Effect of Therapeutic Hypercapnia on Effect of Therapeutic - - PowerPoint PPT Presentation

Effect of Therapeutic Hypercapnia on Effect of Therapeutic Hypercapnia on Inflammatory Responses to One-lung Ventilation in Lobectomy Patients

Anesthesiology 2015; 122:1235-52

林彥助 陳秀屏醫師

Introduction Introduction Introduction Introduction

One-lung ventilation (OLV) can result in local and systemic inflammation.

Inflammation Inflammation & & Acute Acute Lung Lung Injury Injury

Proinflammatory Antiinflammatory

Therapeutic Therapeutic Hypercapnia Hypercapnia

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Materials and Methods Materials and Methods

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Study Study Design Design

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Randomization Randomization

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Blinding: Blinding: 2 Anesthesiologists Anesthesiologists

The First Anesthesiologist

• Did NOT administer anesthesia
• Had access to the randomization code

and prepared the gas with the same

• uter cover.
• Monitored ABG levels using a blood

The Second Anesthesiologist

• Did NOT have knowledge of the gas

monitor and ABG data

• Performed intravenous anesthesia

and bronchoalveolar lavage (BAL) and collected BAL fluid (BALF) and

• Monitored ABG levels using a blood

gas analyzer

• The inspiratory gas (mixed gas of
• xygen, air, and carbon dioxide) was

also monitored

• The concentrations of oxygen and

carbon dioxide were adjusted according to the PaO2 and PaCO2

• All monitored data were kept in a

secure place until analyses and collected BAL fluid (BALF) and blood samples

• During operation, a baffle board was set up between the first and second anesthetists.

Pre-OP Induction Ventilation OLV Return to 2 Lung

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Pre-OP Induction Ventilation OLV Return to 2 Lung

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Bronchoalveolar Lavage

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The The Primary Primary & & Secondary Secondary Outcomes Outcomes

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Data Data Collection Collection

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Results Results

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Complement 3a 1

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Discussion Discussion

Inflammation Inflammation Factors Factors

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Lung Compliance Lung Compliance

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Epithelial & Epithelial & Endothelial cell Endothelial cell

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Activating nuclear factor-κB Increase the expression of proinflammatory cytokines and chemokines, such as TNF-α, IL-1β, IL-6, The recruitment of neutrophils and alveolar macrophages Endothelial and epithelial cell injury TNF-α, IL-1β, IL-6, and IL-8 macrophages

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Activating nuclear factor-κB Increase the expression of proinflammatory cytokines and chemokines, such as TNF-α, IL-1β, IL-6, The recruitment of neutrophils and alveolar macrophages Endothelial and epithelial cell injury TNF-α, IL-1β, IL-6, and IL-8 macrophages

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Difference Difference of

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Serum Cytokines Cytokines Level Level at at T2 T2

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Limitations Limitations-

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Limitations Limitations-

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Conclusion Conclusion Conclusion Conclusion

Conclusion Conclusion

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