VM Ranieri, PM Suter, C Tortorella, et al (Univ of Toronto)
Effect of Mechanical Ventilation on Inflammatory Mediators in Patients with Acute Respiratory Distress Syndrome: A Randomized Controlled Trial.
JAMA 282:54-61, 1999
Mechanical ventilation can escalate or cause an inflammatory response and acute lung injury. The influence of mechanical ventilation on the lung and systemic cytokine release was assessed in patients with ARDS.
Two groups were assessed (1) a control group and (2) a lung protective strategy group.
At baseline physiologic characteristics and cytokine concentrations were similar. But after 24 and 36 hours, there were significant between-group differences in tidal volume, end-inspiratory plateau pressures and PEEP. The lung protective strategy group had significantly better results. It could be concluded that mechanical ventilation can produce a cytokine response that may be diminished by minimising overdistension and recruitment and derecruitment of the lung.