known to be elevated in sepsis and high levels are associated with a poor prognosis. Mechanical ventilation affects systemic inflammation in which lung-protective ventilation attenuates the inflammatory response. The aim was to study the effect of a lung protective ventilator regime on arterial and organ-specific venous blood as well as on trans-organ differences in cf-DNA levels in a porcine post-operative sepsis model. Method One group of anaesthetised, domestic-breed, 9-12 weeks old, pigs were ventilated with protective ventilation (V(T)6 mL x kg(- 1), PEEP 10 cmH(2)O)n = 20. Another group, ventilated with a medium high tidal volume and lower PEEP, served as a control group (V(T)10 mL x kg(- 1), PEEP 5 cm H2O)n = 10. Blood samples were taken from four sources: artery, hepatic vein, portal vein and, jugular bulb. A continuous endotoxin infusion at 0.25 mu g x kg(- 1)x h(- 1)for 5 h was started following 2 h of laparotomy, which simulated a surgical procedure. Inflammatory cytokines and cf-DNA in plasma were analysed and trans-organ differences calculated. Results The protective ventilation group had lower levels of cf-DNA in arterial (p = 0.02) and hepatic venous blood (p = 0.03) compared with the controls. Transhepatic differences in cf-DNA were lower in the protective group, compared with the controls (p = 0.03). No differences between the groups were noted as regards the transcerebral, transsplanchnic or the transpulmonary cf-DNA differences. Conclusions Protective ventilation suppresses arterial levels of cf-DNA. The liver seems to be a net contributor to the systemic cf-DNA levels, but this effect is attenuated by protective ventilation. 

Ämnesord

Medical and Health Sciences  (hsv)

Clinical Medicine  (hsv)

Anesthesiology and Intensive Care  (hsv)

Medicin och hälsovetenskap  (hsv)

Klinisk medicin  (hsv)

Anestesi och intensivvård  (hsv)

Genre

government publication  (marcgt)

Indexterm och SAB-rubrik

Innate immunity

Cytokines

Endotoxin

Low tidal volume ventilation

Intensive care